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SAY No
to Cervical Cancer
With HPV Vaccination
DR. SHARDA JAIN
Secretary General of
Delhi Gynaecologist Forum
Dr.Jyoti Agg...
Our Team
PRESENTED At GYNAECON 10/10/2015
Our MISSION: SAY No TO CERVICAL CANCER
YOU DON’T NEED TO CURE
IF YOU CAN PREVENT IT
CANCER
Breast
Cancer
No 1
Ca.
Cervix
No 2
India ~1,22,844
Total world ~ 5,27,624
India ~23% of new
Cervical Cancer cases in world
India ~ 67,477
Total world ~ 2,65,...
An Airbus-320 full of WOMEN crashing every day in India
Deaths Due to CaCx - Just Think !
Incidence of Ca Cervix in
Metros in INDIA
“The cervical cancer incidence
rates in our metro cities, be it
Mumbai, Delhi or...
Incidence of Ca Cervix
in TOWNS INDIA
Moderately urbanised
town ---- stands at 17
per 1,00,000 population
RURAL INDIA
Cervical cancer incidence
rates in India’s rural areas
have been steady at
30 per 1,00,000
population.
WHY THIS DIFFERENCE ?
• To difference in education,
• Screening ----availability of
medical examination & pap
smear,
• Hyg...
Harald zur Hausen (1936 - ) won the Noble Prize in 2008 for discovering
that a virus, human papilloma virus, causes cervic...
HPVTHE CAUSE
HPV infection is a necessary cause of cervical cancer and is
linked to several other anogenital diseases
15/2...
What Genders are infected by Oncogenic
HPV
• 90% of Cancers caused by Oncogenic HPV
occur in Women only.
• 2% of Cancers c...
At what age Genital HPV Infection
detected ?
• There is no age at which all boys
& girls are uninfected with
oncogenic HPV...
Women Remains at Risk for Acquiring
HPV Infection Throughout Their
Lifetimes
HPV 16
HPV 18
HPV 6
HPV 11
Cancer causing Types
High risk group-16,18,
31,33,45,52,58
Non-cancer causing types
Low risk gr...
1. Forman D et al. Vaccine 30S (2012) F12– F23; 2. Lacey CJ et al (2006). Vaccine, 24 (Suppl 3), S35–S41.
HPV Causes More ...
HPV Vaccination: The Basis of Cancer Control
World Health Organization, United Nations Population Fund. Preparing for the ...
3 HPV Vaccine
available in the World
Gardasil 0 2 6 (MSD)
Cevarix 0 1 6 (GSK)
Nano valent vaccine (MSD)
(3 doses in six mo...
Rationale for Vaccination
Natural Infection – Weak AB response
Vaccination - High AB Response
Higher AB level at
cervical ...
The need for Vaccination against Cervical Cancer
No inflammation,
no danger signals
Local immunosuppression
No viremia
Nat...
Antibody response with Cervarix® significantly higher than with qHPV vaccine
in months 7–60 (18–26 age group)*
1. Einstein...
WHO
Two Vaccine are only
needed
0 & 6 if given
Between 9- 14 years
Right vaccine for Cervical
cancer prevention ?
Higher
antibody
response
Efficacy
beyond
vaccine
HPV types
Long
Duration
of...
Impact of HPV Vaccine in Public
Vaccination Programs:
Over 100 countries
qHPV=quadrivalent human papillomavirus. Please see corresponding slide note for references.
Markowitz. ...
HPV vaccine has been approved for
use in over 100 countries, including
UK, Australia, Israel, the
Netherlands, USA, Switz...
American Society of Clinical Oncology
Vaccine was doing
significantly well in
countries where it was
being offered free or...
1. http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2009/11/news_detail_000389.jsp&mid=WC0b01ac05800...
The USA took decision in Feb
2016 that
“All Children Under 11 years
of age will be vaccinated
free of charge”
HPV in new i...
Time is Slipping Out ….
GOI should do something
for Prevention of Cervical
Cancer
WHO – Criticism for India
Director south...
“It is astounding and shaming that
cervical cancer is the number one
killer in India DESPITE it’s a 100%
preventable cance...
Problems in Our Country
• We don’t have a Compulsory
National vaccination & screening
program.
• Vaccination is expensive
...
Cervical Cancer Screening Practices in India
Estimated coverage of cervical cancer screening in India, by age & study
(1) ...
Delhi Government
Wants to
Kick start HPV Vaccination
programme in
MCD School (pilot project)
for class 6th girls
While the vaccine is approved for
use in India, cost has been big
issue.
