Epidemiology of Cervical cancer

Dr Soni Rani

Department Of Community Medicine

Katihar Medical College

Epidemiology Of

Cervical Cancer

PRESENTATION OUTLINE

Introduction ( Anatomy/ Definition) Risk factors of cervical cancer Epidemiology/ problem statement Signs and symptoms of cervical cancer Screening tests Diagnosis of cervical cancer Staging Prevention of cervical cancer. NCCP/NPDCS/NCRP Conclusion

CERVIX- ANATOMY

The cervix or cervix

uteri (Latin: neck of

Uterus) is the lower part

of the uterus in

the human female

reproductive system.

In a non-pregnant

woman, the cervix is

usually 2 to 3 cm long (1

inch) and roughly

cylindrical in shape.

The narrow,

central cervical

canal runs along its

entire length,connecting

CERVIX- ANATOMY

The opening into the

uterus is called

the internal os, and the

opening into the vagina

is called the external os.

The lower part of the

cervix, known as the

vaginal portion of the

cervix (or ectocervix),

bulges into the top of the

vagina.

The cervix has been

documented

anatomically since at

least the time

of Hippocrates, over

CERVICAL CANCER- DEFINITION

Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina) is known as cervical cancer.

It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests .

Cervical cancer is almost always caused by human papillomavirus (HPV) infection.



RISK FACTORS OF CERVICAL CANCER

MODIFIABLE RISK FACTORSNON-M0DIFIABLE RISK

FACTORS

Early marriage

Early child birth

Having too many

children

Multiple sexual partner

Un-protected sex

Smoking

Oral contraceptive pills

Mental stress

Decrease immunity

(AIDS)

Family history /

hereditary

Socio- economic status

Decrease Immunity (

Congenital)


HPV (human papillomavirus) - a sexually transmitted virus. There are more than 130 different types of HPVs, at least 18 of which can cause cervical cancer.

Many sexual partners or becoming sexually active early - cervical cancer-causing HPV types are nearly always transmitted as a result of sexual contact with an infected individual.

Women who have had many sexual partners generally have a higher risk of becoming infected with HPV, which raises their risk of developing cervical cancer.


Smoking - increases the risk of developing many cancers,

including cervical cancer.

A weakened immune system - such as in people

with AIDS, or transplant recipients taking

immunosuppressive medications.

Long-term mental stress - women who experience high

levels of stress over a sustained period may be less able to

fight off HPV.

A study from the American Academy of Pediatrics in 2016

supported this. Principal investigator Dr. Anna-Barbara

Moscicki said: "Women who reported self-destructive

coping strategies, like drinking, smoking cigarettes or

taking drugs when stressed, were more likely to

develop an active HPV infection."

http://www.medicalnewstoday.com/articles/17131.php



Giving birth at a very young age - women who give birth before the age of 17 are significantly more likely to develop cervical cancer compared with women who have their first baby after the age of 25.

Several pregnancies - women who have had at least three children in separate pregnancies are more likely to develop cervical cancer compared to women who have never had children.

Contraceptive pill - long-term use of some common contraceptive pills slightly raises a woman's risk.


Other sexually transmitted diseases

(STD) - women who become infected

with chlamydia, gonorrhea, or syphilis have a

higher risk of developing cervical cancer.

Socio-economic status - studies in several

countries have revealed that women with low

SES have significantly higher rates of

cervical cancer.




HPV DISEASE SPECTRUM

HPV is a member of the family Papillomaviridae.

They are small, non-enveloped deoxyribonucleic acid (DNA) viruses.

Over 130 serotypes of HPV have been discovered, of which 15–20 are oncogenic.

The lag period between the oncogenic HPV infection and the invasive cervical cancer is 15–20 years.

Based on the association with cervical cancer, genital HPVs are further grouped into high-risk types, probable high-risk types and low-risk types.


