Screening for premalignant cervical lesions in Egypt is important given the high incidence of cervical cancer. Visual inspection with acetic acid (VIA) is recommended for screening in developing countries due to its low cost, simplicity, and ability to provide immediate results and treatment. Mansoura University experience found VIA to be a sensitive screening method, detecting cervical lesions. While a positive VIA does not always indicate cancer, it allows for low-cost screening and identification of suspicious lesions requiring further evaluation or treatment.
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
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.
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
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.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
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
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
this lecture for undergraduates, GP & gynecologists
it includes full simple explanation of CIN (cervical intraepithelial neoplasia)
how to do screening for cervical cancer
methods of screening that include pap smear and HPV testing
it also includes the diagnostic method for the cervical cancer by taking biopsy directed by colposcopy
colposcopy and its rule
how to deal with CIN different grades
follow up after CIN treatment
Cervical cancer kills 270,000 women each year — mainly women in the developing world and in the prime of their productive lives. But cervical cancer is preventable by screening asymptomatic women for precancerous cervical lesions and treating the lesions before they progress to invasive disease. In other words, those deaths are largely preventable. Studies suggest that even if a woman were screened for cervical cancer only once in her lifetime between the ages of 30 and 40, her risk of cancer would be reduced by 25-36%.
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
At the 35th AICC-RCOG Annual Conference in association with FOGSI and MOGS, Dr. Niranjan Chavan, President of MOGS, gave an address on Artificial Intelligence in Gynaecologic Oncology at Taj Lands' End, Bandra, Mumbai on the 6th November 2022
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
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
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
this lecture for undergraduates, GP & gynecologists
it includes full simple explanation of CIN (cervical intraepithelial neoplasia)
how to do screening for cervical cancer
methods of screening that include pap smear and HPV testing
it also includes the diagnostic method for the cervical cancer by taking biopsy directed by colposcopy
colposcopy and its rule
how to deal with CIN different grades
follow up after CIN treatment
Cervical cancer kills 270,000 women each year — mainly women in the developing world and in the prime of their productive lives. But cervical cancer is preventable by screening asymptomatic women for precancerous cervical lesions and treating the lesions before they progress to invasive disease. In other words, those deaths are largely preventable. Studies suggest that even if a woman were screened for cervical cancer only once in her lifetime between the ages of 30 and 40, her risk of cancer would be reduced by 25-36%.
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
At the 35th AICC-RCOG Annual Conference in association with FOGSI and MOGS, Dr. Niranjan Chavan, President of MOGS, gave an address on Artificial Intelligence in Gynaecologic Oncology at Taj Lands' End, Bandra, Mumbai on the 6th November 2022
VIA is an attractive alternative to cytology-based cervix uteri screening in low-resource settings. Cryotherapy is the treatment option for test-positive individuals. Hereby a “Screen and Treat” approach can be integrated into existing reproductive health services in low-resource countries.
The Accuracy of Diagnostic Colposcopy using IFCPC 2011 TerminologySujoy Dasgupta
This paper was presented in the Annual Conference of Bengal Obstetric and Gynaecological Society (BOGSCON) 2014 held at ITC Sonar, Kolkata- January, 2014
Given the availability of a colposcope and a trained colposcopist this method is an essential tool for effective secondary prevention of female reproductive organ diseases. Colposcopic guided procedures enable a preceise diagnostic and consequent treatments with eventually organ preserving means. This power point presentation highlights the range of opportunities offered by Colposcopy.
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
2012 Project design of an Integrated Well Woman Clinic combining a Women's Health assessment with Screening and Early Diagnosis of Breast and Gynecological Cancers
Womans Cancer Foundation, Well Woman ClinicMaheshShettyMD
A suggested model for a Well Woman Examination combined with Screening and Early diagnosis methods for Breast and Gynecological Cancers in developing countries proposed by Woman's Cancer Foundation, USA. www.womanscancerfoundation.org
Similar to Screening c cervix slideshare 2015 (1) (20)
1. Screening for Premalignant cervicalScreening for Premalignant cervical
Lesions In EgyptLesions In Egypt
BYBY
Prof.Prof.
Mohammad EmamMohammad Emam
Director Of Early Cancer Detection UnitDirector Of Early Cancer Detection Unit
OB & GYN Dept.OB & GYN Dept.
Mansoura Faculty of Medicine-Egypt.Mansoura Faculty of Medicine-Egypt.
20152015
3. Who is at riskWho is at risk??
Women who have had more than one partnerWomen who have had more than one partner
Women whoWomen who’’s partner (s) has had more thans partner (s) has had more than
one sexual partner.one sexual partner.
