HPV And Cervical Cancer

Human Papilloma Virus
Updated 02/8/2008, Expires 02/8/2010
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COURSE OBJECTIVES
Upon completion of this self-study module, the learner will be able to:
1. Define HPV
2. List at least 3 of the different types of HPV
3. Discuss the options available to patients with HPV
4. Define the Registered Nurses role when talking with patients about
HPV
5. Explain to patients the when the injections are given and why
6. Explain ways to control Cervical Cancer
7. Why HPV is important
The Facts about HPV
Who should get this vaccine?
This vaccine is recommended for 11-12 year-old girls. The vaccine can be
given to girls as young as 9 years old, at the discretion (judgment) of the
healthcare provider. The vaccine is also recommended for 13-26 year-old
girls/women who have not yet received or completed the vaccine series.
These recommendations were made by the federal Advisory Committee on
Immunization Practices (ACIP)a national group of leading experts, which
advises the Centers for Disease Control and Prevention (CDC) on vaccine
issues. The ACIP decides whether vaccines should be recommended, and if
so, who should get them, and at what ages.
How effective is this vaccine?
The vaccine has mainly been studied in young women who had not been
exposed to any of the four vaccine HPV types. These studies found the
vaccine to be 100% effective in preventing cervical precancers caused by the
vaccine HPV types. These studies also found it to be almost 100% effective
in preventing precancers of the vulva and vagina, and genital warts that are
caused by the vaccine HPV types. The vaccine was less effective in young
women who had already been exposed to a vaccine HPV type. This vaccine
does not treat existing HPV, genital warts, precancers or cancers.
Will sexually active females benefit from the vaccine?
Females who are sexually active may also benefit from the vaccine. But they
may get less benefit from the vaccine since they may have already acquired
one or more vaccine HPV type(s). Still, they would get protection against
the vaccine HPV types they have not yet acquired. Few young women are
infected with all four vaccine HPV types. Currently, there is no test available
to tell whether a girl/woman has had any or all of the four vaccine HPV
types.
How and when is the vaccine delivered?
The vaccine is given through a series of three injections over a six-month
period. The second and third doses should be given two and six months
(respectively) after the first dose.
Is the HPV vaccine safe?
The FDA has approved the HPV vaccine as safe and effective. This vaccine
has been tested in over 11,000 females (ages 9-26 years) in many countries
around the world. These studies have shown no serious side effects. The
most common side effect is soreness at the injection site.
Does this vaccine contain thimerosal or mercury?
No. There is no thimerosal or mercury in the HPV vaccine. It is made up of
proteins from the outer coat of the virus (HPV). There is no infectious
material in this vaccine.
How much will the HPV vaccine cost?
The retail price of the vaccine is $120 per dose ($360 for full series).
Will girls/women who have been vaccinated still need cervical cancer
screening?
Yes. There are three reasons why women will still need regular cervical
cancer screening. First, the vaccine will NOT provide protection against all
types of HPV that cause cervical cancer, so vaccinated women will still be at
risk for some cancers. Second, some women may not get all required doses
of the vaccine (or they may not get them at the right times), so they may not
get the vaccines full benefits. Third, women may not get the full benefit of
the vaccine if they receive it after theyve already acquired a vaccine HPV
type.
Will the HPV vaccine be covered by insurance plans?
While some insurance companies may cover the vaccine, others may not.
Most large group insurance plans usually cover the costs of recommended
vaccines. However, there is often a short lag-time after a vaccine is
recommended, before it is available and covered by health plans.
What kind of government programs may be available to cover HPV
vaccine?
Federal health programs such as Vaccines for Children (VFC) will cover the
HPV vaccine. The VFC program provides free vaccines to children and
adolescents under 19 years of age, who are either uninsured, Medicaideligible,
American Indian, or Alaska Native. There are over 45,000 sites that
provide VFC vaccines, including hospital, private, and public clinics. The
VFC Program also allows children and adolescents to get VFC vaccines
through Federally Qualified Health Centers or Rural Health Centers, if their
private health insurance does not cover the vaccine.
Some states also provide free or low-cost vaccines at public health
department clinics to people without health insurance coverage for vaccines.
Why is HPV important?
Genital HPV is a common virus that is passed on through genital contact,
most often during vaginal and anal sex. About 40 types of HPV can infect
the genital areas of men and women. While most HPV types cause no
symptoms and go away on their own, some types can cause cervical cancer
in women. These types also have been linked to other less common genital
cancers, including cancers of the anus, vagina, and vulva (area around the
opening of the vagina). Other types of HPV can cause warts in the genital
areas of men and women, called genital warts.
How common is HPV?
At least 50% of sexually active people will get HPV at some time in their
lives. Every year in the U.S., about 6.2 million people get HPV. HPV is
most common in young women and men who are in their late teens and early
20s.
Anyone who has ever had genital contact with another person can get HPV.
Both men and women can get it and pass it on to their sex partnerswithout
even realizing it.
