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Patient management based on HPV status

HPV Types and Prevalence

  • Human papillomavirus (HPV) is the most common sexually transmitted virus. More than 100 distinct site-specific papillomaviral types exist, about 30 of which target the genital tract1. Clinical manifestation is dependent upon epithelial location, HPV type and the host's immune status.

  • "High-risk" types of genital HPV are found in virtually all cervical carcinomas and precursor lesions1. Visit our section on HPV types for more information.

Cervical Cancer Prevalence

Cervical cancer is the second—most—common cancer among women worldwide. The American Cancer Society estimates that in 2007, about 11,150 new cases of invasive cervical cancer were diagnosed in the United States and approximately 3,670 women died from the disease.

 

HPV and Cervical Cancer Prevalence
National Cancer Institute SEER data 1990–1994

Relationship Between HPV and Cervical Cancer

  • According to the World Health Organization and the National Institutes of Health, HPV is the cause of virtually all cases of cervical cancer. (A study published in the Aug. 19, 1999, issue of the Journal of Pathology documented that HPV is present in 99.7% of cervical cancers.) Research has confirmed a strong, causal link between HPV and cervical cancer that is independent from other risk factors.

  • Further studies have confirmed that persistent HPV infection is what causes cervical cancer, and that a test for high-risk HPV can predict the risk of cervical cancer, even among women with normal Pap results.

  • Of the approximately 100 types of HPV that have been identified, about 15 "high-risk" types are associated with cancer (of which 13 are considered the most clinically important). Persistent infection with these high-risk types is required for cervical cancer to develop.

  • However, HPV infection alone is not sufficient to cause carcinoma, since malignant tumors develop only after HPV-induced lesions persist for several years2.

  • HPV infection can be latent for many years. Most women will clear an HPV infection within 9-15 months. However, women with persistent high-risk HPV infection are 300 times more likely to develop HSIL.

HPV Testing

  • Historically, the Pap test was the only line of defense against cervical disease and cancer. However, now there is a new weapon — the digene HPV Test*, the first HPV test approved by the U.S. FDA for adjunctive primary screening with a Pap in women age 30 and older, as well as evaluation of women of any age with ASC-US Paps.

  • National guidelines from the American College of Obstetricians and Gynecologists, the American Cancer Society, and the American Society for Colposcopy and Cervical Pathology all now recognize the potential benefit of HPV testing in conjunction with a Pap for women age 30+.

  • By combining the HPV test with a Pap, studies show that the sensitivity for high-grade cervical disease and cancer is as high as 100 percent.

  • Meanwhile, using the HPV test for follow-up evaluation of younger women (beginning at age 20) with ASC-US Paps assures that invasive procedures are minimized.

  • Using the digene HPV Test provides greater assurance that you are not missing CIN 2/3 or cancer in their earliest stages.


References:

1 National Institutes of Health (NIH). Consensus Development Conference Statement. 1996.
2 Pfister H. The role of human papilloma virus in anogenital cancer. In Lorincz AT, Reid R, editors. Human Papillomavirus 1. 2nd ed. Obstet Gynecol Clin NA 1996; 23: 579-595.
3 Franco EL. Epidemiology of anogenital warts and cancer. In: Lorincz AT, Reid R, editors. Human Papillomavirus 1. 2nd ed. Obstet Gynecol Clin NA 1996;23:597-623.
4 Cox JT. Clinical role of HPV DNA testing. In: Lorincz AT , Reid R, editors. Human Papillomavirus 1. 2nd ed.1996. Obstet Gynecol Clin NA 23(3):811-851.
5 Ferenczy A. The bethesda system (TBS): advantages and pitfalls. In: Franco E, Monsonego J, editors. New Developments in Cervical Cancer Screening and Prevention. 1997:151-158.


* "The digene HPV Test" was approved by the U.S. FDA and is also known to laboratories and physicians as the "hc2 High-Risk HPV DNA Test®" and "DNAwithPap® Test." This does not refer to the QIAGEN product that tests for several types of the virus commonly referred to as "low-risk HPV," which are not associated with cervical cancer.