HPV prevention, HPV disease , Cervical cancer , cervical cancer prevention , cervical cancer and control Impact of Vaccination & Screening for woman

1. STRATEGIES TO
PREVENT & CONTROL
HPV INFECTION
AND CERVICAL CANCER
DR. SHARDA JAIN
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar

2. Review this Lecture and others at:
Slideshare.net/lifecarecentre
STRATEGIES TO PREVENT & CONTROL
HPV INFECTION AND CERVICAL CANCER

3. 3
Take home messages of 2 symposium on
Burden of HPV infection and Cervical cancer
Delhi 4/7/2015

4. Presentation Outlines
•Facts on cancer cervix
•Strategy to prevent and control HPV
infection and cervical cancer
•Need of HPV vaccination

5. An Airbus-320 full of WOMEN crashing every day in India
Deaths Due to CaCx
JUST THINK!!!

6. WHO has estimated that
India contributes to
ONE –THIRD
of the Global burden of
Incidence
Deaths
Due to Cervical Cancer

7. Women with
• multiple sexual partners are at a higher risk of
cervical cancer
• Women who being sexual activity before 16 years
of age
• Who are sexually active within year of the onset
of menses.
Who are at risk of Cervical Cancer ?
SEXUAL ACTIVITY
1

8. • STDs such as HIV are associated with an
increased incidence of human papilloma virus
(HPV) infections
• Persistent HPV and cervical dysplasia
substantiate their role in carcinoma of the
cervix.
Who are at risk of Cervical Cancer ?
STD
2

9. Women of the lower socioeconomic status
may not be aware of the illness they are
suffering from and also may not be able to
afford healthcare services , thereby
facilitating the progression of cervical
precursor lesions.
Who are at risk of Cervical Cancer ?
LOWER SOCIOECONOMIC STATUS
3

10. Some studies have indicated that
smokingcan be considered as a risk
factor owing to the direct or indirect systemic
effects on the immune system and local
effects of the certain carcinogens in tobacco.
4
Who are at risk of Cervical Cancer ?
SMOKING 4

11. Certain other studies have recorded an
increase in the occurrence of cervical
carcinoma in people whose immune system
has been suppressed either due to some
disorder or following organ transplants.
Who are at risk of Cervical Cancer ?
COMPROMISED IMMUNE SYSTEM 5

12. While most women tend to remain asymptomatic
for many months to years,
abnormal discharge and postcoital bleeding
may be observed in majority of women with
precancerous lesions.
HPV Infection &
Precancerous Lesions

13. •Primary: Vaccination against HPV
Cervical Cancer: Prevention
and Control
Need a comprehensive approach
that includes
CATCH UP
VACCINATION
No Upper Age
Limit
Preferrably
in
ADOLESCENT
GIRLS
1

14. Cervical Cancer: Prevention
and Control
•Secondary: Screening, detection,
and treatment of pre-cancers
2

15. Cervical Cancer: Prevention
and Control
•Tertiary: Invasive cervical cancer
management and palliative care
3

16. Impact of Vaccination
& Screening for
Precancerous lesions

17. In countries without existing
screening programmes
Like India
Modelling studies suggest that vaccination is
likely to be the most effective option to
reduce the incidence of cervical cancer2,4
2. Goldie SJ, et al. J Natl Cancer Inst 2004; 96:604–615; 4. Goldie SJ, et al. Int J Cancer
2003; 106:896–904;

18. screening programmes for cervical cancer
•Vaccination +screening are more
effective and cost-effective than
screening alone for the prevention of
cervical cancer and cervical pre-
cancer1,2, 3
1. Garnett GP et al. Vaccine 2006; 24:S178–S186; 2. Goldie SJ, et al. J Natl Cancer Inst 2004; 96:604–
615; 3. Elbasha EH, et al. Emerg Infect Dis 2007; 13:28–41
In countries with established screening
programmes

19. •Screening should continue in order to
detect disease related to non-vaccine
HPV types
•Screening intervals are likely to
increase once widespread vaccination
occurs
1. Garnett GP et al. Vaccine 2006; 24:S178–S186; 2. Goldie SJ, et al. J Natl Cancer Inst 2004; 96:604–
615; 3. Elbasha EH, et al. Emerg Infect Dis 2007; 13:28–41
Screening programmes for cervical Cancer

20. TAKE HOME MESSAGE
Vaccination& Screening
BOTH are Complementary
to each other,
NOT Substitutes !

21. CONVENTIONAL
CERVICAL CANCER
SCREENNG
KINDLY SEE 2013 GUIDELINES OF SIX
INSTITUTIONS AND FOLLOW STRICTLY

22. SCR
The decreased incidence of cervical
cancers in developed countries can be
attributed to early and consistent
cancer screening programme In these
counties.
WHO
Screening programmes for cervical Cancer

23. CONVENTIONAL CERVICAL
CANCER SCREENNG
In India,
cervical cancer screening coverage
for all women aged 18-69 yrs
screened every 3 years
is only 2.6%

24. This finding necessitates the importance
of start of cancer cervix screening in
India to avoid the huge morbidity and
mortality associated with cervical cancer.
CONVENTIONAL CERVICAL CANCER
SCREENNG

25. 1.Stanley M. Vaccine 2006; 24: S106-13, 2.Tindle RW. Nat Rev Cancer 2002;2: 59-65, 3.Stanley M. Vaccine
2006; 24: S16-22, 4. Stanley M. HPV Today 2007; 11: 1-16
No viremia
Local infection, local immunosuppression
No cell death, no inflammation, no danger signals
Natural HPV infection induces a weak immune response and does not
offer full protection against new HPV infection.1-4
Need of HPV Vaccination
We need vaccines that induce high immune response than natural
infection

26. Blood Cervical epithelium
1. Parr EL et al. J Virol 1997;71:8109-15, 2. Nardelli HD et al. J Natl Cancer Inst 2003;95:1128-37, 3. Schiller JT et al. Nat
Rev Microbiol 2004;2:343-7, 4. Poncelet et al. ESPID, Porto, Portugal 2007; Abstract 37, session ES2, 5. Stanley M. HPV
Today 2007; 11: 1-16, 6. Einstein M, Cancer Immunol Immunother 2007; 57:443-51.
• Vaccination induces antibodies
in the blood and vaccine-induced
antibodies can reach to the site of
infection1-3
• Higher antibody levels in the blood
mean higher antibody levels at the
site of infection4
• These antibodies neutralize the virus
and prevent entry into cells5,6
Need of Vaccination

27. Take Home Message
HPV VACCINATION
FOR
ADOLESCENT GIRLS
is
PRIORITY
NUMBER ONE

28. Take Home Message
SCREENING IS A MUST
PAP’S SMEAR
(21-65 YRS)
Or
SEE &TREAT
To Detect Early & Treat
Precancerous Cervical
Lesions is
Priority Number 2

29. Take Home Message

30. 30
THANK
YOU
SYMPOPSIUM
DELHI
4/7/2015
DR. SHARDA JAIN DR. SHYAM KUKREJA

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