Cervical Cancer Statistics United States An estimated 12000 new cases each year An estimated 4000 deaths each year 700000 cases of severe precancer International Approximately 500000 cases expected worldwide each year ID: 723748
Download Presentation The PPT/PDF document "What you need to know about cervical can..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
What you need to know about cervical cancerSlide2
Cervical Cancer Statistics
United States
An estimated 12,000 new cases each year
An estimated 4,000
deaths each year 700,000 cases of severe pre-cancer InternationalApproximately 500,000 cases expected worldwide each year!Number one cancer killer of reproductive age womenReference American Cancer SocietySlide3
Cervical Cancer- Risk Factors
Early
age of intercourse
Multiple sexual partners
Tobacco useDiet Oral ContraceptivesHigh-risk male partnerOther sexually transmitted infectionsHuman Papillomavirus (HPV)Diethylstilbestrol (DES)Family History of Cervical CancerSlide4
Cervical Cancer- Human Papillomavirus
HPV DNA is present in virtually all cases of cervical cancer and pre-cancers.
Over 100 strains of HPV identified.
30 to 40 affect the genital area
15 to 20 cause cancerHPV 16 & 18 cause > 70% of cervical cancerHPV may be latent for years before inducing precancerous changes.Slide5
Cervical Cancer- Human Papillomavirus
50
to 80% sexually active adults (exposed)
6.2 million new infections /year in U.S.74% of new infections occur in 15 to 24 y.o.
70% clear within 1
yr.,
90% clear in 2
yrs.
Transmission:
Intercourse (vaginal, anal, oral)
Transmission by genital contact also occursSlide6
Human Papillomavirus & CancersSlide7
Human Papillomavirus Sexual Behavior
2009 National Survey Family Growth
28%
females sexually active by 15
years old70% by 18 years2009 Youth Behavioral Risk Survey4.8% active by age 1341% of 12th
grade females more then
3
partners
40%
to
50%
women
under 25 years old infected with HPVSlide8
Reducing the Risk of HPV Transmission
Abstinence from genital contactLifetime mutual monogamy
If used correctly, condoms can help reduce the risk of HPV infection.
Incidence of genital HPV infection was less than half among women whose partners used condoms for all intercourse, as compared with women whose partners used condoms less than 5% of the time.Slide9
Natural History of Cervical Carcinogenesis
Normal
Cervix
Mild Cytologic and/or
Histologic Abnormalities
Precancer
Cervical
Cancer
HPV=human papillomavirus.
Schiffman M, Kjaer SK.
J Natl Cancer Inst Monogr
. 2003;(31):14-19.
HPV
Progression
Regression
Clearance
Infection
Invasion
HPV- Infected Cervix
Primary prevention
Secondary preventionSlide10
~
99% of HPV-related genital cancers arise within the transformation zone of the cervix
The Pap test is used to obtain cells from the cervix (primarily transformation zone) for cervical cytology screening.
The Cervical Transformation Zone
1. Castle PE.
J Low Genit Tract Dis.
2004;8:224-230. 2. American Cancer Society. Prevention and early detection. Pap test. July 2006; Available at; http://www.cancer.org/docroot/PED/content/PED_2_3X_Pap_Test.asp?sitearea=PEDSlide11
Signs and Symptoms
Bleeding after intercourseFoul vaginal discharge
Abnormal bleeding (60 to 90%)
Pelvic pain
Leg swelling or painPelvic massVisible cervical lesionMay be silent (20 to 30%) Pap Smears help with thisSlide12
Cervical Cancer Pap Smear Screening
Beginning at age 21, or onset of sexual activity
Every 2 years
until age
30 (Recently changed from Annually)After 30, and 3 negative Pap's, may change to every 3 years, depending on the personAfter hysterectomy for benign disease, and negative Pap's,
may discontinue screeningSlide13
Cervical Cancer
Secondary Prevention in the US 50–60 million Pap tests per
year
3.8 million cases of
low grade squamous intraepithelial lesion detected per year700,000 cases of moderate/ severe precancer detected per year6 billion dollars spent on prevention Pap tests, colposcopy, Loop Electrosurgical Excision Procedure (LEEP) etc.
CDC
. MMWK. 2000;49:1001-1003.Slide14
Cervical Cancer: Screening Window
Single Pap false negative rate is 20%.
Time from
precancer
to cancer of the cervix is variable.50% of women with cervical cancer have never had a Pap smear. ( Some women have gone over 5 years since their previous Pap smear) Slide15
Treatments
SurgeryEarly disease
Remove part of cervix (cone biopsy)
Simple or radical hysterectomy
Lymph node biopsiesRadiationAll stages of cervical cancerChemotherapy at same timeSlide16
Survival Rates
Early disease—Stage I85 to 100% 5 year survival
Advanced disease—Stages II to IV
50
to 70% 5 year survival Slide17
Primary Prevention HPV Vaccine
Licensed vaccine available is GARDASIL (Merck)
Noninfectious VLPs (virus like particles) made of virus outer
proteins
HPV Strains 6 & 11 (cause genital warts)HPV Strains 16 & 18 (cause cervical cancer)3 doses of vaccine at 0, 2, 6 months (usually in the arm)Slide18
Secondary HPV Vaccine
Cervarix
Guards against HPV Strains 16 & 18
Distributed by GlaxoSmithKline
For ages 9-25 Slide19
HPV Vaccine
Nearly 100 % effective at preventing
precancers developing
Over 50,000 patients
studied ( ages 9-45)Side effects:Injection site pain 85% (75% placebo)Serious adverse events <0.1%, no differences Safe during breast feeding (patients that became pregnant reported no birth defects during study)Slide20
HPV Vaccine Cont.
Recommended for girls 11-12 years
Available for females 9 to 26 yearsHPV Prevalence in Women 25-45 years old- 25% Full effect if given before onset of sexual activity Still beneficial after onset of sexual activity and in women with history of precancersOnly 1% of women will have been exposed to all 4 strains of quad-vaccine
Crossover protection to other oncogenic strains 30 to 60%
The Center for Disease Control, and the American College of Obstetrics & GynecologySlide21
HPV- Males
60% men are HPV
positive
90% protection from genital warts
Vaccine Age 9 to 26 (Gardasil) Benefit of vaccinating men?Decrease male HPV related cancersDecrease transmission--benefit especially important if vaccine uptake is less then 50% by femalesSlide22
HPV Vaccine– Utah
$120/ dose ($360 for full set)Many insurances will cover the vaccine, or a portion
Uninsured / underinsured
0 to 18
y.o. females: covered under Vaccines For Children program19 to 26 y.o. females eligible for free vaccine through Department of Health (same distribution points as VFC)Phone: 800-717-1811www.utahcancer.org Student Health Clinic on campus Slide23
Cervical Cancer: Summary
Most people will have an HPV infection
HPV causes cervical and other cancers in a predictable, stepwise fashion.
Pap smear screening is effective at detecting pre-cancerous changes
HPV vaccination is nearly 100% effective in preventing infection and pre-cancerous changesSlide24
Cervical Cancer: Summary Cont.
Pap smears remain vitally importantVaccines cover strains that produce 70% of cancers
Needs decades of use before decrease in incidence will be seen
Prevention and early detection saves lives and preserves fertility.Slide25
Follow Us!!!
@NeedsBeyondMed
Twitter
Facebook
InstagramYouTubeGoogle+Slide26
Please Remember to be SCREENED.
Consult your personal physician
with any questions or concerns.
Thank YOU!!!