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Women’s Heath

Women’s Heath. Aningalan , Antonio, Aramburo. Cervical Cancer. Risk Factors/Prevention Screening. National Cancer Institute: Cervical Cancer Prevention and Screening. Risk Factors/Prevention. Avoidance of Human Papillomavirus Infection Cigarette Smoke Reproductive Behavior

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Women’s Heath

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  1. Women’s Heath Aningalan, Antonio, Aramburo

  2. Cervical Cancer • Risk Factors/Prevention • Screening National Cancer Institute: Cervical Cancer Prevention and Screening

  3. Risk Factors/Prevention • Avoidance of Human PapillomavirusInfection • Cigarette Smoke • Reproductive Behavior • Screening Via Gynecologic Examinations and Cytologic Screening Muñoz N, Franceschi S, Bosetti C, et al.: Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 359 (9312): 1093-101, 2002.

  4. Avoidance of HPV Infection • Abstinence from sexual activity • Barrier protection and/or spermicidal gel during sexual intercourse • Decreases cancer incidence with a relative risk of 0.4 Muñoz N, Franceschi S, Bosetti C, et al.: Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 359 (9312): 1093-101, 2002.

  5. Avoidance of HPV Infection • Vaccination against HPV-16/HPV-18 •  Reduces incident and persistent infections with efficacy of 91.6% (95% CI, 64.5–98.0) and 100% (95% CI, 45–100), respectively. • The vaccine protects against infection with these types of HPV for at least five years. Studies are being done to find out if the protection lasts longer than 5 years. • The vaccine does not protect women who are already infected with HPV. Muñoz N, Franceschi S, Bosetti C, et al.: Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 359 (9312): 1093-101, 2002.

  6. HPV Vaccination • Gardasil: 16, 18, 6, and 11 • Cervarix: 16 and 18 • Recommended for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series. • Ideally females should get the vaccine before they become sexually active, which is when they may be exposed to HPV.  http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm

  7. Cigarette Smoking • Among HPV-infected women, current and former smokers have approximately two to three times the incidence of high-grade cervical intraepithelial neoplasia or invasive cancer. • Passive smoking is also associated with increased risk, but to a lesser extent. HellbergD, Nilsson S, Haley NJ, et al.: Smoking and cervical intraepithelial neoplasia: nicotine and cotinine in serum and cervical mucus in smokers and nonsmokers. Am J ObstetGynecol 158 (4): 910-3, 1988.

  8. Reproductive Behavior • High parity • 4x the risk with women who have 7 or more full term pregnancies • 2-3x the risk for women with 1-2 full term pregnancies • Among HPV infected women, and vs. Nulliparous women. • Long-term use of oral contraceptives • 3x the risk with use of oral contraceptives for 5-9 years. • 4x the risk with use of oral contraceptives for 10 or more years Moreno V, Bosch FX, Muñoz N, et al.: Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 359 (9312): 1085-92, 2002

  9. Screening Via Gynecologic Examinations and Cytologic Screening •  Screening is not beneficial: • in detecting invasive cancer in women younger than 25 years because of the low prevalence of invasive disease • in women older than 60 years if they have had a history of recent prior negative tests Sasieni P, Castanon A, Cuzick J: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 339: b2968, 2009. 

  10. Screening • Screening With the PapanicolaouTest • Regular Pap screening decreases cervical cancer incidence and mortality by at least 80%. • Screening Women Without a Cervix • not helpful in women who do not have a cervix as a result of a hysterectomy for a benign condition. • Among women without cervices, fewer than 1 per 1,000 had an abnormal Pap test. Sasieni P, Castanon A, Cuzick J: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 339: b2968, 2009. 

  11. When to start screening • Screening should be done at least once every 2 or 3 years starting within 3 years after a woman begins to have sexual intercourse. Sasieni P, Castanon A, Cuzick J: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 339: b2968, 2009. 

  12. Screening Interval • A prospective cohort analysis of a randomized controlled trial. • Among 2,561 women (mean age 66.7 years) with normal Papanicolaou (Pap) tests at baseline, 110 had an abnormal Pap test within the next 2 years. • No woman was found to have cervical intraepithelial neoplasia (CIN) 2–3 or invasive cancer, and only one had CIN 1–2. • Thus the positive-predictive value (PPV) of screening 1 year after a negative Pap test was 0%; after 2 years the PPV was 0.9%. Sasieni P, Castanon A, Cuzick J: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 339: b2968, 2009. 

  13. Screening Interval • The authors concluded that Pap tests should not be repeated within 2 years of a prior negative test. Sasieni P, Castanon A, Cuzick J: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 339: b2968, 2009. 

  14. HPV Testing • HPV testing is not recommended in adolescent women with ASCUS as the majority of such women are HPV-positive. • HPV DNA testing is generally not appropriate or clinically useful following cytology results of LSIL, which is more severe than ASCUS, and the vast majority of such women (84%–96%) are carcinogenic HPV DNA-positive. Carozzi FM, Del Mistro A, Confortini M, et al.: Reproducibility of HPV DNA Testing by Hybrid Capture 2 in a Screening Setting. Am J ClinPathol 124 (5): 716-21, 2005. 

  15. Start screening for cervical cancer using Pap smear within 3 years of first sexual intercourse • Pap tests should not be repeated within 2 years of a prior negative test. • Screening patients who have no more cervix has no benefits. • HPV vaccine should be offered to girls age 11-26 years old, ideally before the first sexual intercourse.

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