Dr. Nisrin discusses the challenges of addressing cervical cancer in Saudi Arabia. Key challenges include understanding the prevalence of HPV infections and abnormal pap smears in the population. It will also be important to understand sexual practices across different regions and groups. Implementing screening programs will be difficult without addressing sexually transmitted infections. Additionally, the cost-effectiveness of vaccination programs requires consideration given the low cervical cancer rates in Saudi Arabia. Quality assurance for screening and colposcopy procedures also needs to be introduced.
Human papillomavirus (HPV) causes cervical cancer being the fourth most common cancer in women. 99% of all cervical cancer cases are related to genital infection with HPV. HPV Vaccines are now available and are the springboard for a change by primary prevention of this threatening situation.
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
UPDATE HPV Vaccination IN Cervical Cancer Prevention Dr Sharda Jain Lifecare Centre
Cervical Cancer In India: A Preventable Tragedy That Requires Urgent Attention
It is estimated that in India, about 160 million women aged 30-59 years are at risk of developing cervical cancer, with fatality rate of 50 per cent
Human papillomavirus (HPV) causes cervical cancer being the fourth most common cancer in women. 99% of all cervical cancer cases are related to genital infection with HPV. HPV Vaccines are now available and are the springboard for a change by primary prevention of this threatening situation.
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
UPDATE HPV Vaccination IN Cervical Cancer Prevention Dr Sharda Jain Lifecare Centre
Cervical Cancer In India: A Preventable Tragedy That Requires Urgent Attention
It is estimated that in India, about 160 million women aged 30-59 years are at risk of developing cervical cancer, with fatality rate of 50 per cent
HPV Diseases More Than Cervical Cancer, Dr. Sharda Jain Lifecare Centre
HPV Disease . Cervical cancer , prevention cervical cancer , HPV prevention , cancer prevention , Human Papillomavirus (HPV), cervical cancer prevention
Cancer Biomarkers Research, HPV and Cancer, HPV VaccineJames Lyons-Weiler
An overview of advances in cancer biomarker research strategies, the pathogenesis of HPV virus and a focus on the HPV vaccine with an analysis of evidence of type replacement.
Burden of Cervical Cancer & other HPV Related Diseases : Indian Perspectiv...Lifecare Centre
HPV RELATED DISEASES
Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer. HPV causes virtually 100% of cervical cancer cases
There is growing evidence of HPV being a relevant factor in other ANOGENITAL CANCERS (anus, vulva, vagina and penis) and head and neck cancers.
HPV is also responsible for other diseases such as recurrent juvenile respiratory papillomatosis and genital warts
HPV Infection , HPV Vaccination , Cervical cancer , Cancer in India , Dr. SHA...Lifecare Centre
HPV inefection , HPV disease prevention, Cervical cancer prevention , Cervical cancer treatment, Female cancer , Female cancer prevention , Uterine cancer , Cancer in india
Using Mobile Phones for Cervical Cancer ScreeningClickMedix
ClickMedix founder partnered with University of Pennsylvania and Botswana-UPenn Partnership program to pioneer cervical cancer screening using mobile camera phones.
*Note: This presentation contains medical images which may be unsuitable for those not accustomed.
HPV Diseases More Than Cervical Cancer, Dr. Sharda Jain Lifecare Centre
HPV Disease . Cervical cancer , prevention cervical cancer , HPV prevention , cancer prevention , Human Papillomavirus (HPV), cervical cancer prevention
Cancer Biomarkers Research, HPV and Cancer, HPV VaccineJames Lyons-Weiler
An overview of advances in cancer biomarker research strategies, the pathogenesis of HPV virus and a focus on the HPV vaccine with an analysis of evidence of type replacement.
Burden of Cervical Cancer & other HPV Related Diseases : Indian Perspectiv...Lifecare Centre
HPV RELATED DISEASES
Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer. HPV causes virtually 100% of cervical cancer cases
There is growing evidence of HPV being a relevant factor in other ANOGENITAL CANCERS (anus, vulva, vagina and penis) and head and neck cancers.
