Reducing the Burden of HPV-Related Disease: Cervical Cancer and Beyond

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Program Overview:

Human papillomavirus (HPV) is the most common newly acquired sexually transmitted infection in the United States, with an estimated annual incidence of 6.2 million cases. Approximately 75% of sexually active adults will contract HPV in their lifetimes. Infection with HPV is a necessary cause of cervical cancer and genital warts and is associated with other anogenital and head and neck cancers. HPV infection can be classified into 2 types: high-risk (ie, oncogenic) types and low-risk types. The most common high-risk types, HPV 16 and 18, are detected in approximately 70% of all cervical cancer cases. Infection with high-risk HPV types is also associated with 80% to 90% of anal cancers, approximately 80% of penile cancers, and 26% of squamous cell carcinomas of the head and neck. Infection with HPV 6 and 11, 2 of the most common low-risk HPV types, are associated with 90% of genital warts, low-grade anogenital dysplasias, and recurrent respiratory papillomatosis, a rare but potentially fatal disease caused predominantly by vertical transmission from mother to infant, or less frequently, through direct sexual contact in adults.

The high prevalence of HPV infection among sexually active individuals underscores the need for disease prevention strategies. Vaccination against HPV offers an opportunity to prevent infection and the health consequences of HPV-associated disease. A quadrivalent HPV (types 6, 11, 16, 18) vaccine has been approved by the US Food and Drug Administration (FDA) for the prevention of cervical intraepithelial neoplasia 1 to 3, cervical adenocarcinoma in situ, cervical cancer, vulvar and vaginal intraepithelial neoplasia 2 and 3, and genital warts. The Centers for Disease Control and Prevention recommends that the quadrivalent vaccine be administered to all 11- and 12-year-old girls, girls and women 13 through 26 years of age who have not yet been vaccinated or have not completed the vaccination series, and girls as young as 9 years, at the clinician’s discretion. A bivalent HPV (types 16, 18) vaccine is currently under review by the FDA.

Both vaccines have demonstrated lasting efficacy against HPV-associated cervical disease and are generally well tolerated. In addition, emerging research indicates that HPV vaccination provides modest cross-protection against several nonvaccine high-risk HPV types, resulting in a further reduction in the incidence of HPV infection and HPV-related diseases. Recent clinical data also demonstrate that sexually active mid-adult women benefit from HPV vaccination with the quadrivalent HPV vaccine. Studies are ongoing to assess the benefits of HPV vaccination of males.

Learning Objectives

After completing this activity, the participant will be able to:

• Describe the epidemiology, natural history, and consequences of HPV infection
• Evaluate the anticipated benefits of widespread HPV vaccination in preventing cervical and anogenital cancers, genital warts, and other HPV-related diseases

Accreditation/Designation Statement

Primary Care Network, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Primary Care Network designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Target Audience:

This activity is targeted to all physicians and other healthcare professionals who treat patients with HPV.

Release Date: February 23, 2009
Expiration Date: February 23, 2010

Medium: Podcast

Acknowledgement of Commercial Support:

This activity was developed from the live Best Practices in Primary Care™ program held in Anaheim, California on June 14, 2008 which was funded by Merck & Co., Inc.

Method of Participation:

To receive CME credit for this activity, you need to listen to the program. Upon finishing the podcast, complete the post-test and evaluation, and fill out all required personal information. To receive your CME certificate you will need to pass the post-test with 70% accuracy or better.

Post-test and Evaluation:

After completing this activity, click on the Post-test button at the end of the program. If you receive less than 70% on the post-test, you will be returned to the beginning of the activity to review the presentation again. Upon successful completion of the post-test, you will be asked to fill out a program evaluation form and prompted to print your CME certificate.

Statement of Disclosure and Dependence:

It is the policy of Primary Care Network, Inc. to ensure all its sponsored educational activities are planned, developed, and conducted in accordance with the ACCME’s Essential Areas and Policies. In accordance with ACCME requirements, Primary Care Network has Conflict of Interest and Disclosure Policies that are designed to ensure that Primary Care Network sponsored educational activities are fair balanced, independent, evidence-based and based on scientific rigor.

Primary Care Network’s Resolution of Personal Conflicts of Interest (COI) Policy aims to ensure that all conflicts are resolved prior to the activity, content is developed and presented free of commercial bias, and is in the interest of promoting improvements or quality in healthcare. All individuals who are in a position to influence and/or control content of a Primary Care Network sponsored activity are required to disclose to the participants any real or apparent conflict of interest related to the activity. The educational content is also reviewed for independence and content validation by an independent external clinical reviewer and internal clinical reviewer. Independence is also monitored through the activity and overall program evaluation process.

The opinions, ideas, recommendations, and perspectives expressed in the accompanying presentations at this Primary Care Education program are those of the program authors and presenting faculty only and do not necessarily reflect the opinions, ideas, recommendations or perspectives of their affiliated institutions, Primary Care Network, Primary Care Education, Advisory Boards and Consultants, or the activity’s commercial supporters.

Faculty & Planning Committee and Disclosures

J. Thomas Cox, MD
Director, The Women’s Clinic
Student Health Services University of California, Santa Barbara
Santa Barbara, CA

Dr. Cox serves on the advisory boards for Diamics, Inc., Gen-Probe Incorporated, Graceway Pharmaceuticals, LLC, Takeda Pharmaceutical Company Ltd., and Tigris Pharmaceuticals, Inc. He is also on the Data Safety and Monitoring Board: Merck & Co., Inc. HPV Vaccine.

Daron G. Ferris, MD
Professor
Department of Family Medicine
Department of Obstetrics and Gynecology
Director, Gynecologic Cancer Prevention Center
Medical College of Georgia
Augusta, GA

Dr. Ferris is a consultant to GlaxoSmithKline and Merck & Co., Inc. He receives research grants from GlaxoSmithKline, Merck, Novartis Pharmaceuticals, and Takeda Pharmaceuticals North America, Inc. He serves on the advisory board for Merck and Takeda and is a member of the speaker’s bureau for Merck.

Jenny Ko, PharmD
Assistant Scientific Director
SciMed
New York, NY

Ms. Ko has nothing to disclosure.

Review Committee Disclosure

In accordance with our policy, all content is reviewed by external independent peer reviewers for balance, objectivity and commercial bias. The peer reviewers, staff, and other individuals who control content have no relevant financial relationships to disclose.

Unlabeled Use Declaration:

During their presentation(s), faculty may discuss an unlabeled use or an investigational use not approved for a commercial product. Each faculty member is required to disclose this information to the audience when referring to an unlabeled or investigational use.

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