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CERVICAL CARCINOMA
The Role of the Human Papilloma
 Virus and Prospects for Primary
           Prevention

               ...
MAGNITUDE OF THE PROBLEM
carcinoma (ca) of the cervix is the 2nd
commonest female cancer in the world
it is the commonest ...
OBJECTIVES
Literature review
  on aetiology of ca cervix.
  available methods for low resource settings
Identify possible ...
METHODOLOGY
ELECTRONIC SEARCH
Pubmed
Medline
Cochrane library
WHO and collaborative institutions -PATH
unpublished literat...
AETIOLOGY OF CA CERVIX
RISK FACTORS
 early onset of sexual intercourse
 multiple sexual partners
 male partner’s behaviour...
AETIOLOGY OF CERVICAL
       CARCINOMA
Risk factors point to an infectious process
In the 1970s and early ’80s – ?CMV and
...
HPV
Small double-stranded DNA virus with
protein capsid.
About 120 types of HPV described.
Circular viral genome - divided...
MODE of TRANSMISSION
Sexually transmitted ( ~75% sexually
active women infected).
Genital tract micro-trauma enhance viral...
CERVICAL CHANGES
Mutation may occur in the cervical cell
  →pre-cancer → cancer.
Precancerous changes identifiable through...
SCREENING TESTS
PAP SMEAR
Cervical specimen taken with spatula / brush and
smeared on glass slide for examination.
Sensiti...
SCREENING TESTS
Pap smear very expensive for low income
countries
Highly qualified personnel needed for
reading of slides ...
SCREENING TESTS
VISUAL INSPECTION WITH ACETIC ACID
  (VIA).
  New method under investigation.
  Sensitivity and specificit...
SCREENING TESTS
OTHER SCREENING METHODS
visual inspection with magnification
(VIAM)
Cervicography
fluorescent spectroscopy...
VACCINATION
Very attractive idea (compare hepatitis B and ca
liver)
Viral capsid proteins useful - highly immunogenic
henc...
CONCLUSION
HPV causes ca cervix
Screening with pap smear expensive
HPV DNA testing also expensive
Hope for developing coun...
THANK YOU
Geneva Foundation For Medical
Education And Research
WHO
UNDP/UNFPA/World Bank
Dept of Health, Canton of Geneva
...
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CERVICAL CARCINOMA The Role of the Human Papilloma Virus and Prospects for Primary Prevention

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CERVICAL CARCINOMA The Role of the Human Papilloma Virus and Prospects for Primary Prevention

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Transcript of "CERVICAL CARCINOMA The Role of the Human Papilloma Virus and Prospects for Primary Prevention"

  1. 1. CERVICAL CARCINOMA The Role of the Human Papilloma Virus and Prospects for Primary Prevention By Dr. R. A. KWAME-ARYEE (University of Ghana Medical school) And DR. PIERRE VASSILAKOS GENEVA UNIVERSITY 1
  2. 2. MAGNITUDE OF THE PROBLEM carcinoma (ca) of the cervix is the 2nd commonest female cancer in the world it is the commonest cancer in developing countries 500,000 new cases annually 75-80% in developing countries about 300,000 deaths annually 80% are from developing countries. screening in developed countries has reduced cervical cancer death by 70% 2
  3. 3. OBJECTIVES Literature review on aetiology of ca cervix. available methods for low resource settings Identify possible preventive measures to reduce the risk of ca cervix 3
  4. 4. METHODOLOGY ELECTRONIC SEARCH Pubmed Medline Cochrane library WHO and collaborative institutions -PATH unpublished literature 4
  5. 5. AETIOLOGY OF CA CERVIX RISK FACTORS early onset of sexual intercourse multiple sexual partners male partner’s behaviour + ca penis history of ca cervix in close relatives cigarette smoking combined oral contraceptive pill reduced immunity 5
  6. 6. AETIOLOGY OF CERVICAL CARCINOMA Risk factors point to an infectious process In the 1970s and early ’80s – ?CMV and Herpes Simplex type 2 Positive association between HPV and ca cervix - HPV 16 identified in 1983 About 99.7% of Ca cervix associated with HPV infection Main oncogenic strains are: types 16 and 18 Other types: 31, 33, 51, 53, 35 etc. 6
  7. 7. HPV Small double-stranded DNA virus with protein capsid. About 120 types of HPV described. Circular viral genome - divided into 3 regions. Upstream Regulatory Region Early Region - E1, E2, E3, E4, E5, E6, E7 Late Region - L1, L2 E6 & E7 responsible for oncogenic properties of HPV 7
  8. 8. MODE of TRANSMISSION Sexually transmitted ( ~75% sexually active women infected). Genital tract micro-trauma enhance viral entry into host cells. Virus may live transiently in cervix or may persist according to host factors. Persistent infection → cervical changes E6 & E7 proteins block natural control of growth of cervical cells. Integration of viral genome → host cell DNA 8
  9. 9. CERVICAL CHANGES Mutation may occur in the cervical cell →pre-cancer → cancer. Precancerous changes identifiable through exfoliative cytology Papanicolaou and Straut (1943) = Initiation of pap smear test Screening with the pap smear has been used in developed countries for 50 years. Low resource countries cannot afford Pap smear but carry most of disease burden. 9
  10. 10. SCREENING TESTS PAP SMEAR Cervical specimen taken with spatula / brush and smeared on glass slide for examination. Sensitivity - 51% Specificity - 98% High false negative rate Liquid-based thin prep available now → better results Computerised system now available To improve on cervical precancer detection HPV DNA tests (PCR / Hybrid Capture II) 10
  11. 11. SCREENING TESTS Pap smear very expensive for low income countries Highly qualified personnel needed for reading of slides and managing problems with colposcopy etc Effective infrastructure required Need for technique that is easily applied, affordable, accessible, and user friendly 11
  12. 12. SCREENING TESTS VISUAL INSPECTION WITH ACETIC ACID (VIA). New method under investigation. Sensitivity and specificity : 76% / 64% Simplicity of use enables wide clinical application Treatment for low grade lesions can be done at same visit (cryotherapy) Higher grade lesions or cancer referred to hospital 12
  13. 13. SCREENING TESTS OTHER SCREENING METHODS visual inspection with magnification (VIAM) Cervicography fluorescent spectroscopy infra-red spectroscopy polar probe 13
  14. 14. VACCINATION Very attractive idea (compare hepatitis B and ca liver) Viral capsid proteins useful - highly immunogenic hence prospects for vaccine. 1991 - virus-like particles developed with L1 Immunity is type-specific hence may be difficult to develop poly-valent vaccine to prevent all oncogenic types of HPV. About 20 different vaccines currently under development WHO trials 14
  15. 15. CONCLUSION HPV causes ca cervix Screening with pap smear expensive HPV DNA testing also expensive Hope for developing countries = VIA VIA shown to be cost effective. Practising of safe sexual behaviour 15
  16. 16. THANK YOU Geneva Foundation For Medical Education And Research WHO UNDP/UNFPA/World Bank Dept of Health, Canton of Geneva Geneva University Geneva Medical Association IAMANEH 16
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