HPV is also responsible for other diseases such as recurrent juvenile respiratory papillomatosis and genital warts
HPV Infection , HPV Vaccination , Cervical cancer , Cancer in India , Dr. SHA...Lifecare Centre
HPV inefection , HPV disease prevention, Cervical cancer prevention , Cervical cancer treatment, Female cancer , Female cancer prevention , Uterine cancer , Cancer in india
Using Mobile Phones for Cervical Cancer ScreeningClickMedix
ClickMedix founder partnered with University of Pennsylvania and Botswana-UPenn Partnership program to pioneer cervical cancer screening using mobile camera phones.
*Note: This presentation contains medical images which may be unsuitable for those not accustomed.
26th International Papillomavirus Conference: Satellite Symposium
Enhancing HPV Prevention among Indigenous Populations: International Perspectives on Health and Well-Being
Montreal, Quebec
July 5, 2010
Panel 1 , Researching the Burden of HPV Disease, Immunization, and Cervical Screening among Indigenous Populations.
Cervical Cancer is common worldwide , ranking 3rd among all malignancies for women.
Second leading cause of cancer death.
Most of these cancers stem from infection with the Human Pappiloma Virus (HPV).
Don't miss our upcoming webinars! Subscribe today!
In this webinar, Dr. Durand will review the changing landscape of HPV-related diseases and cancers. She will discuss methods of HPV prevention for current cancer patients and cancer survivors. Attendees will learn about the evidence for HPV vaccination in adults. Practical tips will be provided on how to access HPV vaccination.
View the YouTube video: https://youtu.be/wFgpmqOpzC4
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Welcoming remarks by Dr Osborne E Nyandiva on Symposium: Cervical cancer and its prevention
Co-Presenter Dr Giama. We are happy to present to you this very crucial discussion on Cancer.
Cervical cancer is a type of cancer that develops in a woman's cervix (the entrance to the womb from the vagina).
Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.
What is cancer of cervix and how it occurs?
Cancer of the cervix, also the mouth of uterus or the lower most part of womb (where baby grows), Is easily accessible for examination by the gynecologist per vaginal examination. Cancer of cervix is probably caused by high risk strains of the human papilloma-virus (16,18,31,45 etc), a common sexually transmitted infection. In more than 90 percent of the infections, HPV clears up on its own, but in 10 percent of cases either cancer or genital warts develops. Multiple sex partners increases risk of HPV infection and the more partners the current partner has had, the higher is the risk that he will transmit HPV. Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human immunodeficiency virus (HIV) and other factors like smoking, diet, oral contraceptives are other important high risk cofactors in cervical carcinogenesis. Early age of marriage and early child bearing are contributing factor in our country.
The HPV virus causes cervix cancer was established by the research work of Nobel laureate Professor Herald Har Hassen, and this led to development of a vaccine for it . The HPV vaccine can prevent 70 percent of cancer cervix and current guildlines recommend immunization all girls is adolescent age groups i.e. before sexual exposure with 3 doses of HPV vaccine. During cancer development, the HPV viral particles get integrated with DNA of human nucleus resulting in mutation and rapid cancerous proliferation. This process cervical takes a few decades, for precancerous or cancerous changes to occur in cells.
What are the aims of cervical cancer screening and the available methods for it?
Screening aims are to detect cancer cervix the precancerous or early stages , when it is treatable. The Pap smear is the most widely available and effective method for this. Efforts are going on to develop an alternative cost effective method to suite low resource setting, to cater the vast population of developing poor countries. For this VILI /VIA/Low cost HPV DNA testing are being investigated in various research trials.
What is Pap smear? For a PAP smear of vaginal secretions and spreading on slide which is then ….. in the pathology laboratory and examined under the microscope by a trained pathologist to detect precancerous changes in the cells. It is well recognized , that widespread use of Pap smear can reduce cancer rate by more than 50 percent sd precancerous lesions are picked up and treated .
For Patient Related Queries, for Cervical Cancer Treatment call at 91-11-43066353
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. 64,928
Europe
67,078
Africa
49,025
South America
14,845
United States/
Canada
1,077
Australia/
New Zealand
39,648
Southeast
Asia
51,266
Eastern Asia
21,596
Central America
151,297
Southcentral
Asia
Cervical
Cancer:
Worldwide
Prevalence,
Incidence,
and
Mortality
Es8mates
Prevalence:
2,274,000
women
have
cervical
cancer1
Incidence:
510,000
new
cases
each
year1
Mortality:
Second
leading
cause
of
female
cancer-‐related
deaths
(288,000
annually)1
1.