Recently, the Union government
indicated that it ...
Honored
LIFE TIME ACHIEVEMENT AWARD
for Prevention of Cx. Cancer
on 8th march 2016
Summary
1. 25% of the world burden of Cervical Cancer is
seen in India.
2.Cervical Cancer is caused by Human Papilloma
Vir...
Summary
5.Cervical Cancer Vaccination: Recommended
age : 9-45yrs.
6.Vaccination efficacy 98-100%
7.No screening required f...
40
NOW !!!
Public
awareness
rally
Public awareness
rally
ISO 14001:2004 (EMS)
…..Caring hearts, healing hands
ISO 9001:2008
HELPLINE-9650588339/22414049
HELPLINE-9599044257
HELPLI...
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Mission SAY No to Cervical Cancer With HPV Vaccination DR. SHARDA JAIN Secretary General of Delhi Gynaecologist Forum Dr.Jyoti Aggarwal Dr.Jyoti Bhaskar

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YOU DON’T NEED TO CURE
#CANCER #BreastCancer No 1
Cervical Cancer Disease Burden INDIA

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Mission SAY No to Cervical Cancer With HPV Vaccination DR. SHARDA JAIN Secretary General of Delhi Gynaecologist Forum Dr.Jyoti Aggarwal Dr.Jyoti Bhaskar

  1. 1. SAY No to Cervical Cancer With HPV Vaccination DR. SHARDA JAIN Secretary General of Delhi Gynaecologist Forum Dr.Jyoti Aggarwal Dr.Jyoti Bhaskar
  2. 2. Our Team PRESENTED At GYNAECON 10/10/2015 Our MISSION: SAY No TO CERVICAL CANCER
  3. 3. YOU DON’T NEED TO CURE IF YOU CAN PREVENT IT CANCER
  4. 4. Breast Cancer No 1 Ca. Cervix No 2
  5. 5. India ~1,22,844 Total world ~ 5,27,624 India ~23% of new Cervical Cancer cases in world India ~ 67,477 Total world ~ 2,65,653 India ~23% Rest of World - 77% India ~25% of deaths due to Cervical Cancer in world Rest of World - 73% India - 27% 2013 Cervical Cancer Disease Burden INDIA Incidence Mortality India ~25% Rest of World - 75% 2. Bruni L, Barrionuevo-Rosas L, Serrano B, Brotons M, Cosano R, Muñoz J, Bosch FX, de Sanjosé S, Castellsagué X. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in India. Summary Report 2014-01-31. [Accessed on 11th Feb 14]
  6. 6. An Airbus-320 full of WOMEN crashing every day in India Deaths Due to CaCx - Just Think !
  7. 7. Incidence of Ca Cervix in Metros in INDIA “The cervical cancer incidence rates in our metro cities, be it Mumbai, Delhi or Kolkata, are almost to the rates in the USA” In Mumbai stood at 8 per 1,00,000 population. Dr. Badwe Chief Tata Memorial Hospital Bombay
  8. 8. Incidence of Ca Cervix in TOWNS INDIA Moderately urbanised town ---- stands at 17 per 1,00,000 population
  9. 9. RURAL INDIA Cervical cancer incidence rates in India’s rural areas have been steady at 30 per 1,00,000 population.
  10. 10. WHY THIS DIFFERENCE ? • To difference in education, • Screening ----availability of medical examination & pap smear, • Hygiene--- running water and bathrooms.
  11. 11. Harald zur Hausen (1936 - ) won the Noble Prize in 2008 for discovering that a virus, human papilloma virus, causes cervical cancer.
