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Preventing the preventable
cancer
Zero Cervical Cancer in
RAK / UAE by 2020
Fact is ……. While it is possible for a
Global Burden of Cervical Cancer
Courtesy Dr Jalaa Taher, HAAD
Cytology based screening for
Cervical Cancer
Limitations of cytology
Reproducibility of Cervical cytology
after reviewing 5000 slides
Cytology Screen categories
Bethesda Scoring
Management of women with LSIL
Draw backs of cytology screening
(Roche submission to US FDA March 2014)
Harald zur Hausen 1984 isolated HPV 16
from Cx tissue
Awarded Nobel Prize 2008
Relative sensitivities of cytology &
HPV testing
Co Testing
Genotypes separately &
simultaneously reported by
Star Metropolis Clinical Lab
Primary HR HPV Screening with
reflux cytology
Courtesy Dr Jalaa Taher, HAAD
Courtesy Dr Jalaa Taher, HAAD
Courtesy Dr Jalaa Taher, HAAD
UAE study
Age distribution
n = 314
2
33
84
63
48 46
21 18
0
10
20
30
40
50
60
70
80
90
< 20 21 - 25 26 - 30 31 - 35 36 - 4...
HPV Genotypes in UAE
n = 126
8 LR genotypes 14 HR genotypes
Genotype distribution in different
age groups (n = 126)
Age group Genotypes
< 20 [39, 59]
21 - 25 [6, 6, 11,51] [16, 51,61...
HPV genotypes in UAE
0
2
4
6
8
10
12
14
16
genotype6L
g11L
g16H
g18H
g31H
g33H
g35H
g39H
g42L
g43L
g44L
g51H
g52H
g53H
g54...
HPV Genome
• E1-E7 = “Early” genes
(nonstructural)
• L1, L2 = Capsid genes
• URR = upstream regulatory
region
• E6 & E7 pr...
Why Cervical Cancer is preventable ?
Natural History of HPV infection
HPV-containing double
stranded DNA
‘Empty’ non-infectious
virus-like particle (VLP)
mimics the virus
Virus-like particles ...
Vaccines
• Gardasil (2006) :
– Contains HPV 16, 18, 6, 11
• Cerverix (2009): Contains HPV 16, 18
– Females 10 through 25
–...
Two Opportunities to prevent Cx Ca
Normal
cervix
HPV
infection
Cervical
Intraepitheili
al neoplasia
CIN
Cervical
Cancer
HP...
Collection of Cx Swab
Cervical Cancer is entirely preventable
1.Vaccination before exposure
2.Screening after 30 yrs (every 5 yrs)
Though STI,
i...
Please Join, Support & Promote
Scientists have the tools, but cannot do it alone
Thank you for your attention
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
Preventing the preventable cancer
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Preventing the preventable cancer

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HPV is the cause of cervical cancer. There is a long lag between infection and development of cancer. There are two major opportunities to prevent this entirely preventable cancer.

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  • Munoz et al. Vaccine 24S3 (2006) S3/1-S3/10
  • Cervarix®, the candidate cervical cancer vaccine is composed of DNA-free virus-like particles of the capsid protein L1.1 Virus-like particles of L1 alone have been shown to be similar in both structure and immunogenicity to authentic papilloma virions and to be strong inducers of neutralizing antibody responses.1–3
    References
    1. Giannini S, et al. Vaccine 2006; 24:5937–5949.
    2. Christensen N, et al. J Gen Virol 1994; 75:2271–2276.
    3. Rose R, et al. J Gen Virol 1994; 75:2075–2079.
  • Transcript of "Preventing the preventable cancer"

