Managing HPV: A New Era in Patient Care – Counseling Tips

(Published May 2013)

Lack of Information About HPV

• Data from a national survey show that only 40% of women had ever heard of human papillomavirus, or HPV.¹
• Of these, less than half were aware that HPV causes cervical cancer.

General Educational Messages About HPV

• HPV is sexually transmitted.
• HPV is very common.
• Most women with HPV will not get cervical cancer.
• HPV infection usually clears by itself.
• HPV tests are used to detect the virus that causes cell changes and cancer of the cervix.
• Pap tests are used to detect cell changes and precancer caused by HPV.
• Most women who test positive for HPV do not have precancer or cervical cancer.
• However, some women with HPV infection that doesn’t clear quickly will develop cervical cell changes.
• A positive Pap test result probably indicates that a woman has cell changes caused by HPV.
• A positive Pap test result usually means that a woman will need additional testing to make sure she doesn’t have serious cell changes or cancer.
• If a woman is found on additional testing to have serious cell changes or cancer, effective treatment is available.
• HPV vaccines prevent the two types of HPV (16 and 18) that cause 70% of cervical cancers.
• Because 30% of cervical cancers are associated with HPV types that are not covered by the vaccine, women will continue to need cervical cancer screening even if they are vaccinated.

Educational Messages for Women Who Test Positive for HPV

• HPV is very common. Almost 8 out of 10 women will get HPV at some point in their lives.
• There is no way of knowing how long HPV has been present or who transmitted the virus.
• Having HPV is not a sign of infidelity or promiscuity.
• Most women who have HPV do not develop abnormal cells or cancer.
• Women who have HPV in their cells for a long time are at greater risk for developing abnormal cells or cancer.
• If you have a positive HPV test result and a normal Pap test, your health care provider will either:
  • Retest you in 12 months with cotesting. If HPV is still present, colposcopy will be recommended even if your Pap test is still normal.
  • Test immediately for HPV 16/18 genotypes. If you have HPV 16/18, colposcopy will be recommended.²

General HPV Counseling Tips

• Proactively dispel the myths that abound about HPV. Ask your patients what they know about the virus and provide accurate information as needed.
• Provide information about HPV relevant to the clinical situation; then ask your patients whether they have any questions. Tell them how to contact you if they have questions after leaving your office.
• To minimize patient anxiety, be sure to clarify that a positive HPV test result is not a cancer diagnosis. Explain that because of the high prevalence of HPV infection and the relatively small risk of cancer, many patients will have positive test results but never develop cervical cancer.
• Clearly communicate about any necessary follow-up, including the timing, of any procedures or testing that will be done and the approximate length of the follow-up appointment.

References

1. Tiro JA, Meissner HI, Kobrin S, Chollette. What do women in the U.S. know about human papillomavirus and cervical cancer? Cancer Epidemiol Biomarkers Prev. 2007;16:288-94.
2. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62:147-72