[Insert Lecture Name Here][Insert Lecture Name Here] - … HPV Module 5 (Management).pdf · [Insert Lecture Name Here] ‐‐‐ Original content for this slide submitted by ARHP’s

[Insert Lecture Name Here][Insert Lecture Name Here]

This slide should be shown at each presentation. Repeat at end of presentation to signal end and to demonstrate partnership again.

FACULTY ANNOUNCEMENTS

[Note: Please follow ARHP guidelines for CME presentations by including all required information in your introduction. This information is in your teaching packet. As a faculty representative, you are requested to do the following:]representative, you are requested to do the following:]

•Announce program sponsors: Association of Reproductive Health Professionals (ARHP) and Planned Parenthood Federation of America (PPFA).

•Announce unrestricted educational grant from .

•Announce that the presentation may include information that is not on FDA‐required product labels.

•Disclose any financial relationship(s) you have with industry.

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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 1Slide 1

[Insert Lecture Name Here]

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Slide 2

1/26/2008 12/5/2007

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Talking Points:

•This presentation has been peer reviewed.

•There are more details about each of these medical experts in the handout.

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Slide 5


Talking Points: …a continuation of our committee members. I’d like to thank each of them for their expert contribution.

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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Gracewayfrom a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 6


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Slide 7


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Slide 8


Talking points:

• ASCCP recommends 3 options for initial management of ASC‐US in pre‐menopausal women:

1. HPV DNA testing

2. Repeat cytology at 6 and 12 months

3. Colposcopy

• If liquid‐based cytology or co‐collection is used, HPV DNA testing is the preferred option.

Reference:

• Wright TC, Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests. AJOG. 2007;197(4): 346‐355.

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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, GracewayPharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 9


Talking points:

•ASCCP recommends the following for follow‐up management of ASC‐US:

•If HPV reflex testing was used initially:

•If HPV testing is negative, repeat Pap 12 months

•If HPV testing is positive, perform colposcopy

Reference:

•Wright TC, Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests. AJOG. 2007;197(4): 346‐355.

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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www arhp org/coreat www.arhp.org/core.

Slide 10


Talking points:

•ASCCP recommends the following for follow‐up management of ASC‐US:

•If repeat cytology was used:

•If Pap at 6 and 12 months are both negative, patient should undergo routine screening

•If Pap at 6 or 12 months is ≥ ASC, perform colposcopy

Reference:


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Slide 11


Talking points:

•ASCCP recommends the following for post‐colposcopy management of ASC‐US:

•If no CIN is identified at the time of colposcopy, management options are:

•HPV DNA testing at 12 months (it is recommended that HPV DNA testing not be performed at intervals less than 12 months)or

•Repeat cytological testing at 6 and 12 months

•If CIN is identified, manage per ASCCP guidelines

•These recommendations represent no major changes from ASCCP 2001 Guidelines

Reference:•Wright TC, Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests AJOG 2007;197(4): 346 355of Women with Abnormal Cervical Cancer Screening Tests. AJOG. 2007;197(4): 346‐355.

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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Carein September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 12


Talking points:

•This slides illustrates the risk of CIN 2 or greater based on colposcopy findings.

References:


•Guido R, Schiffman M, Solomon D, Burke L; ASCUS LSIL Triage Study (ATLS) Group. Postcolposcopy management strategies for women referred with low‐grade squamous intraepithelial lesions or human papillomavirus DNA‐positive atypical squamous cells of undetermined significance: a two‐year prospective study. Am J Obstet Gynecol. 2003;188(6):1401‐5.undetermined significance: a two year prospective study. Am J Obstet Gynecol. 2003;188(6):1401 5.

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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals Merck and Co Inc QIAGEN and Roche Pharmaceuticals throughPharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 13


Talking points:

•This slide compares the 2001 and 2006 ASCCP recommendations for the management of postmenopausal women or immunosuppressed women with ASC‐US.

•The new recommendations suggest that these women are treated in the same manner as women in the general population who have ASC‐US.

Reference:

•Adapted and printed with permission from ASCCP’s Algorithms: 2006 Consensus Guidelines Speaker’s Kit © 2006, 2007 ASCCP. All rights reserved.

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Slide 14


Talking points:

•The newer recommendations for the management of ASC‐US in immunosuppressed women are based on more recent studies that indicate that HIV positive women with ASC‐US are similar in risk to HIV negative women with ASC‐US.