How common are Genital Warts?
About 1% of sexually active adults in the U.S. (about 1 million people) have
visible genital warts at any point in time.
Is HPV the same thing as HIV or Herpes?
HPV is NOT the same as HIV or Herpes (Herpes simplex virus or HSV).
While these are all viruses that can be sexually transmitted HIV and HSV
do not cause the same symptoms or health problems as HPV.
Can HPV and its associated diseases be treated?
There is no treatment for HPV. But there are treatments for the health
problems that HPV can cause, such as genital warts, cervical cell changes,
and cancers of the cervix, vulva, vagina and anus.
How is HPV related to cervical cancer?
Some types of HPV can infect a womans cervix (lower part of the womb)
and cause the cells to change. Most of the time, HPV goes away on its own.
When HPV is gone, the cervix cells go back to normal. But sometimes, HPV
does not go away. Instead, it lingers (persists) and continues to change the
cells on a womans cervix. These cell changes can lead to cancer over time,
if they are not treated.
How common is cervical cancer in the United States (U.S.)? How many
women die from it?
The American Cancer Society estimates that in 2006, over 9,700 women will
be diagnosed with cervical cancer and 3,700 women will die from this
cancer in the U.S.
Are there other ways to prevent cervical cancer?
Regular Pap tests and follow-up can prevent most, but not all, cases of
cervical cancer. Pap tests can detect cell changes (or precancers) in the
cervix before they turn into cancer. Pap tests can also detect most, but not
all, cervical cancers at an early, curable stage. Most women diagnosed with
cervical cancer in the U.S. have either never had a Pap test, or not had a Pap
test in the last 5 years.
There is also an HPV DNA test available for use with the Pap test, as part of
cervical cancer screening. This test is used for women over 30 or for women
who get an unclear (borderline) Pap test result. While this test can tell if a
woman has HPV on her cervix, it cannot tell which types of HPV she has.
What HPV types does the vaccine protect against?
The new HPV vaccine protects against the two HPV types that cause most
(70%) cervical cancers (types 16 and 18), and the two HPV types that cause
most (90%) genital warts (types 6 and 11).
What does the vaccine not protect against?
Because the vaccine does not protect against all types of HPV, it will not
prevent all cases of cervical cancer or genital warts. About 30% of cervical
cancers will not be prevented by the vaccine, so it will be important for
women to continue getting screened for cervical cancer (regular Pap tests).
Also, the vaccine does not prevent about 10% of genital wartsnor will it
prevent other STIs so it will still be important for sexually active adults to
reduce exposure to HPV and other STIs.
How long does vaccine protection last? Will a booster shot be needed?
The length of vaccine protection (immunity) is usually not known when a
vaccine is first introduced. So far, studies have followed women for five
years and found that they are protected. More research is being done to find
out how long protection will last, and if a booster vaccine is needed years
later.
Why is the vaccine only recommended for girls/women ages 9 to 26?
The vaccine has been extensively tested in 9-to-26 year-old girls/women, but
research on the vaccines efficacy has only recently begun with males, and
with women older than 26 years of age. The FDA will consider licensing the
vaccine for these other groups when the research is completed to show that it
is safe and effective in those groups.
Why is HPV vaccine recommended for such young girls?
Ideally, females should get the vaccine before they are sexually active
since this vaccine is most effective in girls/women who have not yet
acquired any of the HPV vaccine types. Girls/women who have not been
infected with any vaccine HPV type will get the full benefits of the vaccine.
Should girls/women be screened before getting vaccinated?
No. Girls/women should not get an HPV test or Pap test to determine if they
should get the vaccine. An HPV test or a Pap test can tell that a woman may
have HPV, but these tests cannot tell the specific HPV type(s) that a woman
has. Even girls/women with one vaccine HPV type could get protection
against the other vaccine HPV types they have not yet acquired.
What about vaccinating boys?
We do not yet know if the vaccine is effective in boys or men. It is possible
that vaccinating males will have health benefits for them by preventing
genital warts and rare cancers, such as penile and anal cancer. It is also
possible that vaccinating boys/men will have indirect health benefits for
girls/women. Studies are now being done to find out if the vaccine works to
prevent HPV infection and disease in males. When more information is
available, this vaccine may be licensed and recommended for boys/men as
well. Currently, the vaccine is licensed only for use in females ages 9 to 26.
Should pregnant women be vaccinated?
The vaccine is not recommended for pregnant women. There has been
limited research looking at vaccine safety for pregnant women and their
developing fetus. So far, studies suggest that the vaccine has not caused
health problems during pregnancy, nor has it caused health problems for the
infant– but more research is still needed. For now, pregnant women should
complete their pregnancy before getting the vaccine. If a woman finds out
she is pregnant after she has started getting the vaccine series, she should
complete her pregnancy before finishing the three-dose series.
Will girls/women be protected against HPV and related diseases, even if
they dont get all three doses?