Worldwide, high-risk type HPV-16 and 18 contribute over 70% of all cervical cancer cases (the most prevalent being HPV-16 in at least 50–60% and HPV-18 in at least 10–12%).

Similarly, in Indian women, the most common prevalent genotypes are HPV-16 and 18.

Non-oncogenic HPV serotypes-6 and 11 contribute over 90% of benign genital infections such as genital warts.

Oncogenic HPV serotypes have also been implicated in the causation of anal, vulvar, vaginal, penile and oropharyngeal cancers.


HPVs infect the basal epithelium and are grouped as cutaneous and mucosal types.

HPV cervical infection results in cervical morphological lesions ranging from normal (cytologically normal women) to development of different stages of high-grade precancerous lesions cervical intraepithelial neoplasia:

Cervical intraepithelial neoplasia (CIN)-1, CIN-2, CIN-3/Carcinoma in-situ) and, subsequently, invasive cervical cancer (ICC)



CERVICAL CANCER- INCIDENCE

Cervical cancer is the fourth most

common cancer in women, and the

seventh overall, with an estimated

528,000 new cases in 2012.

As with liver cancer, a large majority

(around 85%) of the global burden

occurs in the less developed regions,

where it accounts for almost 12% of all

female cancers.

CERVICAL CANCER- INCIDENCE

High-risk regions, with

estimated ASRs over 30

per 100,000, include

Eastern Africa (42.7),

Melanesia (33.3),

Southern (31.5) and

Middle (30.6) Africa.

Rates are lowest in

Australia/New Zealand

(5.5) and Western Asia

(4.4).

Cervical cancer remains

the most common

cancer in women in

Eastern and Middle

ANNUAL NUMBER OF NEW CASES OF CERVICAL CANCER BY AGE

GROUP IN DEVELOPING AND DEVELOPED REGIONS(ESTIMATES FOR

2012)

Data Source- GLOBOCAN 2012

COMPARISON OF THE TEN MOST FREQUENT CANCERS IN WOMEN AGED

15-44 YEARS BY WORLD DEVELOPING AND DEVELOPED REGIONS (FOR

2012)

Data Source- GLOBOCAN 2012

CERVICAL CANCER- MORTALITY

There were an estimated 266,000 deaths

from cervical cancer worldwide in 2012,

accounting for 7.5% of all female cancer

deaths.

Almost nine out of ten (87%) cervical

cancer deaths occur in the less developed

regions.

CERVICAL CANCER- MORTALITY

Mortality varies 18-

fold between the

different regions of

the world,

less than 2 per

100,000 in Western

Asia, Western

Europe and

Australia/New

Zealand to more

than 20 per 100,000

in Melanesia (20.6),

Middle (22.2) and

Eastern (27.6)

COMPARISON OF THE TEN MOST FREQUENT CANCER DEATHS IN WOMEN

IN THE WORLD COMPARED TO DEVELOPING AND DEVELOPED REGIONS

(FOR 2012)

BURDEN OF CERVICAL CANCER- INDIA

In India, cervical

cancer contributes

to approximately 6–

29% of all cancers

in women.

The ASR is highest

23.07/100,000 in

Mizoram( Aizawl

city) state and the

lowest is

4.91/100,000 in

Dibrugarh district.


India has a population of approximately 365.71 million women above 15 years of age, who are at risk of developing cervical cancer.

The current estimates indicate approximately 132,000 new cases diagnosed and 74,000 deaths annually in India, accounting to nearly 1/3rd of the global cervical cancer deaths.

(Reference- WHO/ICO Information Centre on HPV and Cervical Cancer (Available from:http://www.who.int/hpvcentre.)


At any given time, about 6.6% of women in the general population are estimated to harbor cervical HPV infection.

HPV serotypes 16 and 18 account for nearly 76.7% of cervical cancer in India.

Warts have been reported in 2–25% of sexually transmitted disease clinic attendees in India; however, there is no data on the burden of anogenital warts in the general community.