Reference:

•Kirby TO Allen ME Alvarez RD Hoesley CJ Huh WK High‐risk human papillomavirus and cervical intraepithelial neoplasia•Kirby TO, Allen ME, Alvarez RD, Hoesley CJ, Huh WK. High‐risk human papillomavirus and cervical intraepithelial neoplasia at time of atypical squamous cells of undetermined significance cytologic results in a population with human immunodeficiency virus. J Low Genit Tract Dis. 2004;8(4):298‐303.

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Slide 15


Talking points:

•ASCCP recommends colposcopy for all women with ASC‐H, based on the fact that a number of studies have reported high rates of CIN 2,3 in these women.

Reference:


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Slide 16


Talking points:

•LSIL includes specimens previously classified as having mild dysplasia, CIN 1, and HPV change.

•ASCCP recommends colposcopy for all women with LSIL.

•This slide shows recommended management based on colposcopy results.

References:


Adapted and printed with permission from ASCCP’s Algorithms: 2006 Consensus Guidelines Speaker’s Kit © 2006, 2007 ASCCP. All rights reserved.

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Original content for this slide submitted by ARHP’s Clinical Advisory Committee forOriginal content for this slide submitted by ARHP s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 17


Talking points:

•The ASCUS LSIL Triage Study (ATLS) showed that women with LSIL and women with ASC‐US with high‐risk HPV have an identical risk of high‐grade neoplasia.

•For this reason, ASCCP management guidelines for the two conditions are similar, except in special circumstances.

Reference:


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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies includingreceived from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 18


Talking points:

•This slide compares the 2001 ASCCP guidelines for management of LSIL in postmenopausal women with the new guidelines.

References:


Adapted and printed with permission from ASCCP’s Algorithms: 2006 Consensus Guidelines Speaker’s Kit © 2006, 2007 ASCCP. All rights dreserved.

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Slide 19


Talking points:

•This slide compares the 2001 ASCCP guidelines for management of LSIL in pregnant women with the new guidelines.

References:


Adapted and printed with permission from ASCCP’s Algorithms: 2006 Consensus Guidelines Speaker’s Kit © 2006, 2007 ASCCP. All rights dreserved.

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Slide 20


Talking points:

•Continuation of new ASCCP guidelines for management of LSIL in pregnant women.

References:

•Wright TC, Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus Guidelines for the Management of Women

with Abnormal Cervical Cancer Screening Tests. AJOG. 2007;197(4): 346‐355.


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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through , , Q , gunrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 21


Talking points:

•This slide shows the ASCCP recommendations for initial management of atypical glandular cells (AGC):

•Colposcopy with endocervical sampling for all for women

•Women ≥ 35 should have endometrial sampling in addition to colposcopy and endocervical sampling

•Endometrial sampling is also recommended for women of any age with•Endometrial sampling is also recommended for women of any age with abnormal bleeding suggestive of a risk for neoplastic endometrial lesions

Reference:


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Slide 22


Talking points:

•This slide shows the ASCCP recommendations for post‐colposcopy evaluation and follow‐up of “Atypical Glandular Cells (AGC) Favor Neoplasia or AIS”:

Reference:•Wright TC, Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests. AJOG. 2007;197(4): 346‐355.

‐‐‐

Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants This slide is available at www arhp org/coreunrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 23


Talking points:

•This slide shows the ASCCP recommendations for post‐colposcopy evaluation and follow‐up of “Atypical Endocervical, Endometrial, or Glandular Cells (NOS)”:

•If biopsies and endocervical sample are negative for neoplasia:

•If HPV status is unknown: repeat Pap Q6 months x 4, refer to colposcopy for ≥ ASC

•If HPV status is known:

•HPV negative: repeat pap and HPV in 12 months

•HPV positive: repeat pap and HPV in 6 months

•Refer to colposcopy if HPV+ or cytology ASC‐US or greater

Reference:


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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway

Slide 24

Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.


Talking points:

•This slide shows the ASCCP recommendations for post‐colposcopy evaluation and follow‐up of “Atypical Endocervical, Endometrial, or Glandular Cells (NOS)”:

•If biopsies and endocervical sample are negative for neoplasia:

•If HPV status is unknown: repeat Pap Q6 months x 4, refer to colposcopy for ≥ ASC

•If HPV status is known:

•HPV negative: repeat pap and HPV in 12 months

•HPV positive: repeat pap and HPV in 6 months

•Refer to colposcopy if HPV+ or cytology ASC‐US or greater

Reference:


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Slide 25



Talking points:

•This slide summarizes the significant differences between the 2001 and new ASCCP guidelines for management of AGC.

