Harnessing what we know about the human papillomavirus (HPV) will help us prevent and eliminate cervical cancer, USA Health gynecologic oncologist Jennifer Young Pierce, M.D., M.P.H., told hundreds of providers at a recent meeting of the Society of Gynecologic Oncology.
Pierce, leader of the division of cancer control and prevention at the USA Health Mitchell Cancer Institute, was invited to give the presentation at the SGO winter meeting held Feb. 2-4 in Whistler, British Columbia.
HPV infection is responsible for six types of cancers in men and women, including cervical, oropharyngeal, anal, penile, vaginal and vulvar cancer.
“In May 2018, the WHO director general announced a global call for action to eliminate cervical cancer,” said Pierce, who also is a professor of gynecologic oncology at the Frederick P. Whiddon College of Medicine. “This was the first time the world has committed to eliminating a cancer.”
Two years later, a global strategy was adopted that urged vaccinating 90% of girls with the HPV vaccine, screening 70% of women in their 40s and treating 90% of women with pre-cancer and invasive cancer. The goal: lowering the incidence of cervical cancer by 97% by 2120.
We still have a long way to go toward reaching that goal, Pierce said. Every year, 37,000 people in the U.S. are diagnosed with an HPV-related cancer. “That’s about one case every 20 minutes,” she said.
The HPV vaccine, introduced in 2006, has proven to be safe and effective, with about 350 million doses given around the world in more than 15 years, she said. A population-based study in Finland documented zero HPV cancers in women who were vaccinated against HPV. “HPV vaccination is safe. HPV vaccination works, and HPV vaccination lasts,” she said.
Current knowledge about HPV can inform how we screen women for cervical cancer. In recent years, providers have offered three screening options – primary HPV testing, the Pap test (cytology) and both screening methods used together.
Pierce said the HPV test should be used as the primary method of screening, an approach that is being adopted by health organizations, including the ASCCP, the American Society for Colposcopy and Cervical Pathology. “The Pap is a test developed in the 1940s and needs to be repeated frequently,” Pierce said. “An HPV test is a much better predictor of current and future risk for cervical cancer.”
Relying on HPV testing as the primary screening tool allows providers to assess the risk of cervical cancer for women, and the guidelines can be adjusted for decreasing risk as more vaccinated patients reach the age for screening, she said. Once screened, it’s important to follow up and treat cancers and pre-cancers according to ASCCP guidelines.
Pierce called on GYN oncologists and others to become advocates for this approach. “We need everyone to join the fight for HPV to be used for primary screening, which is more likely to find cancer earlier,” she said.
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