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DOI: 10.1055/s-0041-1727285
HPV infection - Screening, diagnosis and management of HPV-induced lesions
Number 3 - March 2021![](https://www.thieme-connect.de/media/10.1055-s-00030576/202103/lookinside/thumbnails/10-1055-s-0041-1727285_febrasgostatement-1.jpg)
Key points
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Address the importance of organized screening for cervical cancer.
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Indicate new technologies in screening.
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Anogenital warts are caused by HPV, mainly 6 and 11.
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The diagnosis of condyloma acuminata is clinical with several effective therapeutic options.
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Low-grade squamous intraepithelial lesion (LSIL) and atypias of undetermined significance in squamous cells (ASC-US).
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As the risk of histological high-grade squamous intraepithelial lesion (HSIL) in a patient with cytological LSIL is significant, the quality of the cytopathological examination is essential.
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Cases of cytological HSIL should be systematically referred to colposcopy.
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“See-and-treat” is a diagnostic and therapeutic procedure and must be performed according to rules established for non-pregnant women over 25 years of age.
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“See-and-treat” should not be performed in adolescents given the future possibility of obstetric comorbidities.
The National Specialty Commission for Lower Genital Tract of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.
Publication History
Article published online:
15 April 2021
© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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Reference
- 1 Hirth J. Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature. Hum Vaccin Immmunother 2019; 15 (01) 146-55 DOI: 10.1080/21645515.2018.1512453.
- 2 Brianti P, De Flammineis E, Mercuri SR. Review of HPV-related diseases and cancers. New Microbiol 2017; 40 (02) 80-5
- 3 Gultekin M, Karaca MZ, Kucukyildiz I, Dundar S, Keskinkilic B, Turkyilmaz M. Mega HPV laboratories for cervical cancer control: challenges and recommendations from a case study of Turkey. Papillomavirus Res. 2019; 7: 118-22 DOI: 10.1016/j. pvr.2019.03.002.
- 4 Ministério da Saúde. Instituto Nacional de Câncer. Tipos de câncer: câncer do colo do útero [Internet]. 2020 [cited 2020 Oct 15]. Available from: https://www.inca.gov.br/tipos-de-cancer/cancer-do-colo-do-utero
- 5 Possati-Resende JC, Vazquez FL, Pantano NP, Fregnani JHTG, Mauad EC, Longatto-Filho A. Implementation of a cervical cancer screening strategy using HPV self-sampling for women living in rural areas. Acta Cytol. 2019; 64 (1-2) 7-15 DOI: 10.1159/000493333.
- 6 Jansen EEL, Zielonke N, Gini A, Anttila A, Segnan N, Vokó Z. et al. Effect of organised cervical cancer screening on cervical cancer mortality in Europe: a systematic review. Eur J Cancer 2020; 127: 207-23 DOI: 10.1016/j.ejca.2019.12.013.
- 7 Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes brasileiras para rastreamento do câncer do colo do útero [Internet]. 2a ed.. Rio de Janeiro: INCA; 2016. [cited 2019 Nov 18] Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//diretrizesparaorastreamentodocancerdocolodoutero_2016_corrigido.pdf
- 8 Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A. et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020; 70 (05) 321-46 DOI: 10.3322/caac.21628.
- 9 Chrysostomou AC, Stylianou DC, Constantinidou A, Kostrikis LG. Cervical cancer screening Programs in Europe: The transition towards HPV vaccination and population-based HPV testing. Viruses 2018; 10 (12) 729 DOI: 10.3390/v10120729.
- 10 Zeferino LC, Bastos JB, Vale DBAP, Zanine RM, Furtado de Melo YLM, Pereira Primo WQS. et al. Guidelines for HPV-DNA testing for cervical cancer screening in Brazil. Rev Bras Ginecol Obstet. 2018; 40 (06) 360-8 DOI: 10.1055/s-0038-1657754.
- 11 Speck NMG, Carvalho JP. Dossiê de estratégias do rastreamento do câncer de colo uterino no Brasil. São Paulo: FEBRASGO; 2018. [cited 2019 Dec 15]. Available from: https://www.febrasgo.org.br/pt/noticias/item/download/167_d8aac29103a80d079e7031cf127c72d6#:∼:text = Baseado%20em%20revis%C3%A3o%20extensa%20de,o%20rastreamento%20baseado%20em%20citologia
- 12 Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). Rastreamento do câncer de colo útero no Brasil [Internet]. 2019 [cited 2020 Dec 15]. Available from: https://www.febrasgo.org.br/pt/noticias/item/551-rastreamento-do-cancer-de-colo-uterino-no-brasil?highlight=WyJkb3NzaWUiXQ = =
- 13 Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo clínico e diretrizes terapêuticas para atenção integral às pessoas com Infecções Sexualmente Transmissíveis (IST). Brasília (DF): Ministério da Saúde; 2020
- 14 Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines [Internet]. 2015 [cited 2019 Oct 10]. Available from: https://www.cdc.gov/std/tg2015/default.htm
- 15 Grillo-Ardila CF, Angel-Muller E, Salazar-Díaz LC, Gaitán HG, Ruiz-Parra AI, Lethaby A. Imiquimod for anogenital warts in non-immunocompromised adults. Cochrane Database Syst Rev. 2014; (11) CD010389 DOI: 10.1002/14651858.CD010389.pub2.
