Cervical cancer

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  • Vagina and uterus lie behind and above the pubic bone in
    the pelvis.
    Urinary bladder and urethra are in front of the vagina and uterus, and the rectum is behind them.
    Ureters lie close to the cervix on each side.
  • India’s population is approximately 1/6th of the world burden but the disease burden in India is more than 25%( 1/4th)
  • Key Point
    Because HPV infection is common and usually asymptomatic, most transmission may occur unknowingly. HPV infection is usually transmitted by sexual contact, commonly through sexual intercourse, although transmission can occur through nonpenetrative genital contact.
    Background
    The greatest behavioral risk for the acquisition of HPV infection is sexual contact, specifically the rate of new partners per month.1,2 Sexual intercourse is important in the transmission of HPV.2 Other types of genital contact (genital–genital, manual–genital, oral–genital), which may begin at an earlier age than penetrative intercourse, may also lead to HPV infection.1,3,4 A recent US study of 603 college-aged (19 years of age, average age at enrollment) women reported a 2-year genital HPV incidence rate of 39% among sexually active women and 8% among virginal women.1 Genital HPV infection in virgins is rare, but may result from nonpenetrative sexual contact.1 Proper condom use may help reduce the risk of genital warts, CIN 2 or CIN 3, and invasive cervical cancer, but is not fully protective against infection.5
    Other nonsexual routes of HPV infection include vertical transmission (from a mother to a newborn baby), although this is rare.6 A potential consequence of vertical transmission of HPV is recurrent respiratory papillomatosis (RRP), epithelial growths in the respiratory tract. In the larynx, growths may cause hoarseness and airway obstruction, which is potentially fatal. This condition presents most often in children younger than 5 years of age; but it can also occur in adults.7
    Transmission of HPV infection may occur via contact with fomites, such as undergarments, surgical gloves, and biopsy forceps. This route of transmission has been hypothesized but is not well documented and would be rare.8,9
    Although it is clear that sexual contact is the major mode of HPV transmission, most individuals infected by HPV do not know they have the disease.10 Therefore, they may unknowingly spread the virus.
    References
    1. Winer RL, Lee S-K, Hughes JP, Adam DE, Kiviat NB, Koutsky LA. Genital human papillomavirus infection: Incidence and risk factors in a cohort of female university students. Am J Epidemiol. 2003;157:218–226.
    2. Kjaer SK, Chackerian B, van den Brule AJ, et al. High-risk human papillomavirus is sexually transmitted: Evidence from a follow-up study of virgins starting sexual activity (intercourse). Cancer Epidemiol Biomarkers Prev. 2001;10:101–106.
    3. Fairley CK, Gay NJ, Forbes A, Abramson M, Garland SM. Hand–genital transmission of genital warts? An analysis of prevalence data. Epidemiol Infect. 1995;115:169–176.
    4. Herrero R, Castellsagué X, Pawlita M, et al. Human papillomavirus and oral cancer: The International Agency for Research on Cancer multicenter study. J Natl Cancer Inst. 2003;95:1772–1783.
    5. Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis. 2002;29:725−735.
    6. Smith EM, Ritchie JM, Yankowitz J, et al. Human papillomavirus prevalence and types in newborns and parents: Concordance and modes of transmission. Sex Transm Dis. 2004;31:57–62.
    7. Kashima HK, Mounts P, Shah K. Recurrent respiratory papillomatosis. Obstet Gynecol Clin North Am. 1996;23:699–706.
    8. Ferenczy A, Bergeron C, Richart RM. Human papillomavirus DNA in fomites on objects used for the management of patients with genital human papillomavirus infections. Obstet Gynecol. 1989;74:950–954.
    9. Roden RB, Lowy DR, Schiller JT. Papillomavirus is resistant to desiccation. J Infect Dis. 1997;176:1076–1079.
    10. Anhang R, Goodman A, Goldie SJ. HPV communication: Review of existing research and recommendations for patient education. CA Cancer J Clin. 2004;54:248–259.
  • Cervical cancer