BURDEN OF CANCER- BIHAR

Vaishali followed by Bhojpur, Begusarai,

Muzaffarpur and Patna districts have the

highest incidence of cancer in the state.

Mahavir Cancer Sansthan (MCS) has come

out with a new research saying over 50, 000

deaths are caused by cancer every year in

Bihar, while over 80,000 new cancer

patients come up every year in the state.



SIGNS AND SYMPTOMS OF CERVICAL CA

Mostly asymptomatic.

When present, common symptoms of cervical cancer may include:

Vaginal bleeding: This includes bleeding between periods, after sexual intercourse or post-menopausal bleeding.

Unusual vaginal discharge: A watery, pink or foul-smelling discharge is common.

Pelvic pain: Pain during intercourse or at other times may be a sign of abnormal changes to the cervix.

SIGNS AND SYMPTOMS OF CERVICAL CA

Cervical cancer may spread (metastasize) within the pelvis, to the lymph nodes or elsewhere in the body.

Signs of advanced cervical cancer include:

Weight loss

Fatigue

Back pain

Leg pain or swelling

Leakage of urine or feces from the vagina

Bone fractures


Introduction ( Anatomy/ Definition) Risk factors of cervical cancer Epidemiology/ problem statement Signs and symptoms of cervical cancer Screening of cervical cancer Diagnosis of cervical cancer Staging Prevention of cervical cancer. NCCP/NPDCS/NCRP Conclusion

SCREENING OF CERVICAL CANCER

Cervical screening is the process of

detecting and removing abnormal tissue

or cells in the cervix before cervical

cancer develops.

By aiming to detect and treat

cervical neoplasia early on, cervical

screening aims at secondary

prevention of cervical cancer.

CERVICAL CANCER SCREENING

Cervix is amenable to screening by a number

of methods

1. visual inspection with acetic acid (VIA),

2. magnified VIA (VIAM)

3. visual inspection with Lugol's iodine

(VILI),

4. the Papanicolaou test (also Known as

PAP test),

5. and HPV DNA testing.

VIA STRENGTH AND LIMITATIONS

Screening tests Strength Limitations

Acetic acid applied

to cervix to identify

cancerous and

precancerous cells

•Require less

training (5-15 days)

than others.

•Cheaper than PAP

and HPV testing

•Potential for

immediate

treatment ( Screen

and Treat)

•Variable sensitivity

and specificity for

CIN.

•Possibility of

overtreatment .

•Acetic acid must

be prepared directly

before screening.

• inappropriate for

older women( more

than 50 years)

because of change

in cervix position.

VIAM STRENGTH AND LIMITATIONS


•Acetic acid applied

to cervix.

•Viewed under low

magnification.

•Require less

training (5-15 days)

than others.

•Cheaper than PAP

and HPV testing

•Potential for

immediate treatment

( Screen and Treat)

•Same as VIA.

•Magnification does

not improve

performance more

than naked eye.

VILI STRENGTH AND LIMITATIONS


•LUGOL IODNE

applied to cervix to

identify cancerous

and precancerous

cells

•Process is often

added by

magnification tools.

•Require less training

(5-15 days) than

others.

•Cheaper than PAP

and HPV testing

•Potential for

immediate treatment (

Screen and Treat)

•Has a one month

shelf life.

•Variable sensitivity

and specificity for CIN

2+.

•Possibility of

overtreatment ..

PAP TEST

The Pap test is recommended for all women between the ages of 21 and 65 years old.

can be done in a doctor’s office or clinic.

During the Pap test, the doctor will collect a few cells and mucus from the cervix and the area around it.

The cells are then placed on a slide or in a bottle of liquid and sent to a laboratory.

HOW TO PREPARE FOR PAP TEST?

You should not schedule

your Pap test for a time

when you are having your

period.

If you are going to have a

Pap test in the next two

days—

You should not douche

(rinse the vagina with

water or another fluid).

You should not use a

tampon.

You should not have sex.

