Cervical cancer screening and hpv vaccination
- 1. DR SUNITA YADAV SENIOR SPECIALIST OBS AND GYNAE VMMC AND SAFDARJUNG HOSPITAL
- 3. Cervical Cancer Breast Cancer Ovarian cancer Colorectal Cancer Uterine cancer
- 4. MOST COMMON CANCER OF FEMALES IN INDIA. 1 in 5 CASES OF CERVICAL CANCER WORLDWIDE IS FROM INDIA. SECOND MOST COMMON CANCER WORLDWIDE. LEADING CAUSE OF DEATH IN FEMALES. EASIEST CANCER IN FEMALES TO PREVENT THROUGH SCREENING AND VACCINATION.
- 5. OVARIAN CANCER IS SECOND MOST COMMON CANCER SEEN BY THE GYNAECOLOGISTS IN INDIA. BREAST CANCER IS THE SECOND COMMONEST MALIGNANCY OF FEMALES.
- 6. TESTING ASYMPTOMATIC POPULATION TO DETECT PRECANCEROUS LESIONS OR EARLY STAGE OF CANCER. EFFECTIVE SCREENING AVAILABLE FOR CERVICAL AND BREAT CANCER.
- 8. 42 YEARS FEMALE, 2 CHILDREN C/O IRREGULAR BLEEDING PV - 6 MTHS. WITH ANEMIA. 70 YEAR FEMALE , 5 CHILDREN C/O BLEEDING AFTER MENOPAUSE ,FOWL SMELLING DISCHARGE. 40 YEAR INSPECTOR POLICE, 2 CHILDREN C/O HEAVY AND PROLONGED BLEEDING SINCE 1 YEAR.
- 9. BLEEDING FOLLOWING COITUS IRREGULAR BLEEDING IN BETWEEN PERIOD HEAVY OR PROLONGED BLEEDING POSTMENOPAUSAL BLEEDING VAGINAL DISCHARGE PAIN URINARY SYMPTOMS AND RECTAL BLEEDING WT. LOSS,WEAKNESS ASYMPTOMATIC
- 10. ALL CASES OF VAGINAL DISCHARGE ARE NOT DUE TO CANCER CERVIX. CAUSE CAN BE- physiological pathological
- 11. SECRETIONS FROM GLANDS AND VAGINAL TRANSUDATE. COLOUR AMOUNT LEUKORRHEA excessive normal vaginal discharge. ◦ Fear of cancer and STD ◦ Cause-puberty, chronic cervicitis, erosion ,polyp OCP ,regular douching,sedentary occupation
- 12. CAUSE AMOUNT COLOUR ODOUR ITCHING URINARY COMPLAINTS
- 13. HPV INFECTION EARLY MARRIAGE MULTIPLE SEX PARTNERS MUTIPLE BIRTH CIGARETTE SMOKING LOW SOCIOECONOMIC STATUS POOR PERSONAL HYGIENE
- 14. The main cause of cervical cancer is infection with Human Papillomavirus or HPV. Virus that is spread by sex. Infection is asymptomatic. There are many different types of HPV-low and high risk. Certain “high-risk” HPV types can cause cell changes and cervical cancer
- 15. MAJORITY OF FEMALES ACQUIRE HPV BY 30 YEARS. MOST CLEAR THE INFECTION WITHIN 1-2 YEARS. ONLY IN FEW –PRECANCEROUS CHANGES WHICH MAY RESOLVE OR DEVELOP CANCER OVER 10-20 YEARS. SEVERAL TYPES OF HPV AROUND 100. 13 TYPES CAUSE CANCER.
- 16. Most men and women who have had sex(vaginal,oral,anal) acquire HPV within 2 years of active sexual life. People who are not sexually active almost never acqire HPV infection. Correct and consistent use of condoms can reduce HPV transmission.Areas not covered can be infected hence not absolute protection.
- 17. CAUSATIVE AGENT IN MAJORITY OF CASES OF CERVIX CANCER. SEVERAL TYPES- TYPE 16 AND 18 (ASSOCIATED WITH70% CASES OF CANCER CERVIX).
- 18. CANCER PRECURSOR AND CANCER HPV PERSISTENCE HPV ACQUISITION
- 19. Anyone who has had more than one sex partner . Anyone whose sex partner(s) has had more than one sex partner .
