Papillomavirus Infections

Uterine Cervical Dysplasia

Precancerous Conditions

PMID (1):

41837977

MeSH

Adenocarcinoma in Situ

Squamous Intraepithelial Lesions

Uterine Cervical Dysplasia

Precancerous Conditions

Expert guidance on follow-up of patients with precancerous cervical lesions. James W. Mold, MD, MPH

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Each year in the US, an estimated 200 000 patients1 receive a diagnosis of precancerous cervical lesions caused by human papillomavirus (HPV), the most common of which are cervical intraepithelial neoplasia (CIN) grades 2 (CIN2) and 3 (CIN3), also known as high-grade squamous intraepithelial lesion. Most patients undergo treatment with an excisional procedure (loop excision, cold knife cone biopsy), and some undergo an ablative procedure (cryotherapy, laser, thermal ablation). Because treatments have a 5% to 10% risk of failure (defined as residual high-grade squamous intraepithelial lesion) and about 0.5% of patients receive a diagnosis of cancer during the immediate posttreatment period (2.5 years after treatment), close monitoring after treatment is a critical step in further decreasing cervical cancer morbidity and mortality; such monitoring commonly falls within the purview of primary care clinicians. Unfortunately, only half of patients undergo the posttreatment monitoring recommended by guidelines.

This Clinical Insights article is designed to provide primary care clinicians with a comprehensive overview of monitoring patients after treatment of precancerous cervical lesions, much of which may take place outside of the obstetrics and gynecology setting. We focus on posttreatment monitoring of CIN2 and CIN3, not precancerous lesions of endocervical cells (adenocarcinoma in situ). Our article summarizes guidance provided to frontline clinicians by the American Society for Colposcopy and Cervical Pathology through a comprehensive publication, a free online calculator, and a fee-based application.

Author/s:

George F Sawaya, Bennett Lareau, Robyn Lamar

Vulvar cancer

Megan George — Fri, 27 Feb 2026 02:24:14 +0000

Date Added:

February 26, 2026

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

February 23, 2026

URL:

Vulvar cancer

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.250797

Keywords

Vulvar cancer

Uterine Cervical Neoplasms

human papillomavirus

PMID (1):

41730538

MeSH

Vulvar cancer

Cervix Uteri

uterine cervical neoplasms

Lichen Sclerosus et Atrophicus

A concise list of important things to know about vulvar cancer. James W. Mold, MD, MPH

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Vulvar cancer is an underrecognized gynecologic malignant disease. The incidence of vulvar cancer is 2.3 per 100 000 people in Canada, and is increasing with the rising prevalence of human papillomavirus (HPV). More than 90% of vulvar cancers are squamous cell carcinomas (SCC), mostly diagnosed after age 65 years. Vulvar SCC mimics nonspecific inflammation, which often delays diagnosis. Risk factors include advanced age, HPV infection, lichen sclerosis, smoking, immunodeficiency, and pelvic radiation

Author/s:

Jennifer Davis, Jacob McGee, Anjali Kulkarni

Human Papillomavirus and Cancer

Megan George — Thu, 21 Aug 2025 16:13:34 +0000

Date Added:

August 21, 2025

Journal/Publication:

The New England Journal of Medicine

Publication Date:

July 30, 2025

Issue:

Volume:

393

URL:

Human Papillomavirus and Cancer

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Video

DOI (1):

10.1056/NEJMp2414535

Keywords

Uterine Cervical Neoplasms

MeSH

uterine cervical neoplasms

Clinical Validation of a Vaginal Cervical Cancer Screening Self-Collection Method for At-Home Use: A Nonrandomized Clinical Trial

This is a 13 ½ minute audio-review of the link between HPV and various cancers and current recommendations regarding HPV immunization. James W. Mold, MD, MPH

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In this Double Take video from the New England Journal of Medicine, Dr. Julie Barzilay discusses the connection between certain strains of human papillomavirus (HPV) and cancer, as well as the evidence to support the safety and efficacy of the HPV vaccine in reducing the risk of cervical neoplasia. Strategies for discussing the HPV vaccine with patients and families are also reviewed.

Author/s:

Julie R. Barzilay, Sarah Feldman, Alison E. Burke, Emily Ling, Scott Williams, Caren G. Solomon

Clinical Validation of a Vaginal Cervical Cancer Screening Self-Collection Method for At-Home Use: A Nonrandomized Clinical Trial

Alex Haga — Tue, 27 May 2025 13:21:18 +0000

Date Added:

May 27, 2025

Journal/Publication:

JAMA

Publication Date:

May 1, 2025

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2025.11081

Keywords

Vaginal Cervical Cancer

Self-Collection

At-Home

screening

PMID (1):

40388167

MeSH

Early Detection of Cancer* / methods

Mass Screening* / methods

Uterine Cervical Neoplasms* / diagnosis

An in-home, patient administered screening test for cervical cancer was highly accurate when compared with usual in-office testing. James W. Mold, MD, MPH

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Importance: One-quarter of US women who are at risk for cervical cancer delay screening. Self-collected (SC) cervical screening was recently US Food and Drug Administration (FDA)-approved in the US for use in a health care setting only; an at-home SC option is crucial to address clinic-related barriers to screening.