You should not use a birth

control foam, cream, or

HPV TESTING

The HPV test checks for the virus, not cell changes.

The test can be done at the same time as the Pap test, with the same swab or a second swab.

You won’t notice a difference in your exam if you have both tests.

A Pap test plus an HPV test (called co-testing) is the preferred way to find early cervical cancers or pre-cancers in women 30 and older.

WHEN TO START AND FREQUENCY OF

SCREENING

When to start Screening Age- 21 Years

Frequ

ency

of

scree

ning

PAP

TEST

21-29 YEARS EVERY 3 YEAR


Frequ

ency

of

scree

ning

PAP+

HPV(

Co-

testing

)

21-29 YEARS Not recquired


When to stop Age more than 65

years with adequate

negative prior

STRENGTH AND LIMITATIONS OF PAP TEST


Sample of cells

taken from

transformation one

of cervix.

Slide has to be

prepared and sent

to lab for

cytological

examination.

High specificity. Relatively low

sensitivity.

Require lab and

technicians.

Lag in result

may contribute to

loss of follow up

and delayed

treatment.

Require long

duration of training

of cytotechnicians

( 1-2 years)

STRENGTH AND LIMITATIONS OF HPV TEST

Screening

tests

Strength Limitations

Sample of cells

taken from cervix

by provider or

women herself.

Send to lab for

analysis by trained

technician.

High specificity

and high

sensitivity for HPV.

Require minimal

training

Women can self

collect sample.

Has to be

followed by test for

dysplasia.

Require lab and

technicians.

Lag in result

may contribute to

loss of follow up

and delayed

treatment.

Costlier as

compared to other

STUDIES PROVIDING ACCURACY OF

CERVICAL SCREENING TESTS

VIA IAM VILI PAP

SMEAR

HPV

TESTING

SE

N

SP

E

SE

N

SP

E

SE

N

SP

E

SE

N

SP

E

SE

N

SP

E

SHASHTRI

ET AL

59.7 88.4 69.7 87.3 75.4 84.3 57.4 98.6 62.0 93.5

SANKARN

ARAYAN

ET AL

71.2 89.1 - - 76.9 86.3 70.0 98.6 69.1 93.6

GREVITT

ET AL

31.5

6

87.4

5

- - - - 78.2

4

85.8

8

100 90.6

SUMMARY 67.6

5

84.3

2

65.3

6

85.7

6

78.2

7

87.1

0

62.1

1

93.5

1

77.8

1

91.5

4



DIAGNOSIS OF CERVICAL CANCER

If the Pap test showed some abnormal

cells, and the HPV test is also positive,

the doctor may suggest 1 or more of the

following diagnostic tests:

Colposcopy

Biopsy

Pelvic examination

X-Ray


CT Scan ( CAT Scan)

PET/PET-CT Scan

Cystoscopy

MRI

Proctoscopy

Laproscopy

COLPOSCOPY

The colposcope is

not inserted into the

woman’s body and

the examination is

not painful, can be

done in the doctor's

office, and has no

side effects.

It can be done on

pregnant women

also.

BIOPSY

Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis.

If the lesion is small, the doctor may remove all of it during the biopsy.

There are several types of biopsies:

TYPE OF BIOPSY- ECC

One common method uses an instrument to

pinch off small pieces of cervical tissue.

endocervical curettage (ECC) has been

done to check an area inside the opening of

the cervix,.

the doctor scrapes a small amount of tissue

from inside the cervical opening.

TYPE OF BIOPSY- LEEP/CONE BIOPSY

A loop electrosurgical excision procedure (LEEP) uses an electrical current passed through a thin wire hook.

The hook removes tissue for examination in the laboratory.

A LEEP may also be used to remove a precancer or an early-stage cancer.

Conization (a cone biopsy) removes a cone-shaped piece of tissue from the cervix.

Conization may be done as treatment to remove a precancer or an early-stage cancer.


