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Awareness programon

Reproductive Healthand

Cervical Cancer

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Reproductive health issue is now apublic health concern..

Reproductive Health

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The major problem which the women ofreproductive age encounter are

Itching in the genital organ

Excessive bleeding during menstruation Lower abdominal pain.

Cancer of the female reproductive organ is alsoa major reproductive heath problem which areresponsible for one third of gynecological cases

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The ten most common cancers inwomen worldwide (Incidence)

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The ten most common cancers inwomen worldwide (Death)

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Most common female cancersin Bangladesh (Incidence)

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What is cervical cancer?

Cervical cancer is the malignant tumor of Cervix,located in the neck of the womb where it opens intothe vagina

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Cervix: the cancer site

The cervix is the lower pear-shaped opening to the uterus in the

female reproductive system.

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What causes cervical cancer?

Image source: 1. GSK Biologicals

Human papillomavirus (HPV):

Persistent infection with oncogenic HPV is the necessarycause of cervical cancer

But it takes 10-20 years to develop cervical cancer fromincidence of infection

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Harald zur Hausen received the Nobel

Prize in Medicine 2008 for discovering

the role of HPV in Cervical Cancer

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Humanpapilloma virus (HPV)

HPV is transmitted by skin-to-skin

genital contact

Persistent infection with oncogenic HPV

is the necessary cause of cervical

cancer

99.7% of all cervical cancer cases are

related to oncogenic HPV infection

HPV-16/18 are responsible for ~ 70% of

invasive cervical cancers worldwide

HPV capsids,approximately 55 nm in diameter

Image source: GSK Biologicals

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Prevalence

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Size of cervical cancer risk in the world

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Global incidence

Every year approximately 500,000 women

worldwide are victims of cervical cancer

Ferlay J et al. Globocan 2002. IARC 2004.

Age standardised rate (ASR) per 100,000 population (All ages)

Every two minutesa woman dies of cervical cancer,

270000 Deaths in a year

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Cervical Cancer prevalencein Bangladesh

Every year approximately17,686 women are

diagnosed with cervicalcancer in Bangladesh

Every year

approximately 10,364

women are died dueto cervical cancer in

Bangladesh

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Number of cervical cancer diagnosed annually- 17,686

Number of death due to cervical cancer (CC) annually- 10,364

HPV prevalence(%) with normal cytology- 6.6%

Prevalence (%) of HPV16 or 18 in women with CC - 75.1%

Every day 28 women die due to cervical cancer

Ferlay J et al. Globocan 2002. IARC 2004.

Cervical Cancer prevalencein Bangladesh

WHO/ICO Information Centre on HPV and Cervical Cancer 2010

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Symptoms

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Symptoms

Abnormal bleeding/post-menopausal bleeding

Post-coital bleeding

Pervaginal bleeding on straining

Unusual heavy discharge, often foul smellingpervaginally

Pelvic pain (in advance stage)

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Healthy Cervix vs Cancer Cervix

Image source: 1. GSK Biologicals

Normal Cervix Cervix with invasive cancer

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Diagnosis

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1 2

ViaPaps SmearColposcopy

HPV DNA

UltrasonographyCT ScanMRI

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Treatment

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Treatment

All modalities of treatment for

the cancer Cervix is available

though most cases diagnosed at

late stage.

Disease free interval life for a

long period if proper treatment is

received

But prevention is always thebest option

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Prevention

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Primary prevention of CervicalCancer

Vaccine against HPV infection is now available in the market

Carvical cancer is the only cancer which has primary prevention

Vaccination along with screening (i.e pap smears) provides the maximum

protection

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Primary prevention: vaccination

For whom:

Woman 10 years onwards

Dosage:

3 doses IM regimen at 0, 1 & 6 months. No booster isrecommended till now

Safe and well tolerated

Not recommended in pregnancy

Price: MRP Tk. 2000.00 each dose

Tk. 6000.00 for total 3 doses

1. Munoz et al. Int J Cancer2004; 111: 278-285; 2. Bosch FX et al. J Nat Cancer Inst Monograph2003; 31: 313; 55: 244-265; 3. Goldie et al.J NatCancer Inst 2004; 111: 27885; 4. Harper etal.Lancet2004; 364: 1757-65.

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High and Sustained Antibody Levelsin Women Age 15 to 55 Years

6364576251564550394433382532181270

1525 year old women (efficacy study)

3645 year old women

1525 year old women

2635 year old women

4655 year old women

HPV-18 total antibodies

Natural Infection

1

10

100

1,000

10,000

Months follow up time

ELU/mL

At least8-fold higher thannatural infection

Harper DM, et al. Lancet2006; Rombo L, ESPID 2007; Schwarz TF, EUROGIN 2007; Gall S, et al. AACR 2007

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Take home message

Cervical cancer is the leading cause of death among women

Human papillomavirus (HPV) is responsible for cervicalcancer

Prevention is the best option. HPV vaccine (Cervarix) is

available in Bangladesh market

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Thank you