Women with other STDsWomen with other STDs
4. Who is at riskWho is at risk??
Women with immune problems:Women with immune problems:
– Steroid medicationsSteroid medications
– Transplanted organsTransplanted organs
– ChemotherapyChemotherapy
– HIVHIV
Women who smokeWomen who smoke
11stst
intercourse before Age 18intercourse before Age 18
5. Ideal Screening MethodIdeal Screening Method
Adequate sensitivity and specificity.Adequate sensitivity and specificity.
yield reproducible results.yield reproducible results.
Cheap, simple and easy to apply.Cheap, simple and easy to apply.
Without side effects or complications.Without side effects or complications.
Painless .Painless .
Socioculturally acceptable.Socioculturally acceptable.
Infrastructures are easily available.Infrastructures are easily available.
6. RationaleRationale
1.1. Prevention is better than cure.Prevention is better than cure.
2.2. Most Cancers Develop In The UnscreenedMost Cancers Develop In The Unscreened
And The Under screened populationsAnd The Under screened populations
7. Cervical CancerCervical Cancer WorldwideWorldwide
230,000230,000 womenwomen diedie
of cervical cancerof cervical cancer
every yearevery year
– 80 % occur in80 % occur in
developingdeveloping
countries.countries.
““WHO , Cervical Cancer Screening in DevelopingWHO , Cervical Cancer Screening in Developing
Countries. Report of a WHO Consultation. 2001”Countries. Report of a WHO Consultation. 2001”
8. Incidence of Cancers inIncidence of Cancers in
Egyptian WomenEgyptian Women
00
55
1010
1515
2020
2525
BreastBreast
CancerCancer
CervicalCervical
CancerCancer
OvarianOvarian
CancerCancer
UterineUterine
CancerCancer
PercentPercent
Source: GLOBOCAN 2000.Source: GLOBOCAN 2000.
9. RationaleRationale
In developed countriesIn developed countries::
– Cervical cytology is considered to be the only test known toCervical cytology is considered to be the only test known to
reduce cervical cancer .reduce cervical cancer .
In developing countries ( Low resources ):In developing countries ( Low resources ):
– An organized screening program is difficult toAn organized screening program is difficult to
implement ( some counteris like Pakistan , Indonesiaimplement ( some counteris like Pakistan , Indonesia
have started)have started)
10. RationaleRationale
In Egypt:In Egypt:
No national screening program for cancerNo national screening program for cancer
cervix although in developed countries thecervix although in developed countries the
screening is in adulthood ,screening is in adulthood ,
Only sporadic reports regarding the prevalenceOnly sporadic reports regarding the prevalence
in some governorates ( Dakahlia, sharkia ,in some governorates ( Dakahlia, sharkia ,
Assuit, and minia ), utilizing VIA .Assuit, and minia ), utilizing VIA .
11. WHO guidelines for screening and tttWHO guidelines for screening and ttt
::developing countries :developing countries :((of CIN ( 2013of CIN ( 2013
– where screening with an HPV test iswhere screening with an HPV test is
not feasible: screen with VIA and treat.not feasible: screen with VIA and treat.
– Screen-and-treat strategies involve ttt withScreen-and-treat strategies involve ttt with
cryotherapy, or LEEP when the patient iscryotherapy, or LEEP when the patient is
not eligible for cryotherapy.not eligible for cryotherapy.
12. SeriousSerious
WidespreadWidespread
Diagnosable in early stages.Diagnosable in early stages.
TreatableTreatable
Cancer cx. Screening programs are inCancer cx. Screening programs are in
adulthood.adulthood.
ButBut ov. cancer programs are still in relativeov. cancer programs are still in relative
infancy,infancy, why?why?
Cancer Cervix Is an IdealCancer Cervix Is an Ideal
Disease For ScreeningDisease For Screening
13. Screening Of Cervical CancerScreening Of Cervical Cancer
is in adulthood.. Whyis in adulthood.. Why??
1.1. Screening detects Premalignancy.Screening detects Premalignancy.
2.2. PremalignancyPremalignancy can be detected bycan be detected by
noninvasive means.noninvasive means.
3.3. Good prognosis of early stage.Good prognosis of early stage.
4.4. Premalignant Course is slowPremalignant Course is slow..
14. Screening Of Cervical Cancer is inScreening Of Cervical Cancer is in
adulthood.. Why ?adulthood.. Why ? ContCont……
5.5. Effective treatment modalities forEffective treatment modalities for
premalignant lesions .premalignant lesions .
6. C6. Cervical cancer incidence is reduced byervical cancer incidence is reduced by
about 90% inabout 90% in developed countriesdeveloped countries withwith
-organized screening programs.-organized screening programs.