It is not yet known how much protection girls/women would get from
receiving only one or two doses of the vaccine. For this reason, it is very
important that girls/women get all three doses of the vaccine.
Will girls be required to get vaccinated before they enter school?
There are no federal laws that require children or adolescents to get
vaccinated. All school and daycare entry laws are state lawsso they vary
from state to state. To find out what vaccines are needed for children or
adolescents to enter school or daycare in your state, check with your state
health department or board of education.
Are there other HPV vaccines in development?
Another HPV vaccine is in the final stages of clinical testing, but it is not yet
licensed. This vaccine would protect against the two types of HPV that cause
most (70%) cervical cancers (types 16, 18).
Are there other ways to prevent HPV?
The only sure way to prevent HPV is to abstain from all sexual activity.
Sexually active adults can reduce their risk by being in a mutually faithful
relationship with someone who has had no other or few sex partners, or by
limiting their number of sex partners. But even persons with only one
lifetime sex partner can get HPV, if their partner has had previous partners.
It is not known how much protection condoms provide against HPV, since
areas that are not covered by a condom can be exposed to the virus.
However, condoms may reduce the risk of genital warts and cervical cancer.
They can also reduce the risk of HIV and some other sexually transmitted
infections (STIs), when used consistently and correctly (i.e. all the time and
the right way).
Bibliography
American Cancer Society. Detailed Guide: Cervical Cancer. What are the
Key Statistics about Cervical Cancer? Last updated October 31, 2005.
CDC, www.cdc.gov, February 3, 2008
Food and Drug Administration (FDA). FDA News: FDA Licenses New
Vaccine for Prevention of Cervical Cancer and Other Diseases in Females
Caused by Human Papillomavirus.
Harper DM, Franco EL, Wheeler C, et al, HPV Vaccine Study Group.
Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine
against human papillomavirus types 16 and 18: follow-up from a
randomised controlled trial. Lancet. 2006, 367(9518): 1247-1255.
Ho GY, Bierman R, Beardsley L, et al. Natural history of cervicovaginal
papillomavirus infection as measured by repeated DNA testing in adolescent
and young women. N Engl J Med. 1998, 338(7):423-428.
Koutsky LA. Epidemiology of genital human papillomavirus infection. Am J
Med. 2005, 102(5A):3-8.
Mao C, Koutsky LA, Ault KA, et al. Efficacy of human papillomavirus-16
vaccine to prevent cervical intraepithelial neoplasia: a randomized controlled
trial. Obstet Gynecol. 2006, 107(1):18-27.
National Institutes of Health (NIH). NIH Consensus Statement: Cervical
Cancer. 2004, 14:1-38.
Villa LL, Costa RLR, Petta CA, et al. Prophylactic quadrivalent human
papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in
young women: a randomised double-blind placebo-controlled multicentre
phase II efficacy trial. The Lancet Oncology, 2005, 6(5): 271-278.
Weinstock H, Berman S, Cates W, Jr. Sexually transmitted diseases among
American youth: incidence and prevalence estimates, 2000. Perspect Sex
Reprod Health. 2004, 36(1):6-10.
Content reviewed: February 2008




















































































































































































































































Author’s Bio:

Larry Snyder, RN is the Founder and President of RN.ORG. As a licensed healthcare professional with over 15 years of experience in nursing as well as a computer authority with in-excess of 20 years of experience, he is knowledgeable with the integration of healthcare and computers and sees a strong need for licensed professionals to maintain their license in an easy, convenient, comfortable no stress environment. Larry has worked in various aspects of nursing in many states in both large and small hospitals and has the experience and background to make healthcare and nursing education friendly. Larry also functioned as a consulant at large corporations in various aspects of IT management including CBS Sports, Sportsline.com, Sports.com, Viacom, Flexsys and Monsanto. Larry spends a couple of days a month researching and consulting as an expert witness has been in many courtrooms in South and Central Florida sharing his valuable input as an experienced Emergency Room nurse. In his spare time he enjoys traveling, hiking, cooking, scuba diving and contributing his knowledge and experience to help people who live in other parts of the world. Larry enjoys living part time in Envigado, Colombia and in Coral Springs, Florida and is involved in various projects in both continents . In January, 2008 Larry became a grandfather so quite frequently is visiting his grandson and daughter in the United States.

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