    1. 1. Cervical Cancer Prevention Program: DR SHARDA JAiN SECREtARy gENERAl : Dgf CHAiRpERSoN – WoW iNDiA foUNDER CHAiRmAN – gyNAE pUSHpANJAli CRoSSlAy HoSpitAl DR ARUNA SAXENA MD ( Obs & Gynae),KGMC Lucknow Co-CooRDiNAtoR : CERviCAl CANCER pREvENtioN pRogRmmE of Dgf/ WoW iNDiA
    2. 2. Delhi Gynaecologist Forum & WOW India Initiative to spread information to every woman & Girl in India Please share with your friends
    3. 3. CERVIX Or Mouth of Uterus
    4. 4. Human Papillomavirus (HPV) HPV is a necessary cause of cervical cancer – 99.7%4 Cancer causing Types1,2,4 HPV Non-cancer causing types1,2 HPV 16 HPV 6 HPV 18 HPV 11 • >75% of Cervical Cancer5,6 • >50% of Vaginal & Vulvar Cancer5 90% of Anogenital warts5 1.Schiffman M, Castle PE. Arch Pathol Lab Med. 2003;127:930–934. 2. Wiley DJ, Douglas J, Beutner K, et al. Clin Infect Dis. 2002;35(suppl 2):S210–S224. 3. Muñoz N, Bosch FX, Castellsagué X, et al. Int J Cancer. 2004;111:278–285. Reprinted from J Virol. 1994;68:4503–4505 with permission from the American Society for Microbiology Journals Department. 4. Walboomers JM, Jacobs MV, Manos MM, et al. J Pathol. 1999;189:12–19. 5. X. Castellsagué, S. de Sanjose, T. Aguado, K. S. Louie, L. Bruni, J.Muñoz, M. Diaz, K. Irwin, M. Gacic, O. Beauvais, G. Albero, E. Ferrer, S. Byrne,F. X. Bosch. HPV and Cervical Cancer in the World. 2007 Report. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Available at: www.who.int/hpvcentre6. Bhatla N et al.Vaccine (2008;26; 2811-17
    5. 5. Herold Zur Hausen The Nobel Prize Winner, Medicine 2008 HPV is the necessary or the key cause of cervical cancer Cervical cancer does not and will not develop in the absence of the persistent presence of HPV DNA.
    6. 6. Cervical Cancer – Disease Burden in India New Cervical Cancer Cases Deaths due to Cervical cancer India ~1,32,000 World ~ 4,93,000 India ~ 74,000 World ~ 2,73,000 India - 27% India ~27% India ~27% Rest of World - 73% Rest of World - 73% Rest of World - 73% India ~27% of new Cervical Cancer cases in world India ~27% of deaths due to Cervical Cancer in world Bhatla N et al; Vaccine 2008; 26 2811-17
    7. 7. Cervical Cancer in India > 200 women die every day Cervical Cancer : India 8 women die every hour Every 7 minutes a women dies This Cause needs to be taken up by multiple stake holders .
    8. 8. • 60% of girls with one sexual partner will have HPV infection within 3 years of beginning sexual intercourse. • 80% of females get infected with HPV by the age of 50 years.
    9. 9. • Most infected individuals are unaware that they are infected and may unknowingly spread the virus. • Even Married couple with single partner may have the disease
    10. 10. • Cancer cervix is preventable but yet NOT prevented in our country. • Continues to remain No Indian Women 1 cancer in
    11. 11. Slow Growing Cancer: Takes 10-20 yrs Many opportunities for detection &treatment of Precancerous lesions
    12. 12. •GOI – has •NO MONEY •for •universal •vaccination
    13. 13. 1 • Cervical cancer screening in India among rich and poor is uniformly low, 6% and 4% respectively.1 • WHO recommends cervical cancer screening for all women ≥ 30 yrs in India.1 1. Gakidou E, Nordhagen S, Obermeyer Z. Coverage of Cervical Cancer Screening in 57 Countries: Low Average Levels and Large Inequalities. PLoS Medicine. June 2008; 5:863-868 Available at : www.plosmedicine.org 2. WHO. Comprehensive Cervical Cancer Control: A guide to essential practice. 2008: 86. Available at: http://www.who.int/reproductive-health/publications/cervical_cancer_gep/text.pdf
    14. 14. •How • •To •Handle •E •R •V •I •C •A •L •Cancer
    15. 15. HPV vaccination which is highly effective and safe. •New vista in cervical cancer prevention
    16. 16. Efficacy of Vaccine HPV induced lesions Protection Cervical Cancer & Cervical Cancer & Precancers (Grade 2/ 3)11 Precancers (Grade 2/ 3) 98% 98% Vulvar/ Vaginal Precancers Vulvar/ Vaginal Precancers (Grade 1- 3)22 (Grade 1- 3) 100% 100% Genital Warts22 Genital Warts 100% 100% 1. The Future II Study Group. Lancet 2007; 369: 1861–68 2.Garland SM et al. New Engl J Med. 2007;356:1928–1943.
    17. 17. • Age for vaccination is 9 - 45 years. • Three doses at 0, 2 and 6 months are recommended with Quadrivalent vaccine 0 • 2 6 months well tolerated with a favorable safety profile. Consensus Recommendations on Immunization, Indian Academy of Pediatrics Committee On Immunization (IAPCOI). Indian Pediatrics 2008; (45)635-648
    18. 18. • Soreness & redness at local site is common • May be slight fever which is short lasting relieved by simple medication • No serious adverse reaction reported
    19. 19. •Simultaneous Administration of Other Vaccines • Is safe at the same visit such as Tdap, Hepatitis B or Meningococcal vaccines • Vaccines should be administered using a separate syringe at a different anatomic site.
    20. 20. • Australia has already vaccinated 85% of its target population • Male Vaccination is now approved in Aus, NZ, Philippines & recently USA
    21. 21. What Gynaecologists & WOW India Volunteers can do ? • High& middle Income Group: 1.Create awareness about Vaccination & Regular screening 2.Vaccinate Adoloscent Girls & women of 945 yrs of age. Encourage them to form a chain by giving them incentives.
    22. 22. 1. Arrange Fund for vaccination. Can initially target 1016 yrs old unmarried girls 2. See & Treat for married women of >30 yrs . Locate 34 gynaecologists in an area who can do monthly camps at their clinics. 3. Frank cancer cases can be referred to - Rotary Cancer Hospital AIIMS. - Cancer Hospital in GTB
    23. 23. Summary 1. 27% of the world burden of Cervical Cancer is seen in India. 2. Cervical Cancer is caused by Human Papilloma Virus 3. Cervical Cancer is usually diagnosed in late stages in India. 4. Cancer Cervix Screening is recommended in between 21-65 yrs in low risk women 5.Cervical cancer vaccination: Recommended age : 9-45yrs in Govt programme & GOI should take initiative without delay. 6.Vaccination efficacy 98-100% 7.No screening required for unmarried girls before vaccination
    24. 24. & ADDRESS 35 , Defence Enclave, Opp. Preet Vihar Petrol Pump, Metro pillar no. 88, Vikas Marg , Delhi – 110092 CONTACT US 011-22414049, 42401339 WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID Sharda.lifecare@gmail.com Lifecarecentre21@gmail.com info@lifecareivf.com

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