Pelvic examination. The specialist may re-

examine the pelvic area while the patient is

under anesthetic to see if the cancer has

spread to any organs near the cervix,

including the uterus, vagina, bladder, or

rectum.

X-ray.

intravenous urography


Computed tomography (CT or CAT) scan.

A CT scan can also be used to measure the

tumor’s size.

Sometimes, a special dye called a contrast

medium is given before the scan to provide

better detail on the image.

This dye can be injected into a patient’s vein

or given as a pill to swallow.


Magnetic resonance imaging (MRI). MRI

can also be used to measure the tumor’s

size.

Positron emission tomography (PET) or

PET-CT scan. A PET scan is usually

combined with a CT scan , called a PET-CT

scan

A PET scan is a way to create pictures of

organs and tissues inside the body.


Cystoscopy. A cystoscopy is used to

determine whether cancer has spread to the

bladder.

Proctoscopy (also called

sigmoidoscopy). A proctoscopy is used to

see if the cancer has spread to the rectum.

Laparoscopy. A laparoscopy is a procedure

that allows the doctor to see the spread of

cancer within abdominal cavity.



STAGING OF CERVICAL CANCERFIGO (INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS) STAGING

SYSTEM

Stage I. Cancer is confined to the cervix.

Stage II. Cancer is present in the cervix and

upper portion of the vagina.

Stage III. Cancer has moved to the lower

portion of the vagina or internally to the pelvic

side wall.

Stage IV. Cancer has spread to nearby organs,

such as the bladder or rectum, or it has spread

to other areas of the body, such as the lungs,

liver or bones.

STAGING OF CERVICAL CANCERAJCC (AMERICAN JOINT COMMITTEE ON CANCER) TNM STAGING

SYSTEM

The extent of the main tumor (T)

Whether the cancer has spread to nearby

lymph nodes (N)

Whether the cancer has spread

(metastasized) to distant parts of the body

(M)



PREVENTION OF CERVICAL CANCER

Majority of the women become infected with HPV at some point in their lives, soon after the onset of sexual activity.

The lifetime risk for genital HPV is 50–80% and genital warts is approximately 5%.

In women who undergo routine screening, the risk of having an abnormal Papanicolou (Pap) smear is 35%, CIN 20% and ICC is <1% approximately.

Both HPV Vaccination ( Primary Prevention) and Screening ( Secondary prevention) is important for prevention of cervical cancer.

WHY VACCINATION IS THE BEST FORM OF

PREVENTION

There is no clear evidence that barrier methods of contraception, most notably use of condoms, confer a protection against HPV infection.

Secondly, except for genital warts, the infection is asymptomatic.

Adherence to routine screening by the susceptible female population through periodic Pap smears even in developed countries has been unsatisfactory.

In developing countries like India, large-scale routine screening is difficult to achieve.

DEVELOPMENT OF HPV VACCINE HISTORY

Recombinant DNA technology is used to express the L1 major capsid protein of HPV in yeasts (Saccharomyces cerevisiae), which self-assemble to form empty shells resembling a virus, called virus-like particles (VLPs).

The VLPs have the same outer L1 protein coat as HPV but contain no genetic material.

The vaccine uses these VLPs as antigens to induce a strong protective immune response.

TYPES OF HPV VACCINE

Two vaccines licensed globally are available in

India; a quadrivalent vaccine (Gardasil™

marketed by Merck) and a bivalent vaccine

(Cervarix™ marketed by Glaxo Smith Kline).

Clinical trials with both vaccines have used

efficacy against CIN-2/3 and

adenocarcinoma in situ (AIS) caused by HPV.

These vaccines do not protect against the

serotype with which infection has already

occurred before vaccination.

GARDASIL

Gardasil™ is a mixture of

L1 proteins of HPV

serotypes 16, 18, 6 and 11

with aluminum-containing

adjuvant.

Clinical trials with three

doses at 0, 2 and 6 months

in more than 16,000

women aged 16–26 years

from five continents,

including Asia, have

shown 100% efficacy .