•Note that hysterectomy is preferred in women who have completed childbearing if AIS is identified on excisional procedure

References:



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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is availablePharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 26


Talking points:

This slide shows the ASCCP recommendations for management of High‐grade Squamous Intraepithelial Lesion (HSIL). The two recommended management options for women w/ HSIL are:

‐Colposcopic examination with endocervical assessment

OR

Immediate loop electrosurgical excision‐Immediate loop electrosurgical excision

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Slide 27


Talking points:

If colposcopic examination with endocervical assessment is selected and colposcopy satisfactory:

>If biopsy shows CIN 2‐3:-Excision OR-Ablation

References:



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Slide 28


Talking points:

If colposcopic examination with endocervical assessment is selected and colposcopy satisfactory:

>If biopsy does not show CIN 2,3 three treatment options are acceptable:

•Excisional procedure OR

•Review of all findings with management based on revised findings OR

•Observation with Pap and colposcopy every 6 months for one yearObservation with Pap and colposcopy every 6 months for one year

-Excisional procedure recommended if HSIL persists

References:


Adapted and printed with permission from ASCCP’s Algorithms: 2006 Consensus Guidelines Speaker’s Kit © 2006 2007 ASCCP All rights reservedGuidelines Speaker s Kit © 2006, 2007 ASCCP. All rights reserved.

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Slide 29



Talking points:

If colposcopic examination with endocervical assessment is selected:

•If colposcopy unsatisfactory: excisional procedure

References:


Adapted and printed with permission from ASCCP’s Algorithms: 2006 ConsensusAdapted and printed with permission from ASCCP s Algorithms: 2006 Consensus Guidelines Speaker’s Kit © 2006, 2007 ASCCP. All rights reserved.

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Original content for this slide submitted by ARHP’s Clinical Advisory Committee for Managing HPV: A New Era in Patient Care in September 2007. Original funding received f ll b ti f h ti l i i l di Gl S ithKli Gfrom a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Slide 30


Talking points:

•This slides lists the ASCCP guidelines for the management of CIN 1.

•Note that routine use of excisional procedures for CIN 1 is unacceptable

References:

•Wright TC, Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus Guidelines for the Management of Women with Cervical Intraepithelial Neoplasia or Adenocarcinoma in situ. AJOG. 2007;197(4):340‐345.

Adapted and printed with permission from ASCCP’s Algorithms:p p p g2006 Consensus Guidelines Speaker’s Kit © 2006, 2007 ASCCP. All rights reserved.

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Slide 31


Talking points:

•This slides lists the ASCCP guidelines changes for the management of CIN 2,3.

•Note these minor changes from ASCCP 2001 Guidelines:

•Cytology follow‐up post treatment every 6 months instead of every 4‐6 months

•Return to routine screening after two negative pap tests instead of 3

•Follow‐up preferred for CIN 2 in adolescents

References:

•Wright TC, Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus Guidelines for the Management of Women with Cervical Intraepithelial Neoplasia or Adenocarcinoma in situ. AJOG. 2007;197(4):340‐345.

Adapted and printed with permission from ASCCP’s Algorithms: 2006 Consensus Guidelines Speaker’s Kit © 2006, 2007 ASCCP. All rights

reserved.

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Slide 32


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Slide 33


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Slide 34


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Slide 35


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Slide 36


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Slide 37

[Insert Lecture Name Here][Insert Lecture Name Here]

This slide should be shown at each presentation. Repeat at end of presentation to signal end and to demonstrate partnership again.

FACULTY ANNOUNCEMENTS

[Note: Please follow ARHP guidelines for CME presentations by including all required information in your introduction. This information is in your teaching packet. As a faculty representative, you are requested to do the following:]representative, you are requested to do the following:]

•Announce program sponsors: Association of Reproductive Health Professionals (ARHP) and Planned Parenthood Federation of America (PPFA).

•Announce unrestricted educational grant from .

•Announce that the presentation may include information that is not on FDA‐required product labels.

•Disclose any financial relationship(s) you have with industry.

‐‐‐


Slide 38Slide 38

from a collaboration of pharmaceutical companies including GlaxoSmithKline, Graceway Pharmaceuticals, Merck and Co. Inc., QIAGEN, and Roche Pharmaceuticals through unrestricted educational grants. This slide is available at www.arhp.org/core.

Documents

[Insert Lecture Name Here][Insert Lecture Name Here] - … HPV Module 5 (Management).pdf · [Insert Lecture Name Here] ‐‐‐ Original content for this slide submitted by ARHP’s