  12. 12. HPVTHE CAUSE HPV infection is a necessary cause of cervical cancer and is linked to several other anogenital diseases 15/200 HPV Cause Cancer
  13. 13. What Genders are infected by Oncogenic HPV • 90% of Cancers caused by Oncogenic HPV occur in Women only. • 2% of Cancers caused by Oncogenic HPV occur in Men only • 7% case Anal & Oropharangeal cancers in both men & women
  14. 14. At what age Genital HPV Infection detected ? • There is no age at which all boys & girls are uninfected with oncogenic HPV types • In Adolescence point prevalence peaks at 30- 50% in young women between second & third decade due to onset of sexual exploration • 15% infections not associated with penetrative sex
  15. 15. Women Remains at Risk for Acquiring HPV Infection Throughout Their Lifetimes
  16. 16. HPV 16 HPV 18 HPV 6 HPV 11 Cancer causing Types High risk group-16,18, 31,33,45,52,58 Non-cancer causing types Low risk group- 6,11. • >75% of Cervical Cancer5,6 • >50% of Vaginal & Vulvar Cancer5 90% of Anogenital warts5 HPV is a necessary cause of cervical cancer – 99.7%4 HPV 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 Human Papillomavirus (HPV) Need for multivalent HPV vaccine for broader HPV protection
  17. 17. 1. Forman D et al. Vaccine 30S (2012) F12– F23; 2. Lacey CJ et al (2006). Vaccine, 24 (Suppl 3), S35–S41. HPV Causes More Than Cervical Cancer Genital Warts ~100% 70% ~100% 43% 88% Cervical Cancer Vaginal Cancer Vulvar Cancer Anal Cancer 13-56% Orophar yngeal Cancer 50% Penile Cancer HPV Percent of cases attributable to HPV infection 1,2
  18. 18. HPV Vaccination: The Basis of Cancer Control World Health Organization, United Nations Population Fund. Preparing for the Introduction of HPV Vaccines: Policy and Programme Guidance for Countries. Geneva, Switzerland: World Health Organization; 2006. Palliative care Cancer treatment Secondary prevention: Screening and treatment of precancers Primary prevention: Vaccination
  19. 19. 3 HPV Vaccine available in the World Gardasil 0 2 6 (MSD) Cevarix 0 1 6 (GSK) Nano valent vaccine (MSD) (3 doses in six months)
  20. 20. Rationale for Vaccination Natural Infection – Weak AB response Vaccination - High AB Response Higher AB level at cervical epithelium prevents HPV infection
  21. 21. The need for Vaccination against Cervical Cancer No inflammation, no danger signals Local immunosuppression No viremia Natural HPV infection induces a weak immune response1-4 • Vaccine induces higher antibody levels in the blood which means higher antibody levels at the site of infection8 • These Antibodies neutralize the virus & prevent entry into cells4,9 1.Stanley M. Vaccine 2006; 24: S106-13, 2.Tindle, Nat Rev Cancer 2002; 2, 59, 3.Stanley M. Vaccine 2006; 24: S16- 22, 4. Stanley M. HPV Today 2007; 11: 1-16 . 5 Parr EL et al. J Virol 1997;71(11):8109-15, 6. Nardelli-Haefliger D et al. J Natl Cancer Inst 2003;95(15):1128-37, 7. Schiller JT et al. Nat Rev Microbiol 2004;2(4):343-7, 8. Poncelet et al. ESPID, Porto, Portugal 2007; Abstract 37, session ES2, 9. Einstein M, Cancer Immunol Immunother 2007; 57(4):443-51
  22. 22. Antibody response with Cervarix® significantly higher than with qHPV vaccine in months 7–60 (18–26 age group)* 1. Einstein MH, et al. Hum Vaccin 2009; 5: 1–15; 2. Einstein MH, et al. Hum Vaccin 2011; 7: 1343–58; 3.Einstein M, Takacs P et al. Hum Vaccin Immunother. 2014 ;10(12):3435-45; 4. Einstein M, Levin MJ et al. Hum Vaccin Immunother. 2014 10(12):3455-655. Pederson et al, Journal of Adolescent Health 40 (2007) 564–571 1 10 100 1000 10000 100000 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 GMTLog10 Month 1 10 100 1000 10000 100000 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60GMTLog10 Month GMR 7.8 GMR 12.1 Data above derived from individual ATP cohorts of M7, M12, M18, M24, M36, M48 and M60; For each antigen, positivity was defined as a sample dilution ≥40 ED50 (< ED50 at baseline); PBNA, pseudovirion-based neutralisation assay Cervarix® qHPV vaccine HPV-16 HPV-18 Cervarix® qHPV vaccine This study did not compare clinical outcomes and the correlation between antibody levels and clinical outcomes is unclear Natural infection Natural infection HPV-010 Younger age girls show better immune response Cervarix produces 2-3 times higher antibody titres given in 10-14 years naive girls as compared to older girls and women5 Dr. Manoj Patki | GSK Biologicals | Cervical Cancer Prevention: choosing the right vaccine | Pedicon, 2016 | Hyderabad
  23. 23. WHO Two Vaccine are only needed 0 & 6 if given Between 9- 14 years
  24. 24. Right vaccine for Cervical cancer prevention ? Higher antibody response Efficacy beyond vaccine HPV types Long Duration of Protection
  25. 25. Impact of HPV Vaccine in Public Vaccination Programs:
  26. 26. Over 100 countries qHPV=quadrivalent human papillomavirus. Please see corresponding slide note for references. Markowitz. IPV 2012. 2006–2007 Dec ‘09 Jul ‘11Jan ‘11 Dec ‘11 May ‘12Jun ‘11 Jul ‘12 Jan ‘13Dec ‘12Oct ‘12 Introduction of qHPV vaccine Oliphant et al. NZ Med J. 2011. Bauer et al. Am J Pub Health. 2012. Wikström et al. EUROGIN 2012. Mikolajczyk et al. Sex Transm Dis. 2013. Baandrup et al. Sex Transm Dis. 2013. Fairley et al. Sex Transm Infect. 2009; Donovan et al. Lancet Infect Dis. 2011. Kliewer et al. IPV 2012. Kjaer et al. IPV 2012. Brotherton et al. Lancet. 2011. Van Tielen; Weyers et al. EUROGIN 2012. Leval et al. J Infect Dis. 2012. Ali et al. IUSTI 2012. Read et al. Sex Transm Infect. 2011. Powell et al. Vaccine. 2012. Tabrizi et al. J Infect Dis. 2012. 2012 Sep ‘12 Feb ‘13 Leval et al. J Natl Cancer Inst. 2013. Mar ‘13 Ali et al. BMJ 2013 Apr ‘13 Ali et al. BMC Infect Dis 2013.
