A 29-year-old nulliparous woman with HIV comes to the office for her first gynecological examination. The patient acquired HIV from her mother at birth and has been noncompliant with health maintenance visits. Menarche was at age 10, cycles occur every 28 days, and her last menstrual period was 2 weeks ago. The patient has 1 lifetime male partner with whom she has been sexually active for 7 years; they use condoms consistently. Her mother had cervical cancer at age 46 and died of AIDS-related complications at age 48. The patient drinks 3-4 cans of beer each night and does not use tobacco or illicit drugs. Papanicolaou test reveals high-grade cervical dysplasia. Which of the following is the strongest risk factor for cervical dysplasia in this patient?

Question

A 29-year-old nulliparous woman with HIV comes to the office for her first gynecological examination.  The patient acquired HIV from her mother at birth and has been noncompliant with health maintenance visits.  Menarche was at age 10, cycles occur every 28 days, and her last menstrual period was 2 weeks ago.  The patient has 1 lifetime male partner with whom she has been sexually active for 7 years; they use condoms consistently.  Her mother had cervical cancer at age 46 and died of AIDS-related complications at age 48.  The patient drinks 3-4 cans of beer each night and does not use tobacco or illicit drugs.  Papanicolaou test reveals high-grade cervical dysplasia.  Which of the following is the strongest risk factor for cervical dysplasia in this patient?

Quizplus · Accepted Answer

11ec160b_391c_4d40_9249_c5e89844c588_MD0001_00 The strongest risk factor for cervical dysplasia (also known as cervical intraepithelial neoplasia) and carcinoma is infection with human papillomavirus (HPV) type 16 or 18. HPV is transmitted primarily through sexual intercourse but can also be spread via skin-to-skin contact. Most invasive cervical cancer specimens and high-grade cervical lesions contain HPV DNA. Other risk factors for cervical dysplasia are listed in the table above. Cervical cancer is rare in young immunocompetent women as their immune systems can normally combat HPV infection. Approximately 50% of patients with untreated high-grade dysplasia will experience spontaneous regression, whereas only 5% will develop invasive cancer. However, individuals with HIV are unable to mount an immune response against HPV due to immunosuppression from T cell deficiency. Therefore, patients with HIV infection commonly have persistent HPV infection, which allows HPV DNA to become incorporated into the epithelial cells. HIV coinfection may also enhance expression of HPV viral oncogenes E6 and E7, leading to cervical dysplasia/cancer. Therefore, patients with HIV require frequent Papanicolaou screening for cervical dysplasia/cancer. (Choice A) Women who have intercourse before age 18 have twice the risk of cervical cancer compared to women who have initial intercourse after age 21. (Choice B) Alcohol consumption increases the risk of breast cancer but is not associated with cervical cancer. However, tobacco use is a significant risk factor for cervical cancer. (Choice C) Age at menarche does not affect cervical cancer risk. However, women with menarche before age 12 are at increased risk for breast and endometrial cancers. (Choice D) Family history of cervical cancer is not a risk factor for cervical dysplasia/cancer. There is no genetic component to cervical dysplasia/cancer as the majority of cervical dysplasias and cancers are caused by HPV, and HPV is a predominantly sexually transmitted infection. (Choice F) Parity does not affect cervical cancer risk. Anovulatory cycles in nulliparous women increase the risk of endometrial cancer. Educational objective: Human papillomavirus (HPV) infection, especially with strain 16 or 18, is the strongest risk factor for development of cervical dysplasia and invasive cervical carcinoma. HIV coinfection allows HPV infection to persist and enhances expression of HPV oncogenes, increasing the risk for cervical dysplasia/cancer. __________ References: Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. (http://www.ncbi.nlm.nih.gov/pubmed/19104355) ACOG Practice Bulletin No. 131: screening for cervical cancer. (http://www.ncbi.nlm.nih.gov/pubmed/23090560)

A 29-Year-Old Nulliparous Woman with HIV Comes to the Office