Reply #48: You know nothing. 70-90% young women with HPV spontaeously rid themselves of it [View All]

[KittyWampus]

And young women (pre-teens) are the ones this vaccine was/is marketed for. And the older women MAY, in part, have highter rates of abnormal cells simply due to their age. The older you are, the more likely you are to have pre-cancerous or abnormal cells in your genital area. This is the same for men and prostrate cancer. Almost ALL mature men have abnormal cells in their prostates.


NEW York -- There is no need to be overly aggressive with surgical or medical interventions for adolescent girls and young adults with cervical human papillomavirus infections, Dr. Liane Deligdisch said.

Dr. Deligdisch, professor of pathology at Mount Sinai School of Medicine, New York, conducted a comparative study of cytologic samples from HPV-positive teens as well as women older than 35 years. While the younger patients had very distinct and definitely abnormal cytology because these abnormalities are largely transient, they did not warrant aggressive intervention.

"In adolescence, HPV has a much more benign nature than previously thought. Most cases are transient and do not need to be overtreated," she said at a conference on pediatric, adolescent, and young adult gynecology sponsored by Mount Sinai.

Dr. Deligdisch and her colleagues made exhaustive analyses of specimens taken from 100 HPV-positive patients seen at Mount Sinai's adolescent colposcopy clinic. This included a group of 14- to 20-year-olds with low-grade squamous intraepithelial lesions (LSIL) and a second group of teens with high-grade intraepithelial lesions (HSIL). These were compared with samples taken from women aged 35-64 years, who had LSIL and HSIL.

snip
Dr. Deligdisch said it is estimated that in adolescents, 90% of low-risk HPV infections and 70% of high-risk infections will regress spontaneously For older women, the spontaneous regression rate is far lower, and may be as low as 50%.

She said the findings from her group are "somewhat prophetic" in light of the recent Consensus Guidelines for the Management of Women With Cervical Cytological Abnormalities issued by the American Society for Colposcopy and Cervical Pathology (JAMA 287<16>:2120-29, 2002). The new guidelines reflect a definite shift away from aggressive intervention, especially for younger women with HPV.

Dr. J. Thomas Cox, who is the executive director of the National HPV and Cervical Cancer Prevention Center, agreed with Dr. Deligdisch's assessment and with the current general movement away from the colposcopic search-and-destroy mentality that has characterized HPV/cervical cancer management in the past.

"If you balance the risk of damage due to overtreating young women versus the risk of missing a lesion that might become cancerous later on, it weighs in favor of doing less," Dr. Cox said during a live video transmission from his office at the University of California, Santa Barbara.

The guidelines state that for young women with biopsy-confirmed cervical intraepithelial neoplasia (CIN) grades 2-3, observation with colposcopy and repeat cytology for 4-6 months is acceptable for up to 1 year. If the lesion progresses to HSIL or if an HSIL lesion persists for a year or more, only then should one proceed to a diagnostic and/or excisional procedure.

HPV infection alone is not grounds for surgical intervention, especially in teens and young women.

Dr. Cox, an author of the new ASCCP guidelines, cited a 1998 study from Rutgers University assessing the rate of HPV infection in college-aged women seeking oral contraceptives. While 26% of all patients were HPV positive by polymerase chain reaction, the infections cleared in 70% of these patients within 12 months, and only 9% of them remained positive at 24 months (N. Engl. J. Med. 338<7>:423-28, 1998).

Risk of cervical cancer appears to be correlated with HPV type. Therefore, it is important to test women at risk for specific HPV types. "The majority of low-grade lesions will regress over time, and the patients will become HPV negative," he said.

There is a very long time frame for the development of cervical cancer following infection with a high-risk HPV type. The majority of women who get cervical cancer are infected in their 20s, and the median age for diagnosis of CIN is 29 years. The median age for diagnosis of invasive cervical cancer is in the late 40s.