Clinician-to-Clinician Update Clinician-to-Clinician Update

Preventing Cancers Caused by Human Papillomavirus

April 2016

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— In 2014, only 40% of adolescent girls and 22% of boys completed a 3-dose HPV vaccine series.

Human papillomaviruses (HPVs) are a family of DNA viruses that infect cutaneous or mucosal epithelial cells. About 40 types of HPV can potentially be transmitted through sexual contact, making HPV is the most common sexually transmitted infection in both males and females. Over 14 million new cases are reported each year in the United States.1 Most HPV infections are asymptomatic and are cleared by the host immune system within 1 to 2 years; however, some HPV infections persist and can lead to the development of certain types of cancers and precancerous lesions.2 The factors affecting HPV persistence are poorly understood.

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HPVs are divided into two classes: high-risk HPVs, which are oncogenic, and low-risk HPVs. The high-risk HPV subtypes, including HPV-16 and HPV-18, among others, are associated with a very high percentage of cervical, anal, genital, and oropharyngeal cancers (Table 1). Low-risk HPVs, such as HPV-6 and HPV-11, are associated with genital warts, laryngeal papillomas, and recurrent respiratory papillomatosis.3

Widespread use of the HPV vaccine has the potential to reduce the incidence of HPV-induced cancers by at least two-thirds.4 Currently the FDA has approved the use of 3 HPV vaccines (Table 2), all of which require 3 doses spaced over 6 months to provide full protection. Unfortunately, HPV vaccination rates among U.S. adolescents are not on track to meet the Healthy People 2020 goal of 80% coverage. In 2014, only 40% of adolescent girls and 22% of adolescent boys completed a 3-dose HPV vaccine series.5

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M Health physician researchers affiliated with Masonic Cancer Center, University of Minnesota have committed efforts toward encouraging use of the vaccine and preventing HPV-induced cancers. To realize these goals, they have joined forces with the university initiative Minnesota HPV. The initiative has brought together Masonic Cancer Center basic science researchers and clinicians, as well as University of Minnesota students and faculty from the medical school and the schools of nursing, dentistry, public health and the College of Pharmacy to meet one objective: increase HPV vaccination rates across Minnesota. M Health physicians have taken the lead in the initiative, which emphasizes multidisciplinary collaboration across health systems in hopes of ultimately reaching every Minnesotan. Minnesota HPV partners with Minnesota Department of Health and the American Cancer Society in this cancer-prevention initiative.

References

  1. Satterwhite CL, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-193.
  2. Goodman MT, et al. Prevalence, acquisition, and clearance of cervical human papillomavirus infection among women with normal cytology: Hawaii Human Papillomavirus Cohort Study. Cancer Res. 2008;68:8813-8824.
  3. Haedicke J, Iftner T. Human papillomaviruses and cancer. Radiother Oncol. 2013;108:397-402.
  4. Castellsague X, et al. End-of-study safety, immunogenicity, and efficacy of quadrivalent HPV (types 6, 11, 16, 18) recombinant vaccine in adult women 24–45 years of age. Br J Cancer. 2011;105:28-37.
  5. Centers for Disease Control and Prevention. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2014. MMWR Morb Mortal Wkly Rep. 2015; 2015;64(29):784-792.
  6. Centers for Disease Control and Prevention. How many cancers are linked with HPV each year? http://www.cdc.gov/cancer/hpv/statistics/cases.htm. Accessed March 9, 2016.
  7. Centers for Disease Control and Prevention. HPV vaccine information for clinicians. http://www.cdc.gov/hpv/hcp/need-to-know.pdf. Accessed March 9, 2016.

When to refer

We offer multidisciplinary cancer care at locations throughout the greater Twin Cities metro area. We value our relationship with you, your patients, and your office staff. We work hard to keep you informed of your patients’ care by providing detailed reports, from diagnosis to treatment and follow-up. Our goal is to provide you with prompt service and communication for the patients that you refer to us.

To schedule a cancer consultation, referral or appointment: 855-486-7226

To schedule a physician meeting or visit: 612-867-3411

Collaborative Care

Many of our patients do not live within the Twin Cities metropolitan area. To minimize travel difficulties and lost time from school or work for our patients, we are committed to partnering with the patient’s referring provider and other local providers. Some patients can be initially discussed over the phone in collaboration with the referring provider. We aim to expedite the process so that, in one trip to the Twin Cities, patients can be assessed and also complete surgery, if required. In many cases, care after discharge can also be provided locally.

Physician Outreach Program

The Cancer Care Outreach Program is designed to provide education and facilitate knowledge sharing between our team and the medical community.

To schedule a physician meeting or to visit our facility, contact Melinda Tuma Arvold, System Manager, Outreach Services: 612-867-3411; marvold1@fairview.org.

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