A pilot study of a collaborative screening program for HPV-related dysplasia and malignancy in gynecologic oncology patients (376)

Abstract

<b>Objectives:</b> Human papillomavirus (HPV)-related dysplasia or malignancy is associated with a significantly increased risk of second site dysplasia or malignancy. However, screening for additional potential sites of HPV-related pathology is not routinely performed. The primary objective of this study was to determine the feasibility and acceptability of concurrent anal, cervical, or vulvovaginal screening in patients with a history of HPV-related gynecologic high-grade dysplasia or malignancy. The secondary objective was to assess patient knowledge regarding HPV screening and risks. <b>Methods:</b> Women with a diagnosis of cervical high-grade dysplasia or cancer and vulvovaginal high-grade dysplasia or cancer were enrolled during a one-year pilot period. Clinical data on all enrolled subjects were obtained using electronic medical records. All enrolled subjects completed a baseline HPV-knowledge survey. Subjects with cervical dysplasia or malignancy underwent vulvar examination with acetic acid and anoscopy. Subjects with vulvovaginal dysplasia or malignancy underwent a Pap test if indicated and anoscopy. Gynecologic oncologists were trained in anoscopy by colorectal surgery colleagues. Appropriate referrals were made for abnormal findings on screening exams. Feasibility was assessed by compliance using study acceptance rate, screening procedure adherence, and referral adherence. Acceptability was assessed using an acceptability Likert scale completed by subjects after screening procedures were performed. Descriptive statistics were used to assess the data. <b>Results:</b> A total of 103 women with a diagnosis of high-grade vulvovaginal or cervical dysplasia or carcinoma were approached regarding study enrollment; of these, 74 (71.8%) enrolled. Thirty-three (44.5%) had a primary diagnosis of cervical dysplasia or malignancy, and 43 (58.1%) had a primary diagnosis of vulvovaginal dysplasia or malignancy. About 50/74 (68%) were White, and 17/74 (23%) were Black. The median score on the HPV knowledge assessment was 8.1 ± 1.6 (max score of 10). Fifty-two patients (69%) reported that their provider discussed a possible diagnosis of HPV with them; 56 patients (75%) believed that HPV caused ovarian cancer. All enrolled subjects completed screening procedures, and 73/74 (98.6%) patients rated the procedure as acceptable (score of 5/5). On exam, 14 (18.9%) subjects had abnormalities noted; seven (9.5%) were referred for colorectal surgical evaluation, and 6/7 (85.7%) were compliant with their referral appointments. <b>Conclusions:</b> Screening exams for other HPV-related dysplasias and malignancies, including Pap tests, vulvovaginal inspection, and anos- copy, can be performed by gynecologic oncologists and are acceptable to patients with abnormal findings in almost one in five women. Improvements in communication and patient education regarding HPV should be the focus of future research efforts.