Analysis of Cervical Cancer

1. A Analysis of diagnostic interventions in the screening,
detection and prevention of cervical cancer / cervical
intraepithelial neoplasia.
Presented by
Dr Himanshu Thukral

2. Introduction
 Cervical carcinoma is one of the most common and dreaded diseases of women,
and in India, it accounts for 16 per cent of total cervical cancer cases occurring
globally.
 All high-risk HPV types (including HPV 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56,
58, 59, 66, 68, 73, and 82) thus, accounting for majority of the HPV infections
associated with more than 85% of the cervical cancer cases in India.
 The establishment of a strong link between high-risk persistent human
papillomavirus (HPV) infections and the occurrence of cervical cancer has resulted
in the recent development of HPV related control strategies for the prevention of
cervical cancer.

3. Screening
 VIA / VILI-based screening was recommended as it is a low-cost point-of care diagnostic test.
 Cervicography
 Speculoscopy
 A cytology (Pap Smear)-based screening programme takes around two weeks to make the
result of screening test available, hence loss of follow up can be high. Other type – LBC
 HPV DNA- HPV DNA based test as the preferred method than cytology or VIA. Following are
the HPV DNA assays
 Digene
 Hologic
 Gen Probe
 Roche molecular system

4. Fig 1. Primary HPV testing with partial genotyping and cytology triage management flow chart.
Hall MT, Simms KT, Lew JB, Smith MA, Saville M, et al. (2018) Projected future impact of HPV vaccination and primary HPV
screening on cervical cancer rates from 2017–2035: Example from Australia. PLOS ONE 13(2): e0185332.
https://doi.org/10.1371/journal.pone.0185332
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185332

5. Screening Cost
 Unit cost of screening a patient with VIA/VILI was INR 344 of which INR 103 was
spent on the visual inspection and rest (INR 241) on the support activities.
 unit cost of INR 980 was spent on screening a women with HPV DNA, of which INR
162 and INR 578 was spent on sample collection and laboratory processing.
 INR 652 was consumed per women screened with Pap test, of which INR 118, INR
293 and INR 241 was spent on sample collection, lab processing and support
activities respectively

6. Detection Kits
These are many home
collection kits where sample is
collected is your own and sent
to lab for testing.

7. Prevention
 9-valent HPV vaccine
This vaccine is available under the name of Gardasil 9 9vHPV.
 Bivalent HPV vaccine
This is available under the name of Cervarix 2vHPV.
 Quadrivalent HPV vaccine
This vaccine type is available under the name of Gardasil 4vHPV.
 All 3 of these vaccines are licensed by the USFDA (United States Food and Drug
Administration). These vaccines offer protection against HPV 16 and HPV 18, which are
the main cause of most HPV cancers.
 Other than vaccines common prevention methods such as having one partner, using
condom, having sexual interaction at adult age.

8. Treatment
 CIN1 include monitoring for progression with treatment of only persistent lesions
(at least 2 years) by way of ablation or excision.
 Treatments for CIN2 and 3 include ablative or excisional procedures.
 The primary target antigens for the majority of developing therapeutic vaccines are
the viral proteins E6 and E7.

9. Future Aspects
 On Analysing the status of HPV vaccination in the country and found that despite the efforts
to introduce HPV vaccination in the National Immunization Programme and bring down the
vaccine cost, challenges such as inadequate epidemiological evidence for disease
prioritization, duration of vaccine use, and vaccine acceptance in implementing HPV
vaccination in India appeared to be major hurdle.
 One inexpensive and easily affordable tumour marker which has been tried by different
workers is AgNOR pleomorphic counts which showed rise with severity of cervical lesions. (If
screening to be done once after 40 years as per WHO)
 There is also a need for educational intervention and awareness programme not only to
augment HPV immunization programme but also screening for a primary prevention and
control of cervical cancer in India. (A book or note guiding women)
 For various issues specific to the region, a cost-effective second-generation vaccine is the
need of the hour.
 Interpretation of cytology images by artificial intelligence software.

10. Under Investigations for Prevention
 Presently, carrageenan is used as a thickening agent in some commercially
available sexual lubricants, lubricated condoms, and infant formula. Clinical trials
are needed to determine whether carrageenan-based products are effective
as topical agents to prevent genital HPV transmission.
 VGX-3100 Delivered Intramuscularly Followed by Electroporation With
CELLECTRA™-5PSP for the Treatment of HPV-16 and/or HPV-18 Related High
Grade Squamous Intraepithelial Lesion (HSIL) of the Cervix.
 A peptide-vectored vaccine using HPV 16 E6 peptides called PepCan is currently
being studied in a phase II trial.

11. Thank You