- 20. Get regular Pap tests and follow up, if necessary. Limit your number of sex partners Choose a sex partner who has had no or few prior sex partners Do not smoke cigarettes. Keep a healthy diet and lifestyle. Use condoms consistently and correctly during sexual activity.
- 21. CERVICAL CANCER PREVENTABLE BY REGULAR SCREENING. METHODS OF SCREENING PAP SMEAR (CONVENTIONAL,LIQUID BASED CYTOLOGY) HIGH RISK HPV TESTING
- 22. TO BEGIN AT 21 YEARS (EXCEPTIONS- HIV POSITIVE,IMMUNOCOMPROMISED OR YOUNG PT. WITH PREVIOUSLY TREATED HIGH GRADE PRECANCEROUS OR CANCER . STOP SCREENING AT 65 YRS AGE IN THOSE WITH PREVIOUSLY NORMAL SCREEN AND NO HIGH RISK FACTORS. SCREENING GUIDELINES SAME FOR HPV VACCINATED .
- 23. PRESENT VACCINES DO NOT PROTECT AGAINST ALL HPV TYPES THAT CAN CAUSE CANCER.
- 24. SCREEN WITH PAPS 3 YEARLY HPV COTESTING WITH PAPS- 5 YEARLY HPV TESTING NOT DONE BEFORE 30 YEARS
- 25. NO LONGER ANNUAL PAPS . LATEST RECOMMENDATION 3 YEARLY. UNNECESSARY COLPOSCOPY DUE TO ANNUAL SCREEN.NO ADDITIONAL BENEFIT. NEGLIGIBLE RISK OF MISSING CANCER WITH 3 YRLY SCREEN.
- 26. BEGIN SCREENING ON DIAGNOSIS (CDC)/21 YEARS(ACS). SCREEN EVERY 6 MTHS. FOR FIRST YEAR AFTER DIAGNOSIS. 1 YEARLY PAPS SUBSEQUENTLY. COLPOSCOPY TOFOLLOW ABNORMAL PAP . (CENTRE FOR DISEASE CONTROL AND PREVENTION)
- 27. BEGIN AT 21 YEARS IRRESPECTIVE OF SEXUAL INITIATION OR NO. OF SEX PARTNERS. SCREENING BEFORE THIS AGE-HIV POSITIVE,IMMUNOCOMPROMISED,PREVIOUSLY TREATED PRECANCEROUS OR CANCER. PRECANCEROUS LESIONS MORE LIKELY TO REGRESS.ALSO HPV INFECTION CLEARS IN MAJORITY. DON’T REQUIRE IMMEDIATE COLPOSCOPY AND TREATMENT.
- 28. AT 65YEARS PROVIDED 3CONSECUTIVE NEGATIVE PAPS OR2 CONSECUTIVE NEGATIVE COTEST(PAPS WITH HPV) WITHIN 10 YEARS.MOST RECENT TEST WITHIN PAST 5 YEARS. CIN2,CIN3,AIS TO CONTINUE SCREENING FOR 20 YEARS AFTER NORMAL REPORT OR TREATMENT.
- 29. Just like mammogram screening, Pap testing is not a one-time test. The test is not perfect. New changes (abnormalities) can occur after you get tested, even if you have not had new partners. It could take many years for changes to develop or to be noticed. Your risk changes if you have new partners, or if your partner has other partners.
- 30. Cells are collected from the surface of your cervix by a doctor. These cells are then checked under a microscope for any abnormalities. If abnormal (or precancerous) cells are found, they can be treated before they turn into cancer. Cervical cancer can be found in the early stages, when it is easier to treat.
- 31. SENSITIVITY (47-62%) CAUSE OF LOW SENSITIVITY- inappropriate site,inadequate sample,poor quality smear due to delay in fixing or blood,lab errors in interpretation.
- 38. HOW IS IT DONE METHODS-THINPREP TEST AND AUTOCYTE PREP. TESTING-HYBRID CAPTURE OR PCR TECHNIQUE ADVANTAGE-BETTER DETECTION,HPV TESTING CAN BE DONE SIMULTANEOUSLY.