15. Gold standard ScreeningGold standard Screening
test For Cancer Cervixtest For Cancer Cervix
☼
PAP smear test is
considered to be the
gold standard .
☼ Has limitations ?
20. Differences between the Bethesda & PapanicolaouDifferences between the Bethesda & Papanicolaou
SystemSystem
Includes the diagnosis of HPV infections andIncludes the diagnosis of HPV infections and
limits use of the termlimits use of the term “atypia”.“atypia”.
squamous intraepithelial lesion =squamous intraepithelial lesion = SIL:SIL:
– low-grade SIL = HPV change and CIN Ilow-grade SIL = HPV change and CIN I
– high-grade SIL = CIN II and CIN III lesionshigh-grade SIL = CIN II and CIN III lesions
23. HSILHSIL
Enlarged nucleus, less cytoplasm (increased N:C ratio).Enlarged nucleus, less cytoplasm (increased N:C ratio).
Irregular nuclear membraneIrregular nuclear membrane
24. objectiveobjective
To highlight :To highlight :
–Alternative methods forAlternative methods for
screening of premalignantscreening of premalignant
cervical lesions suitable in Egyptcervical lesions suitable in Egypt
–Mansoura Experience.Mansoura Experience.
26. Alternatives to Pap smearAlternatives to Pap smear
– Automated pap screening.Automated pap screening.
– Visual inspection with acetic acidVisual inspection with acetic acid
(VIA), with magnification (VIAM)(VIA), with magnification (VIAM)
&&iodineiodine (VILI).(VILI).
– HPV testing.HPV testing.
– Polar probe.Polar probe.
– cervicographycervicography
27. HPV testingHPV testing
Detect High Risk HPV.Detect High Risk HPV.
Sample from cervix-Sample from cervix-
similar to PAP.similar to PAP.
Special transportSpecial transport
mediummedium
Processed in the labProcessed in the lab
HPVHPV
Objective testsObjective tests
Not suitable for Egypt)Not suitable for Egypt)))
ExpensiveExpensive
29. VILI & VIAVILI & VIA
Sensitivity Specificity
VIA 76.8 85.5
VILI 91.7 85.4
30. Limitations of VILILimitations of VILI
Stains underwear .Stains underwear .
Lugol’s iodine is more expensive than acetic acid.Lugol’s iodine is more expensive than acetic acid.
Moderate specificity may result in over-referralModerate specificity may result in over-referral
and over-treatment in a single-visit approachand over-treatment in a single-visit approach
31. What Infrastructure For VIA?What Infrastructure For VIA?
Examination table.
Sterile speculum ( Cusco's)
Sterile gloves
Source of light, a lamp or a torch
Cotton swabs
Forceps
Syringe for acetic acid lavage
Acetic acid in dilutions of 3%
Recording data
32. Via Is An Ideal Alternative to Pap smearVia Is An Ideal Alternative to Pap smear
Keep a bottleKeep a bottle
of vinegar inof vinegar in
your office.your office.
33. inexpensiveinexpensive&& 1.1. Simple & quickSimple & quick
2. Immediate results2. Immediate results
3. Not need cytopathologist .3. Not need cytopathologist .
4.4. One step diagnosis and tttOne step diagnosis and ttt..
55..SensitiveSensitive
66..SpecificSpecific????????????
Advantages of VIA overAdvantages of VIA over
PAPPAP
34. Disadvantages Of VIADisadvantages Of VIA
Lower specificity than the smear test. (May beLower specificity than the smear test. (May be
an advantage for women, through over refferal).an advantage for women, through over refferal).
Not suitable for endocervicalNot suitable for endocervical
glandular disease.glandular disease.
39. Significance Of Positive VIASignificance Of Positive VIA
MinorityMinority ::
– may bemay be suspicious ofsuspicious of cancer or CINcancer or CIN..
Majority :Majority :
– occur in conditions other than cancer :occur in conditions other than cancer :
– Healing orHealing or regenerating epithelium.regenerating epithelium.
– Inflammation.Inflammation.
– Immature squamous Metaplasia.Immature squamous Metaplasia.
– HPV infection.HPV infection.
40. Positive VIA Suspicious OfPositive VIA Suspicious Of
CancerCancer
Rapid uptake of acetic acid (Rapid uptake of acetic acid (less than 20less than 20
seconds).seconds).
Slow release of acetic acid(Slow release of acetic acid( more than 2more than 2
minutes)minutes)
Sharp raised edges.Sharp raised edges.
Irregular surface.Irregular surface.