This vaccine confers

protection against both

cervical cancer and genital

warts.

CERVARIX

Cervarix™ is a mixture of L1

proteins of HPV serotypes

16 and 18 with AS04 as an

adjuvant.

Clinical trials with three

doses at 0, 1 and 6 months

in more than 18,000 women

globally has shown 90%

efficacy against type 16/18-

related CIN-2/3 and AIS .

Follow-up studies in a

subset of participants over

4–5 years showed no

evidence of waning

immunity.

This vaccine confers

protection only against

EFFICACY OF VACCINES

Participants who were already positive to any

vaccine HPV types before vaccination

acquired protection against disease caused

by other vaccine types.

Additionally, 99–100% efficacy was reported

against vaccine-type related genital warts,

vaginal intraepithelial neoplasia and vulvar

intraepithelial neoplasia.

EFFICACY OF VACCINES

Immunogenicity studies in females aged 9–15 years showed antibody titers non-inferior to those aged 16–26 years.

In a combined analysis of all participants over 3 years and a subset through 5 years, efficacy against vaccine-HPV type disease was 95.8% and efficacy against vaccine-type-related CIN or external genital lesions was 100%.

Longer follow-up studies are under way.

DOSAGE AND SCHEDULE

The vaccine dose is 0.5 mL given

intramuscularly, either in the deltoid muscle or in

the antero-lateral thigh.

It is available as a sterile suspension for

injection in a single-dose vial or a prefilled

syringe.

HPV vaccines can be given simultaneously with

other vaccines such as Hepatitis B and Tdap.

At present, there is no data to support the use of

boosters.

DOSAGE AND SCHEDULE

The recommended age for initiation of vaccination is 9–12 years.

Catch-up vaccination is permitted up to the age of 26 years.

A total of three doses at 0, 2 and 6 months are recommended with Gardasil™ or 0, 1 and 6 months with Cervarix™ (minimum interval of 4 weeks between the first and the second dose, 12 weeks between the second and third dose and 24 weeks between the first and third dose).

DOSAGE AND SCHEDULE

If the HPV vaccine schedule is interrupted,

the vaccine series need not to be restarted.

If the series is interrupted after the first dose,

the second dose should be administered as

soon as possible, with an interval of at least

12 weeks between the second and third

doses.

If only the third dose is delayed, it should be

administered as soon as possible.

SIDE EFFECT AND CONTRAINDICATIONS

The most common adverse reactions are local reactions like pain (mild to moderate) in 83%, swelling with erythema in 25% and systemic adverse effects such as fever in 4% of the vaccinees.

No serious vaccine-related adverse events have been reported.

The HPV vaccine is currently not licensed for use in female patients younger than 9 years or older than 26 years or for use in male patients.


It is contraindicated in people with a history of immediate hypersensitivity to yeast or to any vaccine component.

The vaccine should be deferred in patients with moderate or severe acute illnesses.

The vaccine may be administered in a sitting or lying down position and the patient should be observed for 15 min post-vaccination for syncope.


The vaccine is not recommended for use in pregnant women.

Although it has not been causally associated with adverse outcomes of pregnancy, data are limited.

Any exposure to the vaccine during pregnancy must be immediately reported.

Lactating women and immunosuppressed female patients can receive the vaccine.

The efficacy and the degree of immune response could be poor in the immunosuppressed group.

HPV VACCINATION IN MALE

HPV vaccine is not licensed for use among males in India.

Efficacy studies among males are under way.

Australia is the first country to approve the quadrivalent HPV vaccine in males (between 9 and 15 years old), and the vaccine was approved for administration to males between the ages of 9 and 26 years in other developed nations.

IAP RECOMMENDATIONS

The Indian Academy of Pediatrics Committee on Immunisation (IAPCOI) recommends offering HPV vaccine to all females who can afford the vaccine (Category 2 of IAP categorisation of vaccines).

