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9 September 2010 Cervical cancer screening in resource-limited settings Jose Jeronimo, MD

9 September 2010 Cervical cancer screening in resource-limited settings Jose Jeronimo, MD. Cervical cancer screening in resource-limited settings. Jose Jeronimo, MD I-Tech distance learning sessions September 9, 2010. Cervical Cancer Incidence 1. Europe 59,931. North America 14,670.

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9 September 2010 Cervical cancer screening in resource-limited settings Jose Jeronimo, MD

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  1. 9 September 2010 Cervical cancer screening in resource-limited settings Jose Jeronimo, MD

  2. Cervical cancer screening in resource-limited settings Jose Jeronimo, MD I-Tech distance learning sessions September 9, 2010

  3. Cervical Cancer Incidence1 Europe 59,931 North America 14,670 Asia 265,884 Central and South America 71,862 Africa 78,897 1. Ferlay J, Bray F, Pisani P, Parkins DM; International Agency for Research on Cancer (IARC). GLOBOCAN 2002: Cancer Incidence, Mortality, and Prevalence Worldwide. Lyon, France: IARCPress; 2004. CancerBase No. 5, version 2.0.

  4. Theta Eta Kappa Mu Lambda Nu A10 Lota A13 A1 Zeta A8 Delta A9 Epsilon A11 A7 Alpha A5 Beta A6 A2 A15 A4 New Genus Pi A3 Gamma Xi Omikron Human Papillomavirus (HPV) Condyloma Neoplastic Vaginal ≥100 HPV genotypes ~40 mucotropic HPV genotypes ~15 Carcinogenic HPV genotypes

  5. Natural History of HPV infection and Cervical Cancer Peak Ages: 15-25 25-35 45-50 Schiffman, et al., Lancet, 2007

  6. Primary prevention Secondary Prevention

  7. Current screening options Visual inspection with acetic acid (VIA) PAP smear HPV testing

  8. Cervical Cancer Incidence, England 1971-95 Quinn et al, BMJ 1999

  9. Sensitivity of Cytology: CIN2+ CIN 2+ HART Tuebingen Hannover Jena French Public French Private Seattle Canada Combined 0% 10% 30% 50% 70% 90% 100% Cuzick et al., IJC, 2006 Mayrand et al., NEJM, 2007

  10. VIA “VIA is a good alternative for settings where conventional cytology is not well implemented.” –IARC/WHO, 2005 IARC, WHO. IARC Handbooks of Cancer Prevention: Cervical Cancer Screening. Volume 10. IARC Press; 2005.

  11. VIA Negative Positive

  12. Unmagnified view

  13. Alternatives for screening: HPV DNA testing The digene®HC2 HPV DNA Test The careHPV™ Test

  14. HPV DNA testing CIN 2+ HART Tuebingen Hannover Jena French Public French Private Seattle Canada Combined 0% 10% 30% 50% 70% 90% 100% HPV sensitivity Cuzick et al., IJC, 2006 Mayrand et al., NEJM, 2007

  15. HPV16+ HPV18+ HPV+ HPV- Follow-up time and HPV result Khan et al., JNCI, 2005; Castle et al., AJOG, 2007

  16. The careHPV™ Test: a new HPV DNA test for low-resource settings

  17. The careHPV™ Test: an alternative for developing countries

  18. START-UP* demonstration projects *Screening Technologies to Advance Rapid Testing for Cervical Cancer Prevention—Utility and Program Planning.

  19. Preliminary results *Clinical sensitivity and specificity estimates. Based on results from 2,239 women with screening and final diagnosis completed in Nicaragua and Hyderabad. 41 cases of CIN2+.

  20. Cervical cancer in HIV infected women Higher prevalence of HPV infected women.Performance of screening tests is different than in general population: - Higher positive rates.Need for intervention.Need for evaluation of screening and treatment strategies in countries with high HIV prevalence.

  21. Conclusions • There is no screening test that is 100% effective for detecting cervical precancer. • There are more affordable options forsecondary prevention in low-resource settings. • Screening for cervical cancer and treatment in HIV-infected women seems to be more challenging than screening and treating HIV-negative women.

  22. Thank you jjeronimo@path.org www.path.org www.rho.org

  23. Listserv: itechdistlearning@u.washington.edu Email: DLinfo@u.washington.edu

  24. Next session: 23 September 2010 Mystery Opportunistic Infections Shireesha Dhanireddy MD

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