World
Health
Organization.
Geneva,
Switzerland:
World
Health
Organization;
2003:1–74.
2.
Bosch
FX,
de
Sanjosé
S.
J
Natl
Cancer
Inst
Monogr.
2003;31:3–13.
2000 estimated incidence of invasive cervical cancer !
by selected region2:
3. Saudi Arabia
Cervical
Cancer:
In
Saudi
Arabia
,
Incidence,
and
Mortality
Es8mates
1.9
cases
per
100,000
women,
accounting
for
2.6%
of
diagnosed
cancer
cases
in
women
Every
year,
152
women
are
diagnosed
with
cervical
cancer
and
55
die
from
the
disease.
new
cervical
cancer
cases
and
deaths
in
2025
are
309
Cancer
Incidence
Report
Saudi
Arabia
2007.
Available
at
www.scr.org.sa/reports/SCR2007.pdf
Accessed
on
June
26,
2011
4. Cervical
Cancer:
Global
Stats
Age
Standardized
Incidence
rate/
100000
women
Total
Cases
Deaths
World
15.3
530232
275008
Saudi
Arabia
1.9
152
55
Western
Asia
39.18
4.5
2.1
Canada
6.6
1419
544
Globocan
2008
IARC
5. Cervical
Cancer:
Saudi
Arabia
— Very
low
incidence,
1.9/100,000
women
— ?
Any
demographic
data
on
“high
risk
groups”?
— Very
little
known
about
HPV
incidence
and
transmission
— Data
on
conventional
pap
triage
is
poor
— Hospital
based
— No
population
based
data
6. Foreseeable
Challenges:
— To
understand
the
prevalence
of
high-‐risk
(HR)-‐HPV
infections
and
the
prevalence
of
abnormal
cytology
findings
in
general
population.
To
understand
the
sexual
practices
of
the
population.
By
region
and
population
group.
Implementation
of
any
screening
program,
either
primary
or
secondary,
will
be
difficult
in
patients
with
a
sexually
transmitted
infection.
Vaccination
–
is
it
cost-‐effective
given
the
low
rates
of
cervical
cancer?
Introduction
of
quality
assurance
in
screening
and
colposcopy.
Which
screening
method
should
be
used
and
how
does
one
triage
the
patients?
7. Foreseeable
Challenges:
— To
understand
the
prevalence
of
high-‐risk
(HR)-‐HPV
infections
and
the
prevalence
of
abnormal
cytology
findings
in
general
population.
— To
understand
the
sexual
practices
of
the
population.
— By
region
and
population
group.
Implementation
of
any
screening
program,
either
primary
or
secondary,
will
be
difficult
in
patients
with
a
sexually
transmitted
infection.
Vaccination
–
is
it
cost-‐effective
given
the
low
rates
of
cervical
cancer?
Introduction
of
quality
assurance
in
screening
and
colposcopy.
Which
screening
method
should
be
used
and
how
does
one
triage
the
patients?
8. Foreseeable
Challenges:
— To
understand
the
prevalence
of
high-‐risk
(HR)-‐HPV
infections
and
the
prevalence
of
abnormal
cytology
findings
in
general
population.
— To
understand
the
sexual
practices
of
the
population.
— By
region
and
population
group.
— Implementation
of
any
screening
program,
either
primary
or
secondary,
will
be
difficult
in
patients
with
a
sexually
transmitted
infection.
Vaccination
–
is
it
cost-‐effective
given
the
low
rates
of
cervical
cancer?
Introduction
of
quality
assurance
in
screening
and
colposcopy.
Which
screening
method
should
be
used
and
how
does
one
triage
the
patients
9. Foreseeable
Challenges:
— To
understand
the
prevalence
of
high-‐risk
(HR)-‐HPV
infections
and
the
prevalence
of
abnormal
cytology
findings
in
general
population.
— To
understand
the
sexual
practices
of
the
population.
— By
region
and
population
group.
— Implementation
of
any
screening
program,
either
primary
or
secondary,
will
be
difficult
in
patients
with
a
sexually
transmitted
infection.
— Vaccination
–
is
it
cost-‐effective
given
the
low
rates
of
cervical
cancer?
