Cervical cancer poses a significant disease burden in India, with over 27% of new cervical cancer cases and deaths worldwide occurring in India. Human papillomavirus (HPV) infection is the primary cause of cervical cancer, with HPV types 16 and 18 causing over 75% of cases. While most HPV infections clear without causing health issues, some lead to precancerous lesions and cervical cancer over time. The Gardasil vaccine provides nearly 100% protection against HPV types 16 and 18 and has been shown to prevent cervical cancer and precancerous lesions in clinical trials. India's Academy of Pediatrics recommends HPV vaccination for girls around age 10 to reduce the cervical cancer burden in India.

1. CERVICAL CANCER AWARENESS
PROGRAM
By
A.Arputha Selvaraj APMP IIM Calcutta

2. CERVICAL CANCER AWARENESS PROGRAM
• CANCERS IN INDIA
• CERVICAL CANCER DISEASE
BURDEN
• HPV INTRODUCTION
• GENITAL WARTS
• GUARDYOURSELF
PREVENTION PROGRAM

3. CANCER BURDEN ACROSS WOMEN IN INDIA
• CERVICAL CANCER 26.2*
• BREAST CANCER 16.5*
• ORAL CANCER 6.1*
• OVARIAN CANCER 4.2*
• OESOPHAGUS CANCER 4.1*
• COLON/RECTUM CANCER 2.7*
• * per one lac women

4. Incidence Rates – Age Specific
2. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Summary report on HPV and cervical cancer statistics in
India. 2007. [Accessed on 18th
March 2008. Available at www. who. int/ hpvcentre c WHO/ICO Information Centre on HPV and Cervical Cancer

5. CERVICAL CANCER
• AS PER GLOBAL DATAS,1/10
WOMEN ARE HAVING CERVICAL
CANCER
EVERY 7 MINUTES - A WOMAN IS
DYING DUE TO CERVICAL
CANCER
AS PER INDIAN DATAS 8/10 WOMEN
ARE HAVE BEEN EXPOSED TO HPV
VIRAL INFECTION

6. Incidence ( Women of all ages) – Cervical
Cancer vs other Cancers
2. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Summary report on HPV and cervical cancer statistics in
India. 2007. [Accessed on 18th
March 2008. Available at www. who. int/ hpvcentre c WHO/ICO Information Centre on HPV and Cervical Cancer

7. Mortality Rates – Age Specific
2. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Summary report on HPV and cervical cancer statistics in
India. 2007. [Accessed on 18th
March 2008. Available at www. who. int/ hpvcentre c WHO/ICO Information Centre on HPV and Cervical Cancer

8. Mortality ( Women of all ages) – Cervical
Cancer vs other Cancers
2. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Summary report on HPV and cervical cancer statistics in
India. 2007. [Accessed on 18th
March 2008. Available at www. who. int/ hpvcentre c WHO/ICO Information Centre on HPV and Cervical Cancer

9. Age Specific Incidence vs Mortality
2. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Summary report on HPV and cervical cancer statistics in
India. 2007. [Accessed on 18th
March 2008. Available at www. who. int/ hpvcentre c WHO/ICO Information Centre on HPV and Cervical Cancer

10. FEMALE GENITAL ORGANS-Cervix

11. Internal Organs
• Vagina: The vagina is a canal that joins the cervix (the lower part of
uterus) to the outside of the body. It also is known as the birth canal.
• Uterus (womb): The uterus is a hollow, pear-shaped organ, supported
by ligaments & muscles that is the home to a developing fetus,.
Subdivided into fundus (upper area), body (middle section) & cervix
(lower section that has small opening into the vagina).
• Ovaries: The ovaries are small, oval-shaped glands that are located on
either side of the uterus. The ovaries produce eggs and hormones.
• Fallopian tubes: These are narrow tubes that are attached to the
upper part of the uterus Conception, the fertilization of an egg by a
sperm, normally occurs in the fallopian tubes. The fertilized egg then
moves to the uterus, where it implants to the uterine wall.

12. Internal organs – Front and Side View

13. Internal Organs – cervix- area of infection
Uterus of a woman of reproductive age

14. Internal Organs - Cervix
• The cervix is the lower one-third of the uterus and is composed of
dense, fibromuscular tissue lined by two types of epithelium.
• It is about 3 cm in length and 2.5 cm in diameter.
• The lower part of the cervix (outer cervix or ectocervix) lies within
the vagina , the upper two-thirds (inner cervix or endocervix) lies
above the vagina.
• The cervical canal runs through the centre of the cervix from the
internal os (opening) leading into the uterine cavity to the external os.

