Dr abdo oboud presentation ca cx prevention

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Dr abdo oboud presentation ca cx prevention

  1. 1. Abboud Abdo,MD,FRCSC,Gynecologic Oncologist. DhahranHealthCenter SaudiAramcoMedicalServicesOrganisation
  2. 2. SiteRisk Allsites1in3 Breast1in7 Lung&bronchus1in17 Colon&rectum1in18 Uterinecorpus1in38 Non-Hodgkinlymphoma1in57 Ovary1in59 Pancreas1in83 Melanoma1in82 Urinarybladder1in91 Uterinecervix1in128 Source:DevCan:ProbabilityofDevelopingorDyingofCancerSoftware,Version5.1StatisticalResearchandApplications Branch,NCI,2003.http://srab.cancer.gov/devcan
  3. 3. Primaryprevention:Preventsdiseasefromoccurring. HPVvaccine Secondaryprevention:Detectsandcuresdiseaseinthe asymptomaticphase:PapSmear,HPVtest,Colposcopy Tertiaryprevention:Reducescomplicationsofdisease.
  4. 4. WHO2007
  5. 5. Cervix  uteri  (Non  Saudis)473.9%2.34.2
  6. 6. 0 20 40 60 80 100 120 CervicalCancer:NumberofNewCases1994-­2007
  7. 7. PresenceofHumanPapillomaVirus(HPV) LifestyleactivitiesincreasingexposuretoHPV DecreasedImmunocompetency Cofactors:Smoking,OtherSTD Neverbeenscreened,orinadequatelyscreened: 50%ofcervicalcancerpatientsneverhadaPapSmear 10%werenotscreenedwithinthelast5years
  8. 8. Detectspre-­invasiveneoplasia Twotechniques,bothacceptable ConventionalPapSmear,fixedonaglassslide. Liquidbased,thinlayerpreparation. Collectionfor HPVtest:highriskserotypes,orgenotypes16/18 OtherSTDs Biopsyanyvisiblelesion
  9. 9. Specimentype •ConventionalorLiquidbase Specimenadequacy •Satisfactoryornot Generalcategorisation •NegativeorEpithanomaly Automatedreview •Specifydeviceifaplicable andresult Ancillarytesting •Ifdone;;molecular,HPVand result Interpretation Negative;;Inflam,Endomcell Squamouscellanomaly •ASC,ASC-­US,ASC-­H •LSIL •HSIL •Squamouscellcarcinoma Glandularcellanomaly •Atypical;;Endocerv,Endom •Atypicalfavorneoplastic •Endocervadenoin-­situ(AIS) •Adenocarcinoma Othermalignneoplasms Educationalnotes.
  10. 10. 10,000 cancers 300,000HSIL(High-Grade precancerouslesions) 1.25millionLSIL(Low-Grade precancerouslesions) 2-3millionASC(Atypical SquamousLesions) 50-60millionwomenscreened
  11. 11. Papscreeningq3years Pap-­RegularPapq3y PapASCUS,HPV-­RegularPapq3y. HPV+Colpo Pap>LSILColpo Co-­testscreeningq5years Pap-­,HPV-­Co-­testq5y PapASCUS,HPV-­Co-­testq5y Pap>LSIL,HPVanyColpo Pap-­,HPV+(2options) 1)Repeatbothin12mo.Ifanypos;;Colpo 2)HPVGenotype16/18.Ifneg;;repeatco-­testin12mo Ifpos;;Colpo
  12. 12. Jeddah  Cervical  Screening  Program ww.jcsp.sa.com HR-­‐HPV  testing  and  Reflex  PAP HR-­‐HPV  DNA  in  women  30  +  years  old,        married  more  than  3y Negative Negative Negative Pap  test Positive Positive Colposcopy Positive Repeat  HR-­‐DNA   testing  @  5  year   intervals  till  age  65 Repeat  HR-­‐HPV   testing  at  12   months
  13. 13. QUADRIVALENTBIVALENT TargetHPV:16,18,6,11 TrialsFUTURE1&2 RCT:17400patients Efficacy HPVnaïve:98to100% Intentiontotreat:44% 3doses:0,2mo,6mo. AlsoapprovedforAIN andanalcancer TargetHPV16,18 TrialPATRICIA RCT:18000patients Efficacy HPVnaïve:93% Intentiontotreat:30% 3doses:0,1mo,6mo.
  14. 14. Intendedforprevention.ItdoesnottreatHPV anddoesnotinterferewithpreexistingdisease. MosteffectiveinHPVnaïvepeople. Ideallybeforesexualexposure Age:Between9yand12y.Catch-­uptill26y. PreviousabnormalPaporHPVdiseaseisnota contraindication,butefficacyisless. Durationofprotection??(>8y) Safety:PreandPostlicensuredata.
  15. 15. Preventionisbetterthancure. “Anappleadaykeepsthedoctoraway” Awellappliedprogramofcervicalscreening andHPVvaccinekeepcervicalcanceraway. Becauseitisalmostalwayspreventable,each caseofcervicalcancershouldbeconsidereda failureofthemedicalsystem.

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