Introduction
of
quality
assurance
in
screening
and
colposcopy.
Which
screening
method
should
be
used
and
how
does
one
triage
the
patients?
10. Foreseeable
Challenges:
— To
understand
the
prevalence
of
high-‐risk
(HR)-‐HPV
infections
and
the
prevalence
of
abnormal
cytology
findings
in
general
population.
— To
understand
the
sexual
practices
of
the
population.
— By
region
and
population
group.
— Implementation
of
any
screening
program,
either
primary
or
secondary,
will
be
difficult
in
patients
with
a
sexually
transmitted
infection.
— Vaccination
–
is
it
cost-‐effective
given
the
low
rates
of
cervical
cancer?
— Introduction
of
quality
assurance
in
screening
and
colposcopy.
11. Foreseeable
Challenges:
— To
understand
the
prevalence
of
high-‐risk
(HR)-‐HPV
infections
and
the
prevalence
of
abnormal
cytology
findings
in
general
population.
— To
understand
the
sexual
practices
of
the
population.
— By
region
and
population
group.
— Implementation
of
any
screening
program,
either
primary
or
secondary,
will
be
difficult
in
patients
with
a
sexually
transmitted
infection.
— Vaccination
–
is
it
cost-‐effective
given
the
low
rates
of
cervical
cancer?
— Introduction
of
quality
assurance
in
screening
and
colposcopy.
— Which
screening
method
should
be
used
and
how
does
one
triage
the
patients?
12. Cervical
Cancer
Preven8on
Normal
Cervix
HPV
Infection
Cervical
Dysplasia
Cervical
Cancer
Primary
Prevention:
Vaccination
Secondary
Prevention:
Screening
14. Transmission
of
HPV
— Prevalence
in
asymptomatic
North
American
women
is
2-‐40
%
mean
10.41%
— Highest
in
young
women
— Sexual
contact
primary
route
of
transit,
important
factors
— Earlier
age
at
sexual
debut
— Increased
number
of
partners
— More
transmissible
than
any
virus
but
less
than
bacterial
infections
Burchell
et
al
Vaccine
24S3
(2006)
15. Ac8ve
protec8on
via
vaccina8on
is
mediated
by
neutralizing
an8bodies
at
the
cervix
HPV
Cervical
canal
Neutralizing
an8bodies
Blood
vessel
Epithelial
tear
Basement
membrane
Cervical
epithelium
1.
Stanley
M.
Vaccine
2006;
24:S16–S22;
2.
Giannini
S,
et
al.
Vaccine
2006;
24:5937–5949;
3.
Nardelli-‐Haefliger
D,
et
al.
J
Natl
Cancer
Inst
2003;
95:1128–1137;
4.
Poncelet
S,
et
al.
IPC
2007(poster).
16. Product
characteristics
–
prophylactic
HPV
vaccines
CervarixTM1 Gardasil®2
Antigen VLPs of HPV 16 & 18 VLPs of HPV 16, 18, 6 & 11
Administration 0, 1 & 6 months
by intramuscular injection
0, 2 & 6 months
by intramuscular injection
1.
CervarixTM.
European
Summary
of
Product
Characteris8cs,
2007;
2.
Gardasil®.
European
Summary
of
Product
Characteris8cs,
2008.
18. HPV
Vaccines:
Published
data
Gardasil(Merck) Cervarix (GSK)
Dose and
administration
0.5 ml IM 0.5 ml IM
Schedule 0,2,6 months 0,1,6 months
Trial size 17622 18644
comparator Placebo with alum Hepatitis A
Site Up to 16 countries 14 countries
Age range 16-24; 15-26 15-25
eligibility < 4 sexual partners
( median 2)
< 6 sexual partners
exclusion Hx of abnormal pap
smears; pregnancy
Hx of colposcopy,
immunocompromised or
pregnant
duration 48 month study, 3 year
data
Mean 14.8 months
20. Vaccine
efficacy
— Safe
effective
vaccines
— Trials
show
a
reduction
in
CIN
and
treatment
— Other
trials
have
shown
safety
and
immunogenicity
in
women
9-‐15
years
old
21. Safety/Adverse
Events
GARDASIL Quadravalent CERVARIX Bivalent
14 days after
injection
Gardasil (14
days after
injection)
(n=5088)%
Alum Placebo
(n=3470)%
Saline Placebo
(n=320)%
Cervarix (7
days after
injection)
(n=22806)%
Alum Placebo
(n=4485)%
HAV 720
(n=8750)%
Injection site
Pain 83.9 75.4 48.6 78 52.5 58.9
Swelling 25.4 15.8 7.3 25.8 8.2 10.1
Erythema 24.6 18.4 12.1 29.6 10.6 16.1
Puritis 3.1 2.8 0.6 Not noted Not noted Not noted
Systemic
Fever
(>37.8oC)
10.3 8.6 5.1 5.2 4.6
Nausea 4.2 4.1
12.9 11.6 14.0Diarrhea 1.2 1.5
Dizziness 2.8 2.6
Data
taken
from
product
monograph
Canada
and
Australia
22. When
to
vaccinate?