  27. 27. HPV vaccine has been approved for use in over 100 countries, including UK, Australia, Israel, the Netherlands, USA, Switzerland & many countries in South east Asia. Many of these countries the vaccine are given free.
  28. 28. American Society of Clinical Oncology Vaccine was doing significantly well in countries where it was being offered free or even at cost .
  29. 29. 1. http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2009/11/news_detail_000389.jsp&mid=WC0b01ac058004d5c1 2. Centers for Disease control website. Available at: http://www.cdc.gov/vaccinesafety/vaers/gardasil.htm- last accessed on 16.04.10. 3. RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No. 15, 2009, 84, http://www.who.int/wer 4. Press release Spain MINISTERIO DE SANIDAD Y POLÍTICA SOCIAL 23.04.2009 Post licensure: Health authorities reaffirm the positive safety profile of Gardasil® US CDC & other leading health organizations closely monitor the safety of GARDASIL, as they do with other vaccines
  30. 30. The USA took decision in Feb 2016 that “All Children Under 11 years of age will be vaccinated free of charge” HPV in new in 2016
  31. 31. Time is Slipping Out …. GOI should do something for Prevention of Cervical Cancer WHO – Criticism for India Director south East Asia
  32. 32. “It is astounding and shaming that cervical cancer is the number one killer in India DESPITE it’s a 100% preventable cancer” . Criticism for India American Society of Clinical Oncology Dr. Daniel Hayes, elected president
  33. 33. Problems in Our Country • We don’t have a Compulsory National vaccination & screening program. • Vaccination is expensive • Screening by Pap smear requires expertise & follow up
  34. 34. Cervical Cancer Screening Practices in India Estimated coverage of cervical cancer screening in India, by age & study (1) WHO Household Surveys with geographical information system (GIS) multistage cluster sampling. Screening coverage among women aged 18-69. 2. Bruni L, Barrionuevo-Rosas L, Serrano B, Brotons M, Cosano R, Muñoz J, Bosch FX, de Sanjosé S, Castellsagué X. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in India. Summary Report 2014-01-31. [Accessed on 11th Feb 14]
  35. 35. Delhi Government Wants to Kick start HPV Vaccination programme in MCD School (pilot project) for class 6th girls
  36. 36. While the vaccine is approved for use in India, cost has been big issue. Recently, the Union government indicated that it may include it in National immunization plan. GOI – National Immunisation Programme
  37. 37. Honored LIFE TIME ACHIEVEMENT AWARD for Prevention of Cx. Cancer on 8th march 2016
  38. 38. Summary 1. 25% 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. Screening is recommended in sexually active women of >21yrs by WHO
  39. 39. Summary 5.Cervical Cancer Vaccination: Recommended age : 9-45yrs. 6.Vaccination efficacy 98-100% 7.No screening required for unmarried girls before vaccination 8. Vaccination safety is well documented
  40. 40. 40 NOW !!!
  41. 41. Public awareness rally
  42. 42. Public awareness rally
  43. 43. ISO 14001:2004 (EMS) …..Caring hearts, healing hands ISO 9001:2008 HELPLINE-9650588339/22414049 HELPLINE-9599044257 HELPLINE-9910081484 ISO 9001:2008 HELPLINE 9599044357
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YOU DON’T NEED TO CURE #CANCER #BreastCancer No 1 Cervical Cancer Disease Burden INDIA

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