    1. 1. Preventing the preventable cancer Zero Cervical Cancer in RAK / UAE by 2020
    2. 2. Fact is ……. While it is possible for a
    3. 3. Global Burden of Cervical Cancer
    4. 4. Courtesy Dr Jalaa Taher, HAAD
    5. 5. Cytology based screening for Cervical Cancer
    6. 6. Limitations of cytology
    7. 7. Reproducibility of Cervical cytology after reviewing 5000 slides
    8. 8. Cytology Screen categories Bethesda Scoring
    9. 9. Management of women with LSIL
    10. 10. Draw backs of cytology screening (Roche submission to US FDA March 2014)
    11. 11. Harald zur Hausen 1984 isolated HPV 16 from Cx tissue Awarded Nobel Prize 2008
    12. 12. Relative sensitivities of cytology & HPV testing
    13. 13. Co Testing
    14. 14. Genotypes separately & simultaneously reported by Star Metropolis Clinical Lab
    15. 15. Primary HR HPV Screening with reflux cytology
    16. 16. Courtesy Dr Jalaa Taher, HAAD
    17. 17. Courtesy Dr Jalaa Taher, HAAD
    18. 18. Courtesy Dr Jalaa Taher, HAAD
    19. 19. UAE study Age distribution n = 314 2 33 84 63 48 46 21 18 0 10 20 30 40 50 60 70 80 90 < 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 > 51 number number
    20. 20. HPV Genotypes in UAE n = 126 8 LR genotypes 14 HR genotypes
    21. 21. Genotype distribution in different age groups (n = 126) Age group Genotypes < 20 [39, 59] 21 - 25 [6, 6, 11,51] [16, 51,61,66] [53] [11,18,31,39,58][42] 53, 66, 66, [66,59,52], [52,73], 31, [66,35,54,6] 26 - 30 [16] [42,43,51,66] [6] [16,39.52,61,68] [6,39,61,68,73] [56,42,43], 33, [35,53], [52,70], 42, 16, 6, [51,39,42,6] 31 - 35 [52] [43,58,59,66] [11,16,42,43,53,61,61] [16,73,82] [6,52] 66, 51, [58,16], [33,6], 44 36 - 40 [16,70] [6] 54, [59,31,42,11], [18,54], 18 41 - 45 [42,51,68] [42,53,59] [42,59] [16,16,18,52] [53,53,68,70] 53,58,51 46 - 50 [16] [6, 42], 33 > 51 [16], 53, [33,82], 33, 53, [51,33,35,42,6]
    22. 22. HPV genotypes in UAE 0 2 4 6 8 10 12 14 16 genotype6L g11L g16H g18H g31H g33H g35H g39H g42L g43L g44L g51H g52H g53H g54L g56H g58H g59H g61L g66H g68H g70L g73H g82H 14 HR genotypes : 80 8 LR : 46
    23. 23. HPV Genome • E1-E7 = “Early” genes (nonstructural) • L1, L2 = Capsid genes • URR = upstream regulatory region • E6 & E7 proteins play major role in immortality & malignant transformation of infected cells • E5 has role, but not required to maintain cancer phenotype Munoz et al. 2006.
    24. 24. Why Cervical Cancer is preventable ? Natural History of HPV infection
    25. 25. HPV-containing double stranded DNA ‘Empty’ non-infectious virus-like particle (VLP) mimics the virus Virus-like particles (VLPs) as HPV vaccine antigens mimic the virus structure Stanley M, et al. Vaccine 2006; 24(suppl 3):S3/106–113.
    26. 26. Vaccines • Gardasil (2006) : – Contains HPV 16, 18, 6, 11 • Cerverix (2009): Contains HPV 16, 18 – Females 10 through 25 – For: • Ca Cx • CIN • Adenocarcinoma in situ – Gardasil for males too and for Ca Anus, warts etc
    27. 27. Two Opportunities to prevent Cx Ca Normal cervix HPV infection Cervical Intraepitheili al neoplasia CIN Cervical Cancer HPV vaccine HPV & Cx screen & t/t 10- 18 18 – 25 > 30
    28. 28. Collection of Cx Swab
    29. 29. Cervical Cancer is entirely preventable 1.Vaccination before exposure 2.Screening after 30 yrs (every 5 yrs) Though STI, it does not imply un-faithfullness Cancer free RAK / UAE by 2020 Become a national achievable goal Insurance be instructed to approve Vaccination & Co-testing
    30. 30. Please Join, Support & Promote Scientists have the tools, but cannot do it alone Thank you for your attention
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