1. Abboud
Abdo,MD,FRCSC,Gynecologic
Oncologist.
DhahranHealthCenter
SaudiAramcoMedicalServicesOrganisation

3. 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

4. Primaryprevention:Preventsdiseasefromoccurring.
HPVvaccine
Secondaryprevention:Detectsandcuresdiseaseinthe
asymptomaticphase:PapSmear,HPVtest,Colposcopy
Tertiaryprevention:Reducescomplicationsofdisease.

6. WHO2007

7. Cervix uteri (Non Saudis)473.9%2.34.2

9. 0
20
40
60
80
100
120
CervicalCancer:NumberofNewCases1994-­2007

10. PresenceofHumanPapillomaVirus(HPV)
LifestyleactivitiesincreasingexposuretoHPV
DecreasedImmunocompetency
Cofactors:Smoking,OtherSTD
Neverbeenscreened,orinadequatelyscreened:
50%ofcervicalcancerpatientsneverhadaPapSmear
10%werenotscreenedwithinthelast5years

13. Detectspre-­invasiveneoplasia
Twotechniques,bothacceptable
ConventionalPapSmear,fixedonaglassslide.
Liquidbased,thinlayerpreparation.
Collectionfor
HPVtest:highriskserotypes,orgenotypes16/18
OtherSTDs
Biopsyanyvisiblelesion

14. 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.

15. 10,000
cancers
300,000HSIL(High-Grade
precancerouslesions)
1.25millionLSIL(Low-Grade
precancerouslesions)
2-3millionASC(Atypical
SquamousLesions)
50-60millionwomenscreened

18. 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

19. 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

20. 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.

22. Intendedforprevention.ItdoesnottreatHPV
anddoesnotinterferewithpreexistingdisease.
MosteffectiveinHPVnaïvepeople.
Ideallybeforesexualexposure
Age:Between9yand12y.Catch-­uptill26y.
PreviousabnormalPaporHPVdiseaseisnota
contraindication,butefficacyisless.
Durationofprotection??(>8y)
Safety:PreandPostlicensuredata.

23. Preventionisbetterthancure.
“Anappleadaykeepsthedoctoraway”
Awellappliedprogramofcervicalscreening
andHPVvaccinekeepcervicalcanceraway.
Becauseitisalmostalwayspreventable,each
caseofcervicalcancershouldbeconsidereda
failureofthemedicalsystem.