20171021 Alimin iaccs taipei

1. Cervical cancer screening among women
age 25 -64 in Indonesia
Presented at 10th Asian Conference of Cancer Screening (IACCS),
Taipei, 20 – 22 October 2017
Alimin Maidin and Ansariadi
School of Public Health, Hasanuddin University, Indonesia
HASANUDDIN UNIVERSITY
School of Public Health

2. Background
• WHO: Cancer accounted for about 1 in 6 of all
global deaths
• Cervical cancer the second most common
malignancy in women worldwide (IARC, 2010)
• Leading cause of cancer-related death for
women in developing countries (WHO, 2011).
• It is preventable; 30-50% (WHO, 2017)

3. Background (cont.)
• Indonesia:
• Dharmais national Cancer Hospital (2010-2013) :
– Breast, Cervical, Lung , Ovarian, Colorectal, thyroid, liver and
nasopharings
• Cervical cancer is the most common gynecologic malignancy in
Indonesia (Aziz, 2009)
• Cervical Cancer: Approximately 70% are in the advanced stage when
they come to the hospital (≥ stage IIB) (Anggareni et al 2010)
• No national data on cervical cancer
• Visual inspection with acetic acid (VIA) was identified as the
potentially optimal alternative technique to use in a setting with low
resources

4. Objectives
• To assess the prevalence of cervical precancerous
lesion in urban areas in Indonesia

5. METHOD
 A descriptive cross sectional survey; women age 25-
64 years; VIA: 36 889 women
 Part of Non Communicable Diseases Survey (NCD
Survey) in Indonesia by MoH and Universities in
Indonesia) – Breast Cancer Screening
 Setting: Urban areas in Indonesia
 Time : July – September
5

6. Code Provinces BS SD
11 Aceh 32 2
12 Sumatera Utara 52 3
13 Sumatera Barat 33 2
14 Riau 35 2
15 Jambi 30 2
16 Sumatera Selatan 37 2
17 Bengkulu 28 2
18 Lampung 35 2
19
Kep. Bangka
Belitung 28 2
21 Kepulauan Riau 31 2
31 DKI Jakarta 70 3
32 Jawa Barat 161 4
33 Jawa Tengah 94 3
34 DI Yogyakarta 35 2
35 Jawa Timur 112 4
36 Banten 60 2
51 Bali 35 2
52 NTB 35 2
Code Province BS SD
53 NTT 28 2
61 Kalimantan Barat 32 2
62 Kalimantan Tengah 28 2
63 Kalimantan Selatan 32 2
64 Kalimantan Timur 34 2
65 Kalimantan Utara 26 2
71 Sulawesi Utara 30 2
72 Sulawesi Tengah 28 2
73 Sulawesi Selatan 37 3
74 Sulawesi Tenggara 28 2
75 Gorontalo 26 2
76 Sulawesi Barat 24 2
81 Maluku 28 2
82 Maluku Utara 24 2
91 Papua Barat 24 2
94 Papua 28 2
6
BS: Block Census SD : Sub District

7. Measurement
• Household visit for interviews and measurement: BP,
Weight, Height, Hips circumference
• Screening was conducted at Community Health
Centre (Puskesmas) by trained doctors or midwives
who are working at community health centers
7

8. 8
Women age 25-64 in the selected household
Interviews and measurement of Weight, Height, Blood
Pressure
Memenuhi kriteria CBE
CBE
Pemeriksaan IVA
CBE positif
IVA positif IVA negatif
Krioterapi
Met the criteria
Cancer**
Eligible for IVA
Colposcopy ,
Pathology Anatomy
USG/ Mammography.
Pathology Anatomy
Riwayat kanker
payudara/ovarium
pada keluarga
Pengambilan
spesimen darah
LABORATORY NAS.
BALITBANGKES
Pengambilan secret serviks
CBE negatif
Research flow

9. VIA categories
9

10. Results and Discussion
• This study found that the prevalence
of IVA (+) in urban area : 7.0%
• Previous study in Jakarta, Indonesia:
• The VIA test-positive rate was 4.21%
(970/22,989) (Nuranna et al, 2012)
• Rwanda (Makuza et al, 2015) The
prevalence of pre-cancer was 5.9%

11. VIA Test
Yes No
Pap Smear
Yes No
Cervical screening practices

12. No Symptoms %
1 Bleeding after sexual intercourse 9.4
2 Bleeding during menopause period 8.9
3 Fluor albus with yellow green liquid 8.3
4 Fluor albus and smelling 8.1
5 Fluor albus and itching 7.5
6 Bleeding between period 7.9
Table. Reported Abnormal uterine bleeding among VIA (+)

13. HPV Vaccination
Yes No
HPV Vaccination

14. Thank you… Questions?