Prevention and Early Diagnosis of Lower Anogenital Tract Cancer

Objectives

Lower anogenital tract cancer, comprising vulvar, vaginal, and anal cancers, is the least common of the gynecologic cancers. These types of cancers are all linked to HPV: HPV DNA was detected in 69% of vulvar cancers, 75% of vaginal cancers, and 93% of female anal cancers.¹ HPV vaccination, especially if completed before one’s first instance of sexual intercourse, is extremely effective against lower anogenital tract cancer precursors.^2,3,4,5

There is no simple and reliable way to screen for lower anogenital tract cancer, so it is especially important that health care practitioners help their patients recognize and discuss risk factors and warning signs.

ACOG is pleased to offer the free online course Prevention and Early Diagnosis of Lower Anogenital Tract Cancer, which summarizes the relevant literature and existing recommendations to guide clinicians in the equitable prevention, early diagnosis, and special considerations of lower anogenital tract cancer. The learning objectives are to identify risk factors for lower anogenital tract cancer, summarize key health disparities in lower anogenital tract cancer, and identify effective methods for risk modification and early diagnosis of lower anogenital tract cancer.

Developed through a partnership with the Centers for Disease Control and Prevention, this course is available to women’s health care practitioners including obstetrician–gynecologists, nurses, nurse practitioners, physician assistants, family physicians, medical students and residents, and allied health professionals.

Credits

ACCME Accreditation

The American College of Obstetricians and Gynecologists is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA PRA Category 1 Credit(s)™

The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 7 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

College Cognate Credit(s)

The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 7 Category 1 College Cognate Credits. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credits™ to be equivalent to College Cognate Credits.

American Nurses Credentialing Center's Commission on Accreditation

This nursing continuing professional development activity was approved by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. The last date learners will be able to access this activity to receive contact hours is June 1, 2025.

Evaluation Survey

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Conflict of Interest Disclosure 

FACULTY AND PLANNER DISCLOSURE

This project was supported by the Centers for Disease Control and Prevention of the Department of Health and Human Services under cooperative agreement number 7 NU38OT000330-01-00, which was awarded to ACOG. All authors received a one-time payment from ACOG for their participation in the development of lower anogenital tract cancer educational materials.

All authors, contributors, reviewers, and staff have submitted a conflict of interest disclosure statement, and any potential conflicts have been considered and managed in accordance with ACOG’s Conflict of Interest Disclosure Policy. This policy, along with ACOG’s Privacy Policy, can be found on acog.org.

All authors received a one-time payment from ACOG for their participation in the development of lower anogenital tract cancer educational materials.

All relevant financial relationships have been mitigated. Conflict of interest disclosure for faculty, planning committee, reviewers, and staff:

• David Chelmow is the immediate past president of ASCCP and the Council of University Chairs of Obstetrics and Gynecology, receives a stipend as the editor-in-chief of the Medscape Obstetrics and Gynecology Clinical Reference Book, and was on the American Board of Obstetrics and Gynecology Board of Directors during the evidence review period. David Chelmow is a member of the U.S. Preventive Services Task Force (USPSTF). This course does not necessarily represent the views and policies of the USPSTF.
• Joshua Kesterson receives financial compensation as a member of a speakers’ bureau for: Genmab/Seagen; Baxter; and GSK. In 2022, Dr. Kesterson received compensation for his participation in the LYNPARZA Ovarian Cancer East Gynecologic Oncologist Advisory Board and the Clovis Oncology ATHENA-MONO Commercial Advisory Board. These activities were unrelated to the content of this manuscript. Additionally, Dr. Kesterson previously received bi-annual compensation for authoring a chapter for UpToDate on "Fertility Preservation in Patients with Endometrial Cancer."
• Margaret Long helped validate an anal HPV test that is commercially available via Mayo Clinic Laboratories; she was not compensated for this test, but all proceeds of testing go to the Mayo Clinic Foundation, which pays Dr. Long’s salary.

All other faculty, planning committee members, reviewers, and staff have no conflict of interest to disclose relative to the content of the presentation.

References

1. Saraiya M, Unger ER, Thompson TD, Lynch CF, Hernandez BY, Lyu CW, Steinau M, Watson M, Wilkinson EJ, Hopenhayn C, Copeland G, Cozen W, Peters ES, Huang Y, Saber MS, Altekruse S, Goodman MT; HPV Typing of Cancers Workgroup. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. Journal of the National Cancer Institute 2015;107:djv086. doi: 10.1093/jnci/djv086
2. Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 2007;356(19):1928–1943. doi: 10.1056/NEJMoa061760
3. Joura EA, Giuliano AR, Iversen OE, Bouchard C, Mao C, Mehlsen J, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med 2015;372(8):711–723. doi: 10.1056/NEJMoa1405044
4. Goldstone SE, Giuliano AR, Palefsky JM, Lazcano-Ponce E, Penny ME, Cabello RE, et al. Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 trial. Lancet Infect Dis 2022;22(3):413–425. doi: 10.1016/S1473-3099(21)00327-3
5. Kurosawa M, Sekine M, Yamaguchi M, Kudo R, Hanley S, Hara M, et al. Long-term effects of human papillomavirus vaccination in clinical trials and real-world data: a systematic review. Vaccines 2022;10(2):256. doi: 10.3390/vaccines10020256