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Abboud
Abdo,MD,FRCSC,Gynecologic
Oncologist.
DhahranHealthCenter
SaudiAramcoMedicalServicesOrganisation
SiteRisk
Allsites1in3
Breast1in7
Lung&bronchus1in17
Colon&rectum1in18
Uterinecorpus1in38
Non-Hodgkinlymphoma1in57
Ovary1in...
Primaryprevention:Preventsdiseasefromoccurring.
HPVvaccine
Secondaryprevention:Detectsandcuresdiseaseinthe
asymptomaticpha...
WHO2007
Cervix  uteri  (Non  Saudis)473.9%2.34.2
0
20
40
60
80
100
120
CervicalCancer:NumberofNewCases1994-­2007
PresenceofHumanPapillomaVirus(HPV)
LifestyleactivitiesincreasingexposuretoHPV
DecreasedImmunocompetency
Cofactors:Smoking,...
Detectspre-­invasiveneoplasia
Twotechniques,bothacceptable
ConventionalPapSmear,fixedonaglassslide.
Liquidbased,thinlayerp...
Specimentype
•ConventionalorLiquidbase
Specimenadequacy
•Satisfactoryornot
Generalcategorisation
•NegativeorEpithanomaly
A...
10,000
cancers
300,000HSIL(High-Grade
precancerouslesions)
1.25millionLSIL(Low-Grade
precancerouslesions)
2-3millionASC(At...
Papscreeningq3years
Pap-­RegularPapq3y
PapASCUS,HPV-­RegularPapq3y.
HPV+Colpo
Pap>LSILColpo
Co-­testscreeningq5years
Pap-­...
Jeddah  Cervical  Screening  Program
ww.jcsp.sa.com
HR-­‐HPV  testing  and  Reflex  PAP
HR-­‐HPV  DNA  in  women  30  +  y...
QUADRIVALENTBIVALENT
TargetHPV:16,18,6,11
TrialsFUTURE1&2
RCT:17400patients
Efficacy
HPVnaïve:98to100%
Intentiontotreat:44...
Intendedforprevention.ItdoesnottreatHPV
anddoesnotinterferewithpreexistingdisease.
MosteffectiveinHPVnaïvepeople.
Ideallyb...
Preventionisbetterthancure.
“Anappleadaykeepsthedoctoraway”
Awellappliedprogramofcervicalscreening
andHPVvaccinekeepcervic...
Dr abdo oboud presentation ca cx prevention
Dr abdo oboud presentation ca cx prevention
Dr abdo oboud presentation ca cx prevention
Dr abdo oboud presentation ca cx prevention
Dr abdo oboud presentation ca cx prevention
Dr abdo oboud presentation ca cx prevention
Dr abdo oboud presentation ca cx prevention
Dr abdo oboud presentation ca cx prevention
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Dr abdo oboud presentation ca cx prevention

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Dr abdo oboud presentation ca cx prevention

  1. 1. Abboud Abdo,MD,FRCSC,Gynecologic Oncologist. DhahranHealthCenter SaudiAramcoMedicalServicesOrganisation
  2. 2. SiteRisk Allsites1in3 Breast1in7 Lung&bronchus1in17 Colon&rectum1in18 Uterinecorpus1in38 Non-Hodgkinlymphoma1in57 Ovary1in59 Pancreas1in83 Melanoma1in82 Urinarybladder1in91 Uterinecervix1in128 Source:DevCan:ProbabilityofDevelopingorDyingofCancerSoftware,Version5.1StatisticalResearchandApplications Branch,NCI,2003.http://srab.cancer.gov/devcan
  3. 3. Primaryprevention:Preventsdiseasefromoccurring. HPVvaccine Secondaryprevention:Detectsandcuresdiseaseinthe asymptomaticphase:PapSmear,HPVtest,Colposcopy Tertiaryprevention:Reducescomplicationsofdisease.
  4. 4. WHO2007
  5. 5. Cervix  uteri  (Non  Saudis)473.9%2.34.2
  6. 6. 0 20 40 60 80 100 120 CervicalCancer:NumberofNewCases1994-­2007
  7. 7. PresenceofHumanPapillomaVirus(HPV) LifestyleactivitiesincreasingexposuretoHPV DecreasedImmunocompetency Cofactors:Smoking,OtherSTD Neverbeenscreened,orinadequatelyscreened: 50%ofcervicalcancerpatientsneverhadaPapSmear 10%werenotscreenedwithinthelast5years
  8. 8. Detectspre-­invasiveneoplasia Twotechniques,bothacceptable ConventionalPapSmear,fixedonaglassslide. Liquidbased,thinlayerpreparation. Collectionfor HPVtest:highriskserotypes,orgenotypes16/18 OtherSTDs Biopsyanyvisiblelesion
  9. 9. Specimentype •ConventionalorLiquidbase Specimenadequacy •Satisfactoryornot Generalcategorisation •NegativeorEpithanomaly Automatedreview •Specifydeviceifaplicable andresult Ancillarytesting •Ifdone;;molecular,HPVand result Interpretation Negative;;Inflam,Endomcell Squamouscellanomaly •ASC,ASC-­US,ASC-­H •LSIL •HSIL •Squamouscellcarcinoma Glandularcellanomaly •Atypical;;Endocerv,Endom •Atypicalfavorneoplastic •Endocervadenoin-­situ(AIS) •Adenocarcinoma Othermalignneoplasms Educationalnotes.
  10. 10. 10,000 cancers 300,000HSIL(High-Grade precancerouslesions) 1.25millionLSIL(Low-Grade precancerouslesions) 2-3millionASC(Atypical SquamousLesions) 50-60millionwomenscreened
  11. 11. Papscreeningq3years Pap-­RegularPapq3y PapASCUS,HPV-­RegularPapq3y. HPV+Colpo Pap>LSILColpo Co-­testscreeningq5years Pap-­,HPV-­Co-­testq5y PapASCUS,HPV-­Co-­testq5y Pap>LSIL,HPVanyColpo Pap-­,HPV+(2options) 1)Repeatbothin12mo.Ifanypos;;Colpo 2)HPVGenotype16/18.Ifneg;;repeatco-­testin12mo Ifpos;;Colpo
  12. 12. Jeddah  Cervical  Screening  Program ww.jcsp.sa.com HR-­‐HPV  testing  and  Reflex  PAP HR-­‐HPV  DNA  in  women  30  +  years  old,        married  more  than  3y 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
  13. 13. QUADRIVALENTBIVALENT TargetHPV:16,18,6,11 TrialsFUTURE1&2 RCT:17400patients Efficacy HPVnaïve:98to100% Intentiontotreat:44% 3doses:0,2mo,6mo. AlsoapprovedforAIN andanalcancer TargetHPV16,18 TrialPATRICIA RCT:18000patients Efficacy HPVnaïve:93% Intentiontotreat:30% 3doses:0,1mo,6mo.
  14. 14. Intendedforprevention.ItdoesnottreatHPV anddoesnotinterferewithpreexistingdisease. MosteffectiveinHPVnaïvepeople. Ideallybeforesexualexposure Age:Between9yand12y.Catch-­uptill26y. PreviousabnormalPaporHPVdiseaseisnota contraindication,butefficacyisless. Durationofprotection??(>8y) Safety:PreandPostlicensuredata.
  15. 15. Preventionisbetterthancure. “Anappleadaykeepsthedoctoraway” Awellappliedprogramofcervicalscreening andHPVvaccinekeepcervicalcanceraway. Becauseitisalmostalwayspreventable,each caseofcervicalcancershouldbeconsidereda failureofthemedicalsystem.

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