— Should
vaccinate
before
sexual
activity
— Works
best
in
a
school
based
program
— High
rates
of
vaccination
in
UK,
Canada
Australia
etc;
where
school
based
programs
are
used
23. Dura8on
and
Safety
— Both
vaccines
have
demonstrated
efficacy
beyond
7
years
— Antibody
levels
vary,
but
there
has
been
no
evidence
of
breakthrough
infections
thus
far
— All
evidence
from
the
millions
of
doses
given
confirms
that
they
are
very
safe
vaccines
25. Saudi
Gynecology
Oncology
Group(
SGOG)
statement
— Health
care
providers
should
be
encouraged
to
discuss
HPV
vaccine
for
women
who
wish
to
be
vaccinated
and
help
them
in
the
decision
making.
Primary
Vaccination
with
three
doses
of
cancer
cervix
vaccine
should
be
given
for
females
15
to
26
years
of
age
to
decrease
the
risk
of
HPV
infection
and
subsequently
prevent
cervical
cancer.
In
addition
catch-‐up
immunization
for
women
above
age
26
years
could
be
done
.
Women
who
received
the
HPV
vaccine
should
continue
to
follow
the
existing
cervical
cancer
screening
programs.
26. Saudi
Gynecology
Oncology
Group(
SGOG)
statement
— Health
care
providers
should
be
encouraged
to
discuss
HPV
vaccine
for
women
who
wish
to
be
vaccinated
and
help
them
in
the
decision
making.
— Primary
Vaccination
with
three
doses
of
cancer
cervix
vaccine
should
be
given
for
females
15
to
26
years
of
age
to
decrease
the
risk
of
HPV
infection
and
subsequently
prevent
cervical
cancer.
In
addition
catch-‐up
immunization
for
women
above
age
26
years
could
be
done
.
— Women
who
received
the
HPV
vaccine
should
continue
to
follow
the
existing
cervical
cancer
screening
programs.
27. Saudi
Gynecology
Oncology
Group(
SGOG)
statement
— Health
care
providers
should
be
encouraged
to
discuss
HPV
vaccine
for
women
who
wish
to
be
vaccinated
and
help
them
in
the
decision
making.
— Primary
Vaccination
with
three
doses
of
cancer
cervix
vaccine
should
be
given
for
females
15
to
26
years
of
age
to
decrease
the
risk
of
HPV
infection
and
subsequently
prevent
cervical
cancer.
In
addition
catch-‐up
immunization
for
women
above
age
26
years
could
be
done
.
— Women
who
received
the
HPV
vaccine
should
continue
to
follow
the
existing
cervical
cancer
screening
programs.
28. Cervical
Cancer
Preven8on
Normal
Cervix
HPV
Infection
Cervical
Dysplasia
Cervical
Cancer
Primary
Prevention:
Vaccination
Secondary
Prevention:
Screening
29. Op8ons
in
screening
— PAP
smear
— VIA
— HPV
testing
32. Cervical
Screening:
Status
and
Challenges
— Well
established
system
of
cytology
screening
with
colposcopy
follow-‐up
— Successful
in
reducing
the
incidence
and
mortality
from
cervical
cancer
However:
— Realistically
in
Canada
,
they
have
been
unable
to
screen
more
than
70%
of
the
population
well
— How
would
a
cytology
based
program
work
in
Saudi
Arabia?
—
What
effect
will
vaccination
have?