15. HUMAN PAPILLOMA VIRUS-HPV
100 +
Types of HPV identified
30 Oncogenic 70 Non Ongogenic
Unidentified
HPV types

16. ONCOGENIC HPV TYPES
30 Oncogenic
HPV Types
CERVICAL CANCER
HPV 16 & 18
> 75 % + other types
Vulvar& Vaginal&
Other Cancers

17. HPV 16
HPV 18
HPV 6
HPV 11
Cancer causing Types1,2,4
Non-cancer causing types1,2
• >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)

18. HPV infection is ubiquitous
• Large number of women would acquire HPV infection
sometime during life time.
• Majority would clear infection without developing any
disease.
• Few women develop precancerous lesions and
cervical cancer over 20 years.
Facts about HPV Infection

19. HPV
Infection
Low
Grade
Lesions
High
Grade
Lesions
Invasive
Cancer
0–1 Year 0–5 Years 1–20 Years
HPV Infection Stages
Adapted from Pinto AP et al. Clin Obstet Gynecol. 2000;43:352–362.
Facts about HPV Infection

20. India ~1,32,000
World ~ 4,93,000
India ~27% of new
Cervical Cancer cases in world
India ~ 74,000
World ~ 2,73,000
India ~27%
Rest of World - 73%
India ~27% of deaths
due to Cervical Cancer in world
Rest of World - 73%
India - 27%
Cervical Cancer – Disease Burden
New Cervical Cancer Cases Deaths due to Cervical cancer
India ~27%
Rest of World - 73%
Bhatla N et al; Vaccine 2008; 26 2811-17

21. 0 5 10 15 20 25 30
Cervical Breast (Female) Ovarian
Years of Life Lost to Cervical Cancer*
*In women in the United States (2003)
1. Ries LAG, Harkins D, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975–2003, National Cancer Institute. Bethesda, MD; 2006.
26
19
18
26 Average years of life lost in women with Cervical Cancer

22. 0
5
10
15
20
25
20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64
Age Group (Years)
HPV infection
Cervical Cancer
HPVPrevalence(%)
CancerIncidenceRate(×105
)
25
20
15
10
5
0
(n=3752)
* Two different cohorts (cross-sectional study) followed during the same time span to measure the rate of high-risk HPV infection in one and the rate of cervical cancer in the other.
1. Adapted from Bosch FX, Lorincz A, Muñoz N, Meijer CJLM, Shah KV. J Clin Pathol. 2002;55:244–265, with permission from the BMJ Publishing Group.
Peak of HPV infection
Peak of cervical cancer
Age-Specific Rates of HPV Infection &Cancer*
Age for vaccination
9 – 26 years

23. *Ray K et al, Indian J Med Res 2006; 124: 559-568
18%
6%
11% 10.5%
0
2
4
6
8
10
12
14
16
18
20
1990-93 1994-97 1998-01 2002-04
Study Period
Percentage Genital Warts – Disease Burden: India*
Increasing trend of Genital warts in India

24. Warts - Age at Acquisition: Males vs.
Females
New Genital Wart Cases by Age (2000)
The appearance of genital warts begins in
Adolescent females – in late teens and peaks in their early twenties.
Males - Begins to rise in their early twenties, and peaks in their late twenties

25. Warts
• The prepuce is the most common location for warts in
men, while the vulva is the most common for women.

26. Warts
Causes of Concern Among Men and Women with Anogenital Warts*

27. CERVICAL CANCER IS A COMMUNICABLE
DISEASE?
• YES.YES.YES.
• BY SEXUAL CONTACTS LIKE
HAND-GENITAL,
ORAL-GENITAL,
HOMOSEXUAL
-it is a communicable disease
• Recent study results showing
that Lungs cancers,Oesophagus
cancers & anal cancers are also
caused by HPV
• HPV Is greater than HIV?
• By skin to skin touching also this
deadly cancer disease is
spreading.so by using condems
also this cancer will be
spreadable.

28. HOW TO PROTECT OURSELVES FROM
CERVICAL CANCER?
• REGULAR PAP SMEAR SCREENING OF CERVICAL
CELLS TO FIND OUT THE ABNORMAL CELLS ONCE IN
3 YEARS UPTO 45 YEARS AGE.( W.H.O- REQUEST )
• GET MORE INFORMATION ABOUT CERVICAL
CANCER ,TRY TO EDUCATE YOURSELVES.
• FOR PREVENTION OF CERVICAL CANCER ,NOW
VACCINATION OPTIONS ARE AVAILABLE.

29. • Gardasil®
(quadrivalent vaccine) can prevent HPV
infection aiming at prevention of precancerous lesions
& cervical cancer.
• It has been studied in large number of women (23,000) in
four trials across the globe (17 countries).
• Highly successful in preventing precancerous lesions &
cervical cancer.
• It has also been studied in Indian women as per local
regulations.
• Gardasil®
is available in more than 100 countries across
the world.
HPV Infection can be prevented

30. Vulval & Vaginal
Precancers (Grade 1/2/3)2
Vulval & Vaginal
Precancers (Grade 1/2/3)2
Cervical Cancer &
Precancers (Grade 2/3)1
Cervical Cancer &
Precancers (Grade 2/3)1
100 %100 %
98 %98 %
HPV induced lesions Protection by Gardasil®
1. The Future II Study Group. Lancet 2007; 369: 1861–68 2.Garland SM et al. New Engl J Med. 2007;356:1928–1943.
Benefits of Gardasil®
• As Gardasil®
contains protective agents of four different HPV viruses
- Gardasil®
also offers protection against genital warts2
.

31. • IAP COI strongly recommend use of Gardasil®
in girls
around 10 years of age.
– If missed, catch up vaccination is recommended in
adolescent girls and young women at the earliest
opportunity.
• Basis for recommendation
– High burden & high public health impact (Death of a
woman due to cervical cancer at prime age & impacts
entire family besides individual loss).
– Safe and effective vaccine to prevent cervical cancer.
Indian Academy of Pediatrics - Recommendations
IAP COI - Indian Academy of Pediatrics Committee of Immunization

32. Thank you
• Write to author : arputhaselvaraj@gmail.com