Hpv prevelance and distribution amoung saudi

1. {
“Human Papillomavirus Prevalence
and Type Distribution Among Women
Attending Routine Gynecological
Examinations in Saudi Arabia”
ISMAIL AL-BADAWI, MD, MBChB, FRCSC
Chairman
Department of Obstetrics & Gynecology
King Faisal Specialist Hospital & Research
Centre
Associate Professor, AlFaisal University

3. Saudi Arabia Cervical Cancer Incidence
Percentage distribution of cancer incidence among Saudis by
sex, according to age group.
Source: Saudi Cancer Registry, 2002

4. GLOBOCAN DATA (http://www-dep.iarc.fr/)
Cervical Cancer Data - Incidence

5. Saudi Arabia Cervical Cancer Incidence
Age specific incidence rate for Cervical Cancer in Saudi Arabia
Source: Saudi Cancer Registry, 2002

6. Incidence of cervical cancer in Saudi
Arabia, Western Asia and the World

7. Estimated number of new cases of cervical cancer in
Saudi Arabia by age group, in 2002 and projected in 2025

8. Strength of the Associations Between
Risk Factors and Human Cancer
HBsAG=hepatitis B surface antigen; HBV=hepatitis B virus; HCV=hepatitis C virus;
HRT=hormone replacement therapy.
Bosch FX et al. J Clin Pathol. 2002;55;244-265.
BASELINE REFERENCE
Cigarette smoking and lung cancer
Smoking cessation before middle age and lung cancer
HPV-DNA – 18 and cervical adenocarcinoma in the Philippines
HPV-DNA – 16 and cervical cancer in Costa Rica
HPV-DNA and cervical cancer in Bangkok
HBsAg and liver cancer in Taiwan
HCV and liver cancer in Italy
HBV vaccination adults in Korea and liver cancer
HBV vaccination newborns in Taiwan and liver cancer
HBsAg and liver cancer in Greece
1
> 500
100
20
10
0.1
0.6
0.1
50
RR / OR AF (%)
90
40
90
90
60
40
80
99
80
60
PF (%)HRT and breast cancer1.4

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10.  6.51 million Saudi women ages 15 years and older at risk of developing cervical cancer.
 Every year
 271 women diagnosed with cervical cancer
 143 die from the disease
 Cervical cancer ranks (women aged 15 and 44 years of age) as
 7th most frequent cancer among women in Saudi Arabia, and
 8th most frequent cancer among women
Data is not yet available on the
HPV burden in the general
population of Saudi Arabia. ???????
 In Western Asia about 2.2% of women in the general population are estimated to harbour
cervical HPV infection at a given time
WHO Report on Cervical Cancer and
HPV (2009)

11.  Worldwide prevalence of HPV infection is estimated to
be between 9% and 13%: ~630 million infected
individuals.1
 Estimated prevalence of HPV infection in selected
geographic areas:
Global HPV Statistics
16.6%4
Concordia, Argentina
40.2%–41.6%6
Harare, Zimbabwe
13.3%2
Ontario, Canada
18%*,7
Shanxi Province, China
*Among women 30–45 years of age
1. World Health Organization; 2001. Available at: http://www.who.int/vaccines/en/hpvrd/shtml. Accessed July 12, 2004.
2. Sellors JW, Mahony JB, Kaczorowski J, et al. CMAJ. 2000;163:503–508. 3. Lazcano-Ponce E, Herrero R, Muñoz N, et
al. Int J Cancer. 2001;91:412–420. 4. Matos E, Loria D, Amestoy GM, et al. Sex Transm Dis. 2003;30:593–599. 5. Clavel
C, Masure M, Bory JP, et al. Br J Cancer. 2001;84:1616–1623. 6. Blumenthal PD, Gaffikin L, Chirenje ZM, McGrath J,
Womack S, Shah K. Int J Gynecol Obstet. 2001;72:47–53. 7. Belinson J, Qiao YL, Pretorius R, et al. Gynecol Oncol.
2001;83:439–444.
14.5%3
Morelos State, Mexico
15.3%5
Reims, France

12.  Limited published data on the
HPV prevalence in Kingdom of Saudi
Arabia.
 Study aims to fill the existing
data-gap on HPV prevalence
 May be a valuable reference
database for future
epidemiological comparisons.
Study Rationale