33. Limita8ons
of
Cytology
— Sensitivity
of
pap
test
to
detect
CIN3+:
55%
— Should
be
done
in
the
context
of
an
organized
screening
program
— Quality
assurance
of
cytology
needs
to
be
very
good
— system
of
communication
to
the
women
screened
so
that
they
may
receive
sufficient
treatment.
— Requires
colposcopy
and
biopsy
to
confirm
dysplasia
— The
necessity
for
multiple
visits
with
cytology
based
screening
results
in
significant
loss
to
follow-‐up
34. Limita8ons
of
Cytology
— Sensitivity
of
pap
test
to
detect
CIN3+:
55%
— Should
be
done
in
the
context
of
an
organized
screening
program
— Quality
assurance
of
cytology
needs
to
be
very
good
— system
of
communication
to
the
women
screened
so
that
they
may
receive
sufficient
treatment.
— Requires
colposcopy
and
biopsy
to
confirm
dysplasia
— The
necessity
for
multiple
visits
with
cytology
based
screening
results
in
significant
loss
to
follow-‐up
35. Limita8ons
of
Cytology
— Sensitivity
of
pap
test
to
detect
CIN3+:
55%
— Should
be
done
in
the
context
of
an
organized
screening
program
— Quality
assurance
of
cytology
needs
to
be
very
good
— system
of
communication
to
the
women
screened
so
that
they
may
receive
sufficient
treatment.
— Requires
colposcopy
and
biopsy
to
confirm
dysplasia
— The
necessity
for
multiple
visits
with
cytology
based
screening
results
in
significant
loss
to
follow-‐up
36. Authora
Duration
Total no
Abnormal PAP
smear
ASC-US
ASC-H
LSIL
HSIL
AGUS
INVASIVE
CANCER
Al-Jaroudi (8)
2008-2009
241
7
(2.9%)
3
(1.2%)
1
(0.4%)
2
(0.83%)
NR
1
(0.4%)
NR
Jamal
1984-2000
22089
368
(1.66%)
88
(0.4%)
NR
81
(0.37%)
72
(0.32%)
36
(0.16%)
26
(0.1%)
Altaf
2001
3088
97
(3.14%)
14
(0.45%)
NR
29
(0.93%)
17
(0.55%)
4
(0.13%)
5
(0.16%)
Abdullah L (1)
1998 – 2005
5590
261
(4.7%)
103
(1.84%)
6
(0.10%)
5
(0.09%)
31
(0.55%)
30
(0.53%)
2
(0.04%)
Altaf
2000-2004
5132
241
(4.7%)
124
(2.4%)
NR
31
(0.6%)
22
(0.4%)
58
(1.1%)
6
(0.1%)
Summary
of
reported
data
on
Pap
smear
abnormalities
in
Saudi
Arabia
38. Op8ons
in
Screening
— VIA:
Visual
inspection
with
acetic
acid
— VILI:
Visual
inspection
with
Lugols
iodine
— Both
Low
tech
can
be
done
by
nurses
— May
need
to
utilize
colposcopy
to
triage
post
positive
test
to
rule
out
cancer
39. Test
Quali8es
of
VIA
in
Primary
Healthcare
Sefng
(Phase
2)
TEST
SENSITIVITY
(%)
SPECIFICITY
(%)*
POSITIVE
PREDICTIVE
VALUE (%)*
NEGATIVE
PREDICTIVE
VALUE (%)*
VIA
(n = 2,130)
77
(70–82)
64
(62–66) 19 96
Pap smear
(n = 2,092)
44
(35–51)
91
(37–51) 33 94
95%
Confidence
Interval
University
of
Zimbabwe/JHPIEGO
Cervical
Cancer
Project
1999.
40.
