Why cervical cancer prevention need
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Myanmar is one of the high cervical cancer countries. as a resource poor country, VIA and Cryotherapy are the effective preventive approach.
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Why cervical cancer prevention need
- 2. Incidence rate per 100,000 females (2005)
- 3. Death from Cx Ca in developing countries 80% 85% 90% 95% 100% 2002 2008 2030 GLOBOCAN 2008 report
- 4. Cx Ca situation at a glance in Myanmar 2nd most common Cancer in women and Asian countries? 15.8 15.4 25.4 World SEA Myanmar Crude incidence rate (100,000 women/year)
- 5. Myanmar women at risk 13-million
- 6. What causes Cx Ca? HPV as main cause Sex as transmission mode
- 7. Period from HPV infection to cancer HPV infected 10 – 20 years 10 – 15 years
- 8. Natural history of CIN 57% 43% 32% 32% 11% 1% 35% 22% 5% 56% 12% CIN 1 Mild dysplasia CIN 2 Mod dysplasia CIN 3 Severe dysplasia Regress Persist Progress to CIS Progress to invasion Int J Gyne Path 1993; 12:186-192
- 9. The consequences of HPV infection 90% heal within 2 years 0.8% develop Ca HPV into Cx cells thro’ micro-abrasion
- 10. Can we prevent the progress to cancer? If we can detect cervical epithelial abnormality… and If we can remove it. It is called “Screen and Treat” approach.
- 11. The age to get screening + 25 – 65 years
- 12. The screening tests Cytology HPV test VIA
- 13. Different screening tests for precancerous Cx Pap smear HPV test VIA Which is the most suitable for the resource poor? Correctly identified Correctly excluded 38-84% 50-95% 56-94% >90% 84% 74-94% Easy-to-perform Lab facilities No Lab Comprehensive cervical cancer control : a guide to essential practice, WHO, 2006 Lab facilities
- 14. VIA map (2011) VIA as National program VIA as Pilot program No VIA program
- 15. If she has no evidence of Ca Cx, will she be free from Ca Cx throughout her life time? No! Risk reduction 1 time per life time 2 time per life time 3 time per life time Every 3 years Every 2 years Every year 17 – 32% 29 – 42% 35 – 55% 75 – 88% 86 – 91% 90 – 93%
- 17. Loop Electrosurgical Excision Procedure Electricity or Battery Specialist Anesthesia (Local) Bleeding
- 18. Cold Knife Cone (Conization) Electricity Specialist Anesthesia (General) Bleeding ↑↑
- 20. Treatment options for pre-cancer cervix Cryotherapy LEEP Cold knife cone Effectiveness Setting Direct medical Cost 86 – 95% 91 – 98% 90 – 94% Clinic Hospital Hospital 16-45$ 100-320$ Which is the most suitable for the resource poor? Comprehensive cervical cancer control : a guide to essential practice Pg 140, WHO, 2006 Cost-effectiveness of Cx Ca in India and Thai, NEJM 353:20, Nov, 2005 210-490$ In a place where there are no electricity and anesthetist
- 21. Single Visit Approach Total time for the service - <20 minutes (Screen & Treat)
- 22. Thanks If we can effectively “screen & Treat”