41. Categorize YourselfCategorize Yourself::
Has no ColposcopyHas no Colposcopy
VIAVIA ± biopsy± biopsy
Has ColposcopyHas Colposcopy
One step :( see and treat ).One step :( see and treat ).
Two stepsTwo steps
What To Do if VIA is Positive &What To Do if VIA is Positive &
suspicioussuspicious??
42. VIA DISCOVERSVIA DISCOVERS
THE CRIMETHE CRIME
LOCATES THELOCATES THE
CULPRIT +/-CULPRIT +/-
COLPOSCOPYCOLPOSCOPY
And canAnd can
CytologyCytology
discoversdiscovers
the crimethe crime
And needAnd need
ColposcopyColposcopy
for locatingfor locating
the culprit.the culprit.
43. Age to
initiate
screening
Age to discontinue
screening
Screening interval for
cervical cytology
Post
hysterectomy
for benign
disease
ACS
(2002(
3years after
onset of sexual
intercourse, or
by age 21
Women may choose, if
70 years and 3
negative tests and no
positive tests within
last 10 years
Annual for conventional
cytology: every 2 years for
liquid-based cytology; for age
>30, every 2 to 3 years after 3
normal consecutive smears and
no increased risk
Not Indicated
ACOG
(2003(
3years after
onset of sexual
intercourse, or
by age 21
Inconclusive evidence Annual for age <30; for age >30,
every 2 to 3 years after 3 normal
consecutive smears, no history
CIN 2 or 3, and no increased risk
Women may
decline testing
USPSTF
(2003(
3years after
onset of sexual
intercourse, or
by age 21
Age 65, if not at high
risk
At least every 3 years Not indicated
44. Mansoura ExperienceMansoura Experience
Int J Gynaecol Obstet.Int J Gynaecol Obstet. 20062006
May;93(2):118-22. Epub 2006 Mar 20.May;93(2):118-22. Epub 2006 Mar 20.
Screening for cervical carcinoma using visualScreening for cervical carcinoma using visual
inspection with acetic acid.inspection with acetic acid.
Abdel-Hady ESAbdel-Hady ES11
,, Emam MEmam M,, Al-Gohary AAl-Gohary A,,
Hassan MHassan M, Farag MK, Abo-Elkheir M, Farag MK, Abo-Elkheir M
45. Mansoura ExperienceMansoura Experience
J Exp Ther Oncol.J Exp Ther Oncol. 2014;10(4):247-53.2014;10(4):247-53.
Human papillomavirus (HPV) is not theHuman papillomavirus (HPV) is not the
main cause of preinvasive and invasivemain cause of preinvasive and invasive
cervical cancer among patients in Deltacervical cancer among patients in Delta
Region, Egypt.Region, Egypt.
Thabet M, HemidaThabet M, Hemida R, Hasan M, ElshamyR, Hasan M, Elshamy
M, Elfaraash M, Emam M.M, Elfaraash M, Emam M.
46. ConclusionsConclusions
The easiest female cancer to preventThe easiest female cancer to prevent
through screening is cancer cervix.through screening is cancer cervix.
Regular ( VIA ) are the best way toRegular ( VIA ) are the best way to
prevent cervical cancer in developingprevent cervical cancer in developing
counteriescounteries
An abnormal Pap testAn abnormal Pap test
or ( VIA ) does not mean cancer.or ( VIA ) does not mean cancer.
The third test that is being assessed by ACCP is HPV test.
Currently available tests need lab processing. However efforts are under way to develop HPV tests which can provide immediate results. PATH’s new project is working on this. Fortunate…
Slide overview: The well-defined, mustard-yellow lesions in the transformation zone indicate cervical intraepithelial neoplasia.
Note for bullet 1: The squamocolumnar junction (SCJ) is the point at which columnar cells meet ectocervical squamous cells on the cervix. This junction marks the furthest extent of the transformation zone towards or, in the case of post-menopausal women, into the cervical canal.
Slide overview: The test performance of each screening method is rated by its sensitivity and specificity. Before discussing VILI’s test performance, it is important to understand what sensitivity and specificity mean.
This quote comes from an editorial which accompanied the March 1999 Lancet article on a VIA study in Zimbabwe, on which I was one of the leading investigators.
Key words from this quote are “proven” and “simple”
The picture on your left is the magnified image of a normal cervix after the application of Acetic acid.
The picture to your right is the magnified image of a cervix with an abnormal Aceto white lesion- ie a Positive tests.
Slide 15. Cervical Cancer: Abnormal VIA
Atypical acetowhite lesion extending up into the canal —colposcopy and biopsy indicated.
Bleeding fungating lesion—probable cancer—colposcopy and biopsy indicated.