Objective: To clinically validate the use of an SC device that was designed for optimal at-home performance, safety, ease-of-use, and dry storage and transport.

Design, setting, and participants: This nonrandomized clinical trial used a prospective method comparison study design. Participants aged 25 to 65 years were recruited from 16 clinical sites in the US including community and academic practices from November 20, 2023, to April 5, 2024. Data analysis was conducted from April to August 2024.

Intervention: Eligible participants collected a sample with the SC method, followed by a clinician-collected (CC) sample. The SC sample was eluted into PreservCyt at the laboratory and both samples were tested on an FDA-approved high risk human papillomavirus (hrHPV) test approved for primary screening. Participants were followed up for safety and completed usability and screening preference surveys.

Main outcome and measures: The primary outcome measures were positive percentage agreement (PPA) and negative percentage agreement for detection of hrHPV between the SC and CC samples. Other study measures included clinical sensitivity for high grade cervical dysplasia and usability.

Results: Of 609 screening-eligible participants, 599 (262 aged 30-39 years [43.7%]; 583 identified as female [97.3%]) had paired SC-CC samples, of which 582 had valid paired samples included in the end point analysis. Among the 582 evaluable paired samples, the PPA between SC compared with paired CC samples for detection of hrHPV was 95.2% (95% CI, 92.1%-97.1%; 278 of 292 participants). The absolute clinical sensitivity for detection of high-grade cervical dysplasia was 95.8% (95% CI, 86.0%-98.8%; 46 of 48 participants), equivalent to the CC (relative sensitivity, 1.00). Nearly all participants (555 of 601 participants [92.3%]) reported that the device instructions were easy or very easy to understand and also that they would choose SC if they knew the results were comparable to CC results (560 of 602 participants [93.0%]).

Conclusions and relevance: In this nonrandomized clinical trial, SC samples collected with the device showed equivalent clinical sensitivity and exceeded the PPA end point for cervical screening. This SC method was found to be easy to use and to be a preferred option with high clinical performance intended for use in an at-home setting.

Author/s:

Megan B Fitzpatrick, Catherine M Behrens, Karl Hibler, Courtney Parsons

Cervical cancer screening guideline for individuals at average risk

Bethie Seay — Sun, 14 Nov 2021 06:00:00 +0000

Date Added:

November 14, 2021

Journal/Publication:

JAMA

Publication Date:

November 12, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1001/jama.2021.13448

MeSH

female

Adult

aged

uterine cervical neoplasms

early detection of cancer

Human Papillomavirus Immunization in Rural Primary Care

American Cancer Society

The American Cancer Society’s most recent recommendations regarding cervical cancer screening.

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Major recommendations

Begin screening at age 25 years regardless of sexual history or HPV vaccination status (strong recommendation)

Primary HPV testing every 5 years through age 65 years (strong recommendation)

If primary HPV testing is not available use cotesting (HPV+ cytology) every 5 years or every 3 years if cytology only (strong recommendation)

Discontinue screening at age 65 years if no history of cervical intraepithelial neoplasia grade 2 or more severe diagnosis in last 25 years and adequate negative prior screening in last 10 years (qualified recommendation)

Author/s:

Chor, J., Davis, A. M., Rusiecki, J. M.

Human Papillomavirus Immunization in Rural Primary Care

Brian Desmarais — Thu, 20 Aug 2020 14:11:00 +0000

Date Added:

August 20, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publication Date:

June 27, 2020

Issue:

Volume:

Pages:

377-385

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2020.03.018

MeSH

Papillomaviridae

Immunization Programs

Parents

Surveys and Questionnaires

primary health care

An OKPRN-like study of high performing practices on HPV immunization. James W. Mold, MD, MPH

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Abstract

Introduction: Despite the safety and efficacy of the human papillomavirus vaccine, thousands are impacted by human papillomavirus and its related cancers. Rural regions have disproportionately low rates of human papillomavirus vaccination. Primary care clinics play an important role in delivering the human papillomavirus vaccine. A positive deviance approach is used to identify workflows, organizational factors, and communication strategies in rural clinics with higher human papillomavirus vaccine up-to-date rates. Positive deviance is a process by which exceptional behaviors and strategies are identified to understand factors that enable success.

Methods: Rural primary care clinics were rank ordered by human papillomavirus vaccine up-to-date rates using 2018 Oregon Immunization Program data, then recruited via purposive sampling of clinics in the top and bottom quartiles. Two study team members conducted previsit interviews, intake surveys, and 2-day observation visits with 12 clinics and prepared detailed field notes. Data were collected October-December 2018 and analyzed using a thematic approach January-April 2019.

