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,