- 16 Speck NMG, Ribalta JCL, Focchi J, Costa RRL, Kesselring F, Freitas VG. Low-dose 5-fluoruracil adjuvant in laser therapy for HPV lesions in immunosuppressed patients and cases of difficult control. Eur J Gynaecol Oncol. 2004; 25 (05) 597-9
- 17 Meijer CJ, van den Brule AJ, Snijders PJ, Helmerhorst T, Kenemans P, Walboomers JM. Detection of human papillomavirus in cervical scrapes by the polymerase chain reaction in relation to cytology: possible implications for cervical cancer screening. IARC Sci Publ. 1992; (119) 271-81
- 18 Mitchell MF, Hittelman WN, Hong WK, Lotan R, Schottenfeld D. The natural history of cervical intraepithelial neoplasia: an argument for intermediate endpoint biomarkers. Cancer Epidemiol Biomarkers Prev. 1994; 3 (07) 619-26
- 19 Holowaty P, Miller AB, Rohan T, To T. Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst. 1999; 91 (03) 252-8 DOI: 10.1093/jnci/91.3.252.
- 20 Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F. et al. ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020; 24 (02) 102-31 DOI: 10.1097/LGT.0000000000000525.
- 21 Rufail M, Lew M, Pang J, Jing X, Heider A, Cantley RL. Low-grade squamous intraepithelial lesion on Papanicolaou test: follow-up rates and stratification of risk for high-grade squamous intraepithelial lesion. J Am Soc Cytopathol. 2020; 9 (04) 258-65 DOI: 10.1016/j.jasc.2020.02.003.
- 22 Queiroz Filho J, Freitas JOC, Pessoa DC, Eleutério Júnior J, Giraldo PC, Gonçalves AK. Assessment of 100% rapid review as an effective tool for internal quality control in cytopathological services. Acta Cytol. 2017; 61 (03) 207-13 DOI: 10.1159/000475833.
- 23 Federação Brasileira das Associações de Ginecologia e Obstetrícia. Rastreio, diagnóstico e tratamento do câncer de colo de útero. São Paulo: FEBRASGO; 2017
- 24 Wong OGW, Tsun OKL, Tsui EY, Chow JNK, Ip PPC, Cheung ANY. HPV genotyping and E6/E7 transcript assays for cervical lesion detection in an Asian screening population-Cobas and Aptima HPV tests. J Clin Virol. 2018; 109: 13-8 DOI: 10.1016/j. jcv.2018.10.004.
- 25 ASCUS-LSIL Traige Study (ALTS) Group. A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Am J Obstet Gynecol. 2003; 188 (06) 1393-400 DOI: 10.1067/mob.2003.462.
- 26 Massad LS, Collins YC, Meyer PM. Biopsy correlates of abnormal cervical cytology classified using the Bethesda System. Gynecol Oncol. 2001; 82 (03) 516-22 DOI: 10.1006/gyno.2001.6323.
- 27 Ministério da Saúde. Departamento de Informática do SUS (Datasus). Sistema de Informação do Câncer do Colo do Útero (SISCOLO) [Internet]. 2013 [cited 2018 Aug 13]. Available from: http://w3.datasus.gov.br/siscam/index.php
- 28 Castle PE, Adcock R, Cuzick J, Wentzensen N, Torrez-Martinez NE, Torres SM. et al. Relationships of p16 immunohistochemistry and other biomarkers with diagnoses of cervical abnormalities: implications for LAST terminology. Arch Pathol Lab Med. 2020; 144 (06) 725-34 DOI: 10.5858/ arpa.2019-0241-OA.
- 29 Chen JY, Wang ZL, Wang ZY, Yang XS. The risk factors of residual lesions and recurrence of the high-grade of cervical intraepithelial lesions (HSIL) patients with positive-margin after conization. Medicine (Baltimore) 2018; 97 (041) e12792 DOI: 10.1097/MD.0000000000012792.
- 30 Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA. et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020; 395 (10224): 575-90 DOI: 10.1016/S0140-6736(20)30068-4.