The Advisory Committee on Immunization Practices currently recommends routine vaccination of females aged 11–12 years with three doses of the HPV vaccine.

Vaccination can be given to females as young as 9 years as well as in those aged 13–26 years who have not previously completed vaccination.

CONCERN AND SAFETY

The primary obstacle to HPV vaccination is

financial.

Because of the high cost of the present

vaccines, the affordability and accessibility of

these vaccines is a major concern for a mass

vaccination program in developing countries

like India.

CONCERN AND SAFETY

One study in India has been conducted by the State governments in collaboration with the Indian Council of Medical Research (ICMR) and PATH for operational feasibility .

The other was a clinical trial to investigate the immunogenic efficacy of two doses (6 months apart) compared with the conventional three doses (0–2–6 months) of Gardasil.

There were allegations in the media of vaccine-caused death of four girls in north India, and the Union Government suspended both studies and initiated enquiry into the safety of both vaccines.

CONCERN AND SAFETY

The causes of death have been scrutinized by the State Government and reported to ICMR and DCGI; all were satisfied that no deaths were related to the vaccine.

The vaccines continue to remain as a licensed product approved by the DCGA.

To date, no deaths have been causally associated with HPV vaccination in India or elsewhere.

LACUNAE AND FUTURE

More research is needed regarding duration of protection induced by these vaccines, need for boosters, effect on prevalence and incidence of HPV types included in the vaccine.

The efficacy in female patients older than 26 years and in male patients, the role of routine HPV vaccine in males for prevention of genital warts and emergence of other rarer HPV types after the current common types are controlled has to be studied in detail.

LACUNAE AND FUTURE

The effect on cervical cancer screening practices, safe sex behavior and further economic analysis are a few questions to be answered in the future.

As prophylactic, vaccines will be effective pre-exposure to virus and, hence, the target population for vaccination will be 9–10-year-old pre-pubertal girls, but this will raise cultural and social issues.

There is an urgent need to conduct epidemiological studies in countries like India on the long-term efficacy, logistics and economics of universal HPV vaccination in eligible females.



NATIONAL CANCER CONTROL PROGRAMME

NCCP-1984

NPDCS-2010

NPCDCS-

2011MDCCPNCRP/ICM

R


The National Cancer Control Programme for India was formulated in 1984 with four major goals:

1. Primary prevention of tobacco related cancers.

2. Early detection of cancers of easily accessible sites

3. Augmentation of treatment facilities, and

4. Establishment of equitable, pain control and palliative care network throughout the country.


National programme for prevention and control of Diabetes, cardiovascular disease and stroke (NPDCS) was initiated in 2010.

National cancer control programme (NCCP) has been integrated with NPDCS to formulate a national programme for control of cancer, Diabetes, cardiovascular disease and stroke (NPCDCS) in 2011.

The focus of NPCDCS is on promotion of healthy lifestyle, early diagnosis and management.

EXISTING SCHEMES UNDER NPCDCS

Financial Assistance to Voluntary

Organizations

District Cancer Control Scheme

Cobalt Therapy Installation

Development of Oncology Wings in Govt.

Medical College Hospitals

MODIFIED DISTRICT CANCER CONTROL PROGRAMME

Modified District Cancer Control Programmehas been initiated in four states namely Uttar Pradesh, Bihar, Tamil Nadu & West Bengal.

This will be a Survey , in which about 12 lakhwomen in the age group 20–65 years are being contacted.

Health education about general ailments, cancer prevention and early detection besides ‘Self Breast Examination’ will be imparted.

The project will be completed in about a year’s time.

NATIONAL CANCER REGISTRY PROGRAMME( NCRP)

The NCRP commenced by the ICMR in December 1981

NCRP is now working on the objectives of collection of authentic data on cancer occurrence, and helping national programmefor control of cancer, Diabetes, cardiovascular disease and stroke (NPCDCS)

NCRP began with a population based cancer registries (PBCRs) at Bangalore, Chennai, Mumbai and hospital-based cancer registries (HBCRs) at Chandigarh, Dibrugarh, and Thiruvananthapuram.