41. HPV
tes8ng
in
cervical
cancer
screening
Approaches
already
implemented
or
being
examined:
Ø Serial:
Cytology
screening
followed
by
HPV
testing
to
triage
ASC-‐US
(USA,
Nfld)
Ø Parallel:
Cytology
and
HPV
cotesting
(approved
in
USA,
implemented
in
California(Kaiser),Quebec)
Ø Serial:
HPV
testing
followed
by
cytologic
triage
(being
examined
in
the
Finnish
trial,
BC
RCT,
a.k.a.,
HPV
FOCAL
Study)
42. HPV
Tes8ng
ADVANTAGES
— Very
sensitive
— Better
quality
control
— Decreases
the
number
of
cytologists
needed
— Increase
screening
interval
which
decreases
cost
and
improves
convenience
DISADVANTAGES
— Need
a
second
test
due
to
lower
specificity
43. Role
of
HPV
tes8ng
• Triage
equivocal
or
low
grade
cytology
smears
(ALTS
trial)
• FUP
of
women
with
abnormal
cytology
but
normal
colposcopy
• Predict
outcome
after
treatment
of
high
grade
disease
• Primary
Screening
Cuzick
J.
Vaccine
2008
44. CCCAST
trial
PAP
HPV
55.6%
94.6%
Sensitivity
96.8%
94.1%
Specificity
Mayrand
et
al.;
Ø compare
the
relative
efficacy
of
HPV
DNA
testing
and
Pap
cytology
in
primary
screening
for
cervical
cancer
and
its
high-‐grade
precursors
NEJM
2007
Ø Pap
screening
followed
by
HPV
(hc
2)
vs
hc2
testing
followed
by
HPV
in
women
30-‐69
Ø
9,667
women
HPV
testing
is
significantly
more
sensitive
to
detect
CIN
2+
45. HPV
Screening
for
Cervical
Cancer
in
India
Sankaranarayanan,R:
— RCT
,4
Arms
of
screening
tool
in
India
— HPV
test
vs.
Pap
test
vs.
VIA
vs.
Observation
— Cervical
cancer
as
an
endpoint
— 32000
women
in
each
arm
— Screen
positive
received
colposcopy
and
treatment
— Only
significant
screening
method
to
reduce
deaths
from
cervical
cancer
was
HPV
testing
— Significant
reduction
in
Ca
Cervix
in
the
HPV
negative
compared
to
negative
Pap
and
VIA
NEJM
Apr2009
360(14)1385-‐94
46. HPV
tes8ng
RCT
Ronco
etal
— Trial
in
Italy
— 94000
women
25-‐60
randomized
in
2
phases
Ø Cytology
vs.
HPV
testing
and
cytology
(phase
1)
Ø
HPV
testing
alone
(phase
2).
— Same
rate
of
cancer
in
round
one
of
testing
— Increased
cancer
in
cytology
group
in
round
two
— HPV
testing
was
more
effective
in
preventing
cancer
by
detecting
high
grade
lesions
earlier.
— However:
HPV
testing
leads
to
over
diagnosis
of
CIN
2
which
is
likely
to
resolve
Ronco
G;
Lancet
March
2010
47. Cost
Effec8veness
Several
studies
proved
the
cost
effectiveness
of
HPV
testing
as
screening
test
for
Cervical
cancer
— In
developing
countries
— Screening
program
not
well
established
— Middle
income
Br
J
Cancer.2010
Dec
7;103(12):1773-‐82.
Cancer
Causes
Control.2011
Feb;22(2):261-‐72.
Eur
J
Cancer.
2011
Jul;47(11):1633-‐46
49. Suggested
Screening
Strategy
— Use
the
high
sensitivity
of
HPV
test
initially
— Digene
Hybrid
capture
2
test
is
suitable
— Positive
HPV
test
has
reflex
pap
testing
— If
both
positive
colposcopy
is
performed
— If
HPV
neg
repeat
screen
in
5
years
— If
HPV
+ve
and
pap
neg,
repeat
HPV
and
pap
in
1
year
50.
HR-‐HPV
tes8ng
and
Reflex
PAP
HR-‐HPV
DNA
in
women
30
+
years
old
Negative
Negative
Negative
Pap
test
Positive
Positive
Colposcopy
Positive
Repeat
HR-‐DNA
testing
@
5
year
intervals
till
age
65
Repeat
HR-‐
HPV
testing
at
12
months
51. Conclusions
— Introduction
of
a
cervical
cancer
prevention
program
in
Saudi
Arabia
is
possible
— Vaccination
has
the
promise
to
prevent
cervical
cancer
in
a
large
group
of
women
— Screening
should
be
done
using
HPV
testing
as
the
initial
method
— All
aspects,
i.e.
Screening,
colposcopy,
treatment
and
invasive
cancer
surveillance
require
very
careful
quality
assurance
processes.