CERVICAL CANCER 4th most common cancer in women worldwide CERVICAL CANCER 4th most common cancer in women worldwide gt250000 deathsyear CERVICAL CANCER 4th most common cancer in women worldwide ID: 1036188
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1. The RenewalTHE NEW CERVICAL CANCER SCREENING PROGRAM
2. CERVICAL CANCER4th most common cancer in women worldwide
3. CERVICAL CANCER4th most common cancer in women worldwide>250,000 deaths/year
4. CERVICAL CANCER4th most common cancer in women worldwide>250,000 deaths/year85% of cervical cancer incidence and mortality occurs in less developed countries
5. CERVICAL CANCER4th most common cancer in women worldwide>250,000 deaths/year85% of cervical cancer incidence and mortality occurs in less developed countries – limited or no screening
6. CERVICAL CANCERIncidence
7. CERVICAL CANCER Mortality
8. CERVICAL CANCERIn our regionAustralia:Incidence - 5 per 100,000 womenMortality - 2 per 100,000 womenMelanesia (PNG, Vanuatu, Fiji) :Incidence - 33 per 100,000 women (x7)Mortality - 20 per 100,000 women (x10)
9. FIJI – Nurse training VIA
10. Screening room
11. Sterilising equipment
12. VANUATUHPV vaccination & testing
13. Cold chain challenges
14. THE IMPORTANCE OF SCREENING80% of women with cervical cancer are either under-screened, or have never been screened
15. CERVICAL CANCERSCREENING in AUSTRALIA National Cervical Cancer Screening Program since 1991Women aged 18-69 yrs2 yearly Pap testsState/Territory based RegistersCurrent
16. THE PAP TEST
17. CERVICAL CANCERSCREENING in AUSTRALIAHugely successful – 50% reduction in cervical cancer incidence and mortalityCurrent
18. SO WHY CHANGE??
19. SO WHY CHANGE??Online petition shows women want to know moreThe past week saw 70,000 people (so far) sign an online petition opposing the changes to the cervical screening program.The person behind the petition said she was motivated by “concern and worry”, because “[she] didn’t know about it and no one seemed to know about it”, and because “[she’d] love someone to be able to get down on our level and explain the testing”.Responses to her petition indicated widespread concern about safety of the new starting age and the wider screening interval. In addition, women perceived the renewed program as a cutback – that less screening is being driven by cost-savings rather than the availability of a better test.
20. SO WHY CHANGE??1. LIMITATIONS of CURRENT TESTINGReductions in cervical cancer incidence and mortality have plateaued over the last 10 yearsCurrent program has had no impact on certain groups – women < 25 years, subgroups of cancers (adenocarcinomas)
21. SO WHY CHANGE??2. INCREASED KNOWLEDGEThe role of HPV in cervical lesions and cancer (causes >99% of cancer, most HPV infections will regress within 18 months)Pathogenesis of cervical cancer (most cancers take 10-15 years to develop)
22. HPV HPV causes >99% of cervical cancerOver 200 genotypes of HPV, 40 affect ano-genital tractHigh risk HPV: 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82
23. HPV Anal cancer – 90%Vaginal cancer – 70%Penile cancer – 50%Vulvar cancer – 40%Head and neck/orophayngeal cancers – 13 – 72%
24. HPV
25. HPV Over 80% of HPV infections will clear within 12- 18 months
26. HPV Persistent infection with high-risk HPV is the most important risk factor for cervical cancer
27. SO WHY CHANGE??3. NEW TECHNOLOGIESHPV DNA testLiquid based cytology & computer-assisted image analysis
28. SO WHY CHANGE??3. NEW TECHNOLOGIESHPV DNA testMuch higher sensitivity compared with Pap smears (95% v 55%): better testHigh negative predictive value (>99%), allowing for longer screening interval
29. SO WHY CHANGE??4. NATIONAL HPV VACCINATION PROGRAM3 dose quadrivalent vaccination (Gardasil): HPV 6,11,16,182007 – girls (12-26yrs), 2013 – girls and boys (12-13 years)Coverage with 3 doses: around 70-80%86% reduction in HPV 16,18,6,11 92% reduction in genital warts45% reduction in low grade lesions 85% reduction in high grade lesions
30. WHAT IS THE CHANGE?5 yearly screeningBased on HPV DNA testWomen 25 – 74 yrsOption for self-collected sample (for never screened or under-screened women)National RegisterRenewal
31. HPV testIdentical procedure to Pap test - sample from SC junction using cervical sampler, spatula +/- cytobrushThen sample is placed in liquid based mediumHPV DNA testing (with partial genotyping) is performedIf positive for oncogenic HPV type, reflex liquid based cytology (LBC) is performed on the same sample
32. SCREENING PATHWAY
33. SCREENING PATHWAY
34. SCREENING PATHWAY
35. SCREENING PATHWAY
36. SCREENING PATHWAY
37. SCREENING PATHWAY
38. SCREENING PATHWAY
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42. SCREENING PATHWAY
43. SCREENING PATHWAY
44. Self collected swabDry flocked swab inserted into vaginaCannot perform LBC on sampleMedicare rebate for “never or under screened women” If +ve HPV 16/18 – refer for colposcopyIf +ve for oncogenic HPV (not 16/18) – invite back for reflex LBC under direct visionSensitivity 88% – better than Pap, not as good as physician collected sample
45. SPECIAL CASESPregnancyImmune-deficient/HIVDES in uteroSymptomattic women (any age)History childhood sexual abuse/first sexual activity <14 yrs
46. NATIONAL REGISTEROperated by Telstra HealthBowel Cancer Screening & Cervical Cancer Screening Legislative Framework:- National Cancer Screening Register Act 2016 - Others: Privacy Act 1988, Cybercrimes Act 2001 etcFAQ: http://www.health.gov.au/internet/main/publishing.nsf/Content/National-Cancer-Screening-Register
47. NATIONAL REGISTERSingle electronic record Send out invitations, reminders, and FOBT kitsAllow practitioners access to patients records/results through medical softwareUpload data to Register through medical softwareAllow patients to access screening record/results
48. TRANSITIONING TO THE NEW PROGRAMWomen who:are aged 25+ years will be invited into the new program 2 years after their last Pap testhave had a Pap test below the age of 25 will be invited into the program at the routine screening age of 25 (explanatory letter to be sent by National Register)
49. TRANSITIONING TO THE NEW PROGRAMWomen who:are in follow-up for LSIL should have co-test (HPV + LBC) at next scheduled follow-up; refer for colposcopy if + for any oncogenic HPV type; if negative return to 5-yearly screeninghave been treated for HSIL (CIN2/3) in the pre-renewal program should start or continue Test of Cure (annual co-test until 2 consecutive negatives)have been treated for adenocarcinoma in situ will have annual co-testing (HPV and LBC) indefinitely
50. TRANSITIONING TO THE NEW PROGRAMhttp://wiki.cancer.org.au/australia/Guidelines:Cervical_cancer/Screening
51. THE NEW SCREENING PROGRAM We have a BETTER TEST
52. THE NEW SCREENING PROGRAM We have a BETTER TEST
53. THE NEW SCREENING PROGRAM We have a BETTER TESTIt will further reduce rates of cervical cancer (additional 20% reduction)- Increased detection of adenocarcinoma
54. THE NEW SCREENING PROGRAM The better test means we can SAFELY SCREEN LESS OFTEN- So we allow women adequate time to clear the virus themselves (much like the common cold)
55. THANK YOU