NATIONAL CANCER REGISTRY PROGRAMME( NCRP)

NCRP, it has been now been extended to cover other common noncommunicable diseases under the National Centre for Disease Informatics and Research (NCDIR) under the ICMR in March 2011.

The broad and overall objectives of the NCDIR is to sustain and develop a national research data-base on cancer, diabetes, CVD and Stroke

The current thrust areas of NCDIR are cancer registries, patterns of care and survival studies (POCSS) and development of software applications programmes.

NATIONAL CANCER AWARENESS DAY

Cancer Awareness day was first observed on 7–

11–2001.

Hon’ble Min. of State, Ministry of

Communications Shri Tapan Sikdar at Vigyan

Bhawan on the same day, released a

commemorative stamp on Cancer and first day

cover portraying Madame Curie.

A newspaper advertisement on National Cancer

Awareness Day was also released in prominent

dailies across the country.


Introduction ( Anatomy/ Definition) Risk factors of cervical cancer Epidemiology/ problem statement Signs and symptoms of cervical cancer Screening tests Diagnosis of cervical cancer Staging Prevention of cervical cancer. NCCP/NPDCS/NCRP Conclusion references

CONCLUSION

HPV vaccination is for primary prevention (serotype-specific with limited cross-protection) of carcinoma cervix.

A cost-effective second-generation HPV vaccine is needed for developing countries to address various issues specific to the region.

However, till such time, secondary prevention through periodic cervical cancer screening should be in place to use the existing infrastructure and cost-effective screening methods such as Pap smear and HPV DNA tests.

CONCLUSION

There is no risk of getting an HPV infection

from the vaccine as the vaccine does not

contain live virus.

HPV vaccination and regular cervical

screening is the most effective way to

prevent cervical cancer.

REFERENCES

1. World Health Organization. HPV IARC monograph

summary. Lancet Oncol. 2005;6:204.

2. Dunne EF, Markowitz LE. Genital human Papillomavirus

infection. Clin Infect Dis. 2006;43:624–9.

3. Carter JJ, Koutsky LA, Hughes JP, Lee SK, Kuypers J, Kiviat N, et

al. Comparison of human papillomavirus types 16, 18, and 6 capsid

antibody responses following incident infection. J Infect

Dis. 2000;181:1911–9.

4. Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB.

Mathematical model for the natural history of human papillomavirus

infection and cervical carcinogenesis. Am J

Epidemiol. 2000;151:1158–71

5. Bosch FX, de Sanjosé SS. Human papillomavirus and cervical

cancer - burden and assessment of causality. J Natl Cancer Inst

Monogr. 2003;31:3–13.

6. Munoz N, Castellsague X, de Gonzalez AB, Gissmann L. HPV in

the etiology of human cancer. Vaccine. 2006;24:S1–10.

REFERENCES

7. American College of Obstetricians and Gynecologists. HPV

Vaccine - ACOG Recommendations. [Last Accessed on 2008,

April 28]. Available

from: http://www.acog.org/departments/dept_notice.cfm?recno=

7andbulletin=3945 .

8. Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris

DG, et al. Gynaecologic Cancer Advisory Group. American

Cancer Society guideline for human papillomavirus (HPV)

vaccine use to prevent cervical cancer and its precursors. CA

Cancer J Clin. 2007;57:7–28.

9. Choudhury P, John TJ. Human papilloma virus vaccines and

current controversy. Indian Pediatr. 2010;47:724–5.

10. Choudhury P, Yewale V. Human papilloma virus vaccines and

current controversy-reply. Indian Pediatr. 2011;48:248–9.

http://www.acog.org/departments/dept_notice.cfm?recno=7andbulletin=3945

THANK

S

Health & Medicine

Epidemiology of Cervical cancer