13.  Two HPV vaccines are currently
licensed in many countries: a
bivalent vaccine (Cervarix) and
a quadrivalent vaccine
(Gardasil). The introduction of
these vaccines requires baseline
data on national epidemiology
and prevalent circulating HPV
strains.
Study Rationale

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An observational, Prospective
epidemiological
study on the prevalence of
human papillomavirus (HPV)
types
in women ≥15 years of age,
in the Kingdom of Saudi
Arabia.
Funding:
GlaxoSmithKline Biologicals
SA

15.  To describe the prevalence
and types of HPV (including
multiple infections) among
women ≥15 years of age,
attending out-patient health
services for routine cervical
screening, in the Kingdom of
Saudi Arabia
Objectives (primary)

16.  To describe the HPV type distribution by
risk categories (high-risk [HR] and low-risk
[LR]) in women of different age-strata (<25
years, 25-34 years, 35-44 years, 45-54 years
and 55+ years).
 To describe demographic characteristics
and health related behaviours of women in
Kingdom of Saudi Arabia.
 To describe the awareness of HPV infection
among women.
Objectives (secondary)

17. {
Methods:
420 women aged ≥15 years were
enrolled at three hospitals (April
2010-December 2011) and
completed two questionnaires to
report health-related behaviour and
awareness of HPV infection.
Cervical samples were collected
and tested for HPV-DNA for at
least 57 HPV genotypes including
HR and LR-types

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Ethical considerations:
The study was approved by the
following local ethics review
bodies:
Institutional Review Board at
KAMC-NGHA; Institutional Review
Board at KFMC; Research Ethics
Committee of Office of Research
Affairs at KFSH and RC.

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Statistical analyses:
Descriptive analyses regarding HPV
prevalence, HPV-types, age distribution,
potential risk factors (education level, life-
time marital partners, parity and smoking
status) and HPV status were performed.
All statistical analyses were performed
using the statistical analysis software (SAS)
version 9.2.

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Results:
417 subjects were included in the final
analysis(3 subjects excluded due to
pregnancy or history of hysterectomy)
Majority(77%) were Saudi nationals;
mean age(SD) was 41.90(±10.45) years.

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Results:
HPV-DNA was detected in 9.8%
of women(41/417, 95% confidence
interval [CI] 7.1-13.1%)
Prevalence of any HR-HPV in
women <25 years, 25-34 years, 35-
44 years, 45-54 years, and >55 years
was 0%, 3.0%, 4.5%, 3.2% and
10.9%, respectively

22. {
Results:
the most prevalent HR-HPV types
were HPV-68/73 (5 cases); HPV-18 (4
cases); HPV-16 (3 cases)
and the most prevalent LR types
were HPV-6 (4 cases); HPV-42,
HPV-53 and HPV-54 (2 cases each)
(Table 1).

24. {
Results:
Prevalence of HPV was significantly
higher among non-Saudi nationals(96)
vs. Saudi nationals(321) (16.7% vs.
7.8%,P=0.01)
No statistically significant risk factors
were identified from questionnaire
data. 32.2%(101/314) of women were
aware of HPV and 89.9%(285/317)
showed interest for vaccination.

27. {
Conclusion:
Overall HPV prevalence in the
Kingdom of Saudi Arabia was
9.8%, with higher prevalence
reported in women >55 years, as
well as in non-Saudi nationals.

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Conclusion:
This data provides a reference for
public health authorities and may
also help in determining future
policies for HPV vaccination and
CC prevention.

29. {Thank You!

30. {
“HPV Status in Saudi Women”
Presented by:
Ismail Al-Badawi, MBChB, FRCSC
Associate Professor, Al-Faisal University
Deputy Executive Director, Academic & Training Affairs
Section Head/Consultant, Gynecology Oncology
Department of Obstetrics & Gynecology
King Faisal Specialist Hospital & Research Centre
Riyadh, Saudi Arabia

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Sample size calculation:
The primary objective of the study
was to describe the prevalence
and types of HPV (including
multiple infections). To meet this
objective, an estimated HPV
prevalence ranging from 10 to
30%. The required number of
subjects ranged from 188 subjects
for a 10% HPV prevalence to 450
subjects for a 30% prevalence,
including an assumption of 10% of
subjects non-evaluable.

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