oncology

1. Cervical Cancer Prevention
–
Current Scenario
Partha Basu
Associate Prof. & Head
Dept. of Gynecologic Oncology
&
In Charge, Preventive Oncology Division
Chittaranjan National Cancer Institute, Kolkata

2. ‘Persistent Infection
With Oncogenic HPV is
THE NECESSARY CAUSE
of cervical cancer’
IARC Working Group. (1995) Human papilloma viruses.
IARC
Monograph on the evaluation of carcinogenic risks to
humans

3. ScreeningVaccination Treatment
15 years 30 years 45 years
Target age groups of different interventions

4. HPV
>100 types
Ano-genital
40 types
Others
Oncogenic
~20 types
Non-oncogenic
Types 16, 18 cause
>70% cervical cancers
Types 6, 11 cause
genital warts

6. Normal
epithelium
Basement membrane
Basal (stem)
cells
Parabasal
cells
Squamous
layer
Mature
squamous
layer
Infected
epithelium
Cervical canal
HPV Lifecycle in the Cervix
Frazer IH. Nat Rev Immunol 2004; 4:46–54.
Infection of basal
cells (E1 & E2)
Viral assembly
(L1, L2, E4)
Shedding of virus-
laden epithelial cells
Episomal viral DNA
in cell nucleus
(E1 & E2, E6 & E7)
Viral DNA replication
(E6 & E7)

7. Composition of HPV
vaccines
+
HPV 16 VLPs HPV 18 VLPs
Antigens AS04 Adjuvant system
AS04-containing vaccine
+
Aluminium
salt
(Al(OH)3)
MPL
I(monophosp
horyl lipid A)
t
CervarixTM
+ Aluminium salt
(amorphous aluminium
hydroxyphosphate
sulphate)
HPV 16 VLPs HPV 18 VLPs HPV 6 VLPs HPV 11 VLPs
Antigens
AAHS-containing vaccine
Adjuvant
Gardasil®

9. HPV Type Prevalence by Age
0
2
4
6
8
10
12
<35 35-44 45-54 >54
%
Age
HPV16/18 All HPV HC2+ve
Basu et al. Int J Gyn Pathology

10. HPV TYPE SOUTH (%) NORTH (%) EAST (%) CENTRAL (%)
16 53.6 65.2 63.6 56.0
18 10.9 10.9 6.8 17.3
31 0 0 3.4 0
33 7.2 2.2 2.3 4.0
45 1.4 0 3.4 1.3
52 2.9 0 0 1.3
53 1.4 0 0 0
56 1.4 0 0 4.0
16+18 1.4 2.2 5.7 4.0
16+18+45 1.4 0 0 0
16+31 0 0 2.3 2.7
16+52 1.4 0 1.1 0
58+33 1.4 0 0 2.7
62+33 1.4 0 0 0
NEG 5.8 15.2 10.2 5.3
Genotype Distribution in Cx Ca in India
78.365.9 76.1 77.3
(Int J Microbiology 2010; Basu et
al)

11. Quadrivalent Vaccine: Combined
Phase II/Phase III Efficacy
HPV types Endpoint Efficacy 95% CI
16,18 CIN 2/ 3 or AIS
16, 18 CIN 2
16, 18 CIN 3
16, 18 AIS
99 %
100 %
98 %
1. The Future II Study Group. Lancet 2007; 369: 1861–68
93-100
93-100
89-100%
100 % 31-100%

12. 18-24 yrs
age cohorts
J Infectious Dis 2012

13. Read T R H et al. Sex Transm Infect 2011;87:544-547

15. Finnish Cancer Registry Data
CIN 3 CA Cx Incidence
of CIN 3+
HPV 6/11/16/18
vaccinated
(N=866)
0 0 0/100,000
person yrs
Placebo Cohort
(50% vaccinated
later) (N=861)
3 0
Unvaccinated
(N=15719)
59 3 98.6/100,0
00 person

16. Medicines and Healthcare products
Regulatory Agency (MHRA) UK

17. Safety of Cervarix
Vast majority of suspected AEs
are
◦ recognised side effects
◦ due to the injection process
◦ events that occur commonly in the
population receiving the vaccine
following substantial usage, no
serious new risks have been
identified

18. “Post-licensure surveillance data
for each vaccine have detected no
safety issues to date (as at
November 2011) except rare
reports of anaphylaxis”

19. Details of Death Reported
(From Press note of Health Minister- AP)

20. WHO Position Paper
 Vaccination should be
introduced into national
immunization program
 Prioritize high coverage in
target population of girls 9-10
through 13 yr.

21. Cytology Sensitivity
to Detect CIN 2 & CIN 3: 29.5%

22. Poor-Moderate Sensitivity of
Cytology

23. Specimen Collection
Using the DNA Collection Device
1
2
3
4

24. Sensitivity of a single HPV
test

25. Screening Interval Can be
Increased

42. • TREATMENT• DIAGNOSIS
• COVERAGE• SCREENING
Targeted
IEC
Assess
Impact of
Program
Develop
Protocol/
Guideline
Build
Capacity &
Infra-
structure