Results: Four themes distinguished rural clinics with higher human papillomavirus vaccine up-to-date rates from those with lower rates. First, they implemented standardized workflows to identify patients due for the vaccine and had vaccine administration protocols. Second, they designated and supported a vaccine champion. Third, clinical staff in higher performing sites were comfortable providing immunizations regardless of visit type. Finally, they used clear, persuasive language to recommend or educate parents and patients about the vaccine's importance.

Conclusions: Positive deviance identified characteristics associated with higher human papillomavirus vaccine up-to-date rates in rural primary care clinics. These findings provide guidance for rural clinics to inform human papillomavirus vaccination quality improvement interventions.

Author/s:

Ferrara, Laura, K., Gunn, Rose, Dickinson, Caitlin, Stock, Isabel, Griffith-Weprin, Jennifer, Wiser, Amy, Hatch, Brigit, Fagnan, L.J., Carney, P.A., Davis, M.M.

Human Papillomavirus Immunization in Rural Primary Care

Brian Desmarais — Mon, 29 Jun 2020 17:01:39 +0000

Date Added:

June 29, 2020

Journal/Publication:

American Journal of Preventive Medicine

URL:

Human Papillomavirus Immunization in Rural Primary Care

Type:

Best Local Practices

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amepre.2020.03.018

Keywords

MeSH

Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices

The results might be helpful to practices trying to increase HPV immunization rates. James W. Mold, MD, MPH

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Not available.

Author/s:

Gunn, R., Ferrara, L.K., Dickinson, C., Fagnan, L.J., Carney, P.A., Davis, M.M.

Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices

Brian Desmarais — Tue, 14 Jan 2020 15:17:31 +0000

Date Added:

January 14, 2020

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

U.S. Department of Health and Human Services

Publication Date:

August 16, 2019

URL:

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

http://dx.doi.org/10.15585/mmwr.mm6832a3

MeSH

Centers for Disease Control and Prevention, U.S.

Data Collection

Papillomaviridae

clinical decision-making

public health

Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices

Middle Aged

child

United States

HPV vaccination appears to be both safe and effective in adults 27-45 years of age. While the public health impact of routine HPV vaccination of adults would be small, some high-risk individuals could benefit significantly. James W. Mold, MD, MPH

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Summary

What is already known about this topic?

Vaccination against human papillomavirus (HPV) is routinely recommended at age 11 or 12 years. Catch-up recommendations apply to persons not vaccinated at age 11 or 12 years.

What is added by this report?

After reviewing new evidence, CDC updated HPV vaccination recommendations for U.S. adults.

What are the implications for public health practice?

Routine recommendations for HPV vaccination of adolescents have not changed. Catch-up HPV vaccination is now recommended for all persons through age 26 years. For adults aged 27 through 45 years, public health benefit of HPV vaccination in this age range is minimal; shared clinical decision-making is recommended because some persons who are not adequately vaccinated might benefit.

Author/s:

Meites, E., Szilagyi, P., Chesson, H.W., Unger, E.R., Romero, J.R., Markowitz, L.E.

Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices

Brian Desmarais — Mon, 19 Aug 2019 12:55:58 +0000

Date Added:

August 19, 2019

Journal/Publication:

Morbidity and Mortality Weekly Report

Publication Date:

August 16, 2019

Issue:

Volume:

Pages:

698-702

URL:

Type:

Public Health Announcements

Format:

Article

DOI (1):

10.15585/mmwr.mm6832a3

Keywords

MeSH

clinical decision-making

Advisory Committees

Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis

Updated recommendations on HPV vaccination from the CDC. You can skip down to the “recommendations” section. James W. Mold, MD, MPH

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Vaccination against human papillomavirus (HPV) is recommended to prevent new HPV infections and HPV-associated diseases, including some cancers. The Advisory Committee on Immunization Practices (ACIP)* routinely recommends HPV vaccination at age 11 or 12 years; vaccination can be given starting at age 9 years. Catch-up vaccination has been recommended since 2006 for females through age 26 years, and since 2011 for males through age 21 years and certain special populations through age 26 years. This report updates ACIP catch-up HPV vaccination recommendations and guidance published in 2014, 2015, and 2016 (1-3). Routine recommendations for vaccination of adolescents have not changed. In June 2019, ACIP recommended catch-up HPV vaccination for all persons through age 26 years. ACIP did not recommend catch-up vaccination for all adults aged 27 through 45 years, but recognized that some persons who are not adequately vaccinated might be at risk for new HPV infection and might benefit from vaccination in this age range; therefore, ACIP recommended shared clinical decision-making regarding potential HPV vaccination for these persons.

Author/s:

Meites, E, Szilagyi, P.G., Chesson, H.W., Unger, E.R., Romero, J.R., Markowitz, L.E.

Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis

John Bayhi — Fri, 09 Aug 2019 19:52:40 +0000

Date Added:

August 9, 2019

Journal/Publication:

Lancet

Publisher:

Elsevier Ltd

Publication Date:

June 26, 2019

Issue:

10197

Volume:

394

Pages:

497-509

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(19)30298-3

Keywords

human papillomavirus

hpv vaccine

PMID (1):

31255301

MeSH