HPV Communication: Review of Existing Research and Recommendations for Patient Education

Abstract

The potential for human papillomavirus (HPV) DNA testing in cervical cancer prevention programs has been a topic at the forefront of cervical cancer policy discussions in recent years. To prevent some of the anxiety and psychological distress often experienced on HPV diagnosis and during the period of management, mass patient education must accompany the incorporation of HPV DNA testing into screening protocols. To contribute to a growing body of work that provides an empiric basis for development of effective counseling messages about HPV and HPV testing, this paper highlights women's most common information gaps and psychosocial concerns and describes the different perspectives offered by women's usual sources of information about HPV, including the crucial role of the clinical community in creating a shared decision making environment in which screening decisions and results can be discussed. (CA Cancer J Clin 2004;54:248 -259.) © American Cancer Society, Inc., 2004. Research in the last decade has conclusively demonstrated that sexually-transmitted infection with carcinogenic types of HPV, often referred to as high-risk types of HPV, is required for the subsequent development of virtually all cervical cancers.1 However, HPV infections are extremely common in sexually active women and the vast majority will spontaneously resolve or cause only transient minor lesions. HPV DNA testing is now included in cervical cancer screening guidelines as an adjunct to cytological screening.2,3 Mass patient education must accompany the incorporation of HPV DNA testing into screening protocols to prevent the anxiety and psychological distress often experienced on HPV diagnosis and during the period of management. To contribute to a growing body of work that provides an empiric basis for development of effective counseling messages about HPV and HPV testing, this paper will highlight women's most common information gaps and psychosocial concerns and describe the crucial role of the clinical community in creating a shared decision making environment in which screening decisions and results can be discussed. EPIDEMIOLOGY AND PATHOGENESISHPV is associated with nearly all cases of preinvasive and invasive cervical neoplasia.1 Eighty HPV types have been sequenced, although more than 200 types likely exist based on data from partially sequenced DNA fragments. 4 Approximately 30 specific HPV types infect the male and female genital tract and two-thirds of these are classified as high risk because of their etiological association with cervical cancer. In most countries, HPV-16 accounts for more than 50% to 60% of cervical cancer cases followed by HPV-18 (10%-12%) and HPVs 31 and 45 (4%-5% each).5 HPV types associated with genital warts, such as HPV-6, and HPV-11, are referred to as low risk because they are rarely associated with malignant disease. Ms. Anhang is Research Associate,

Café Discussions on Oral Sex, Oral Cancer, and HPV Infection: Summative Report

“…Such acknowledgment followed the American Cancer Society (2008) statement about HPV being a potential risk factor for the development of almost 30% of oral and oropharyngeal cancers. In this regard, oral sex can be a venue for HPV transmission and should be discussed accordingly since fewer than onethird of the sexually active individuals infected by HPV actually heard about this virus (Anhang et al, 2004). As shared by presenters and attendees of the Cafes, and by worldwide researchers (Scully, 2005), it is time to open our eyes about other potential risks for oral cancer beyond tobacco smoking and excessive alcohol consumption.…”

“…Oral cancer significantly impacts quality of life, physically and psychosocially, and the genetic links between some types of oral-pharyngeal carcinomas and ano-genital malignancies have been established via the human papillomavirus (HPV), particularly the strains 16 and 18 as found by Herrero et al (2003) and others (Anhang, Goodman, & Goldie, 2004;Cox, 2000;D'Souza et al, 2007;Ha & Califano, 2004). Since HPV 16 is the most predominant strain in ano-genital carcinomas, its transmission to the oropharyngeal region can occur through the mouth, especially during oral sex in sexually active individuals (Scully, 2005).…”

Disparities in How Parents Are Learning about the Human Papillomavirus Vaccine

“…Whereas many sources offer health information, the general public often turns to mass media (30)(31)(32)(33). Thus, harnessing the power of media is one way to educate the public on this important and timely issue.…”

Encouragement of Patient Self-management and Adherence through Use of a Computerized Tracking System for Cervical and Colon Cancer Screening

“…For both Paps and FOBTs, the test sensitivity is such that that the power of screening is achieved only after years of serial testing. 13,15,17 Once positive, Paps with low-grade and high-grade SIL progress at rates of 0.15% and 1.44% (respectively) to invasive cervical cancer at 2 years after the Papanicolaou. 18 Given all this, there is divergence of expert opinion on management.…”

“…18 Given all this, there is divergence of expert opinion on management. 14,17,19 Getting a follow-up completed is the major task. Patient involvement and patient selfmanagement represent personalized care, 17 and may prevail.…”