- 39. NOT TO BE DONE DURING PERIODS AVOID FOR 2 DAYS BEFORE SCREEN douching tampons vaginal tablet or gel intercourse no birth control foam or jelly
- 40. That the cells in your cervix are… Normal Abnormal: ◦ Minor cell changes of unknown importance, possibly unrelated to precancer (ASCUS) ◦ Minor cell changes (LSIL) ◦ Moderate to Severe cell changes (HSIL) Possibly cancerous
- 41. Abnormal Pap test results are quite common. They are usually only slightly abnormal. 80-90% of low grade cervical abnormalities regress on their own. If followed up and treated early, you can prevent the abnormality from turning into cervical cancer.
- 42. No! Most people get HPV infection, but very few get cervical cancer In most cases, HPV infection goes away on its own Sometimes, the HPV infection does not go away after many years. This type is called “persistent”. It can lead to cervical cancer
- 43. If you had treatment for precancer or cancer of the cervix, you will need a Pap test. If the cervix was left in place at the time of your hysterectomy, you will need Pap tests.
- 44. TREAT INFECTION AND REPEAT HIGH RISK HPV TESTING COLPOSCOPY TO LOCALIZE LESION Excisional/ ablative procedures CERVICAL PUNCH/CONE BIOPSY LEEP/LLETZ CRYO/CAUTERY LASER ABLATION
- 50. LACK OF AWARENESS FEAR OF EXAMINATION AND PAIN NONAVAILABILITY OF TEST INCREASED PATIENT LOAD IN HOSPITALS MAY REQUIRE REPEAT VISIT
- 51. VISUAL INSPECTION AFTER APPLICATION OF 3-5% ACETIC ACID (VIA). VISUAL INSPECTION AFTER APPLICATION OF LUGOL IODINE (VILI).
- 52. LIQUID BASED CYTOLOGY COMBINATION OF PAPS WITH HIGH RISK HPV SCREENING INTERVAL 3-5 YEARLY HPV VACCINES
- 53. HPV RESPONSIBLE FOR CERVICAL,VAGINAL VULVAR,ANAL,OROPHARYNGEAL CANCER,PRECANCEROUS LESIONS,GENITAL WARTS. ALSO ANAL, PENILE ,OROPHARYNGEAL CANCER AND GENITAL WARTS IN MALES.
- 54. FIRST INTRODUCED IN 2006. HPV 16 AND 18 CAUSE 70% OF CERVICAL CANCERS. ALL HPV VACCINES PREVENT HPV 16 AND 18 INFECTION. GIVE STRONGER AND PROLONGED PROTECTION THAN NATURAL INFECTION. TWO FDA APPROVED AVAILABLE IN INDIA- CERVARIX AND GARDASIL.
- 55. CERVARIX (BIVALENT-16 AND 18 ) GARDASIL(QUADRIVALENT -16 ,18,6, 11) TYPE 6 AND 11 CAUSE 90% OF GENITAL WARTS. NONAVALENT VACCINE NOT YET AVAILABLE IN INDIA.
- 56. 3 INJECTIONS I/M OVER 6 MONTHS. MOST EFFECTIVE WHEN GIVEN BEFORE PERSON IS SEXUALLY ACTIVE. INDIAN ACADEMY OF PAEDIATRICS HAS INCLUDED IN ITS SCHEDULE- 2 DOSES - (9-14 YRS FEMALE) 3 DOSES - (>15 YRS, IMMUNOCOMPROMISED) FOR 2 DOSES MINIMUM INTERVAL 6 MTHS. FOR 3 DOSES - 0, 1 / 2 & 6 MTHS.
- 57. GARDASIL APPROVED FOR MALES. AGE OF ADMINISTRATION- 9-26 YRS
- 58. 100% PROTECTION PROTECTION LASTS FOR 8-9 YEARS.
- 59. FDA APPROVED. NO SERIOUS SIDE EFFECTS HAS BEEN INCLUDED IN MANY NATIONAL IMMUNIZATION PROGRAMME INCLUDING UK,USA AUSTRALIA AND EUROPEAN COUNTRIES.
- 60. REGULAR SCREENING AND PROPHYLACTIC VACCINATION CAN PREVENT YOU FROM DEVELOPING THE MOST COMMON AND DREADFUL CANCER .PROTECT YOURSELF.