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+ Dr. Nisreen Anfinan
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Page 1: Jcsp park hayat final ks

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Dr. Nisreen Anfinan

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Cancer Incidence Report Saudi Arabia 2007. Available at www.scr.org.sa/reports/SCR2007.pdf Accessed on June 26, 2011

Prevalence: 2,274,000 women have cervical cancer1 Incidence: 510,000 new cases each year1

14,845

United States/Canada

49,025

South America

67,078

Africa

1,077

Australia/New Zealand

64,928

Europe

151,297

Southcentral Asia

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Every year, 152 women are diagnosed with cervical cancer and 55 die from the disease.

new cervical cancer cases and deaths in 2025 are 309

1.9 cases per 100,000 women, accounting for 2.6% of diagnosed cancer cases in women

Cancer Incidence Report Saudi Arabia 2007. Available at www.scr.org.sa/reports/SCR2007.pdf Accessed on June 26, 2011

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Normal Cervix

HPV Infection

Cervical Dysplasia

Cervical Cancer

Primary

Prevention:

Vaccination

Secondary

Prevention:

Screening

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PAP smear

VIA

HPV testing

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Sensitivity of pap test to detect CIN3+: 55%.

Should be done in the context of an organized screening

program.

Quality assurance of cytology needs to be very good.

System of communication to the women screened so that

they may receive sufficient treatment.

Requires colposcopy and biopsy to confirm dysplasia.

The necessity for multiple visits with cytology based.

Screening results in significant loss to follow-up.

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+ I f we don’t have establish screening

program for cervical cancer in low

resources setting

what you will use ??

Visual inspection of ascitic acid (VIA )

or

HPV testing

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Budget for screening efforts is limited

Difficult access to health care

No follow up surveillance

Screening test need to be very sensitive

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VIA: Visual inspection with acetic acid

VILI: Visual inspection with Lugols iodine

Both Low tech can be done by nurses

May need to utilize colposcopy to triage post positive test

to rule out cancer

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TEST

SENSITIVITY

(%)

SPECIFICITY

(%)*

POSITIVE

PREDICTIVE

VALUE (%)*

NEGATIVE

PREDICTIVE

VALUE (%)*

VIA

(n = 2,130)

77

(70–82)

64

(62–66) 19 96

Pap smear

(n = 2,092)

44

(35–51)

91

(37–51) 33 94

University of Zimbabwe/JHPIEGO Cervical Cancer Project 1999.

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Country Sensitivity Specificity

Arbyn, 2008 Africa & India 79.2 84.7

Sarian, 2005 Argentina & Brazil 50.0 89.7

Perez-Cruz, 2005 Mexico 14.3 97.3

Al Monte, 2007 Peru 41.2 76.7

Murillo, 2010 Colombia 53.6 93.2

Arbyn et al., IJC 2008; Sarian et al., JMedScreen 2005,

Perez-Cruz et al., SalpublicaMex 2005, Al Monte, IJC 2007,

Murillo et al., IJGO 2010

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Triage equivocal or low grade cytology

smears (ALTS trial).

FUP of women with abnormal cytology

but normal colposcopy.

Predict outcome after treatment of high

grade disease.

Primary Screening.

Cuzick J. Vaccine 2008

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Comment Specificity Sensitivity Method

Easy, relatively inexpensive, but subjective,

insensitive, and nonspecific Low Cytology

Radioactive, commercially available as

ViraPap, ViraType, HPV Profile; labor intensive Moderate Dot blot

Rarely used today Low Filter in situ hybridization

Detects HPV in paraffin-embedded tissue Moderate In situ hybridization

Gold standard but cumbersome; not feasible

for large-scale clinical use High Southern blot hybridization

Newly approved for commercial use;

nonradioactive, easier to use and less

expensive than dot blot

High Hybrid capture

Uses amplification and so is prone to

contamination errors (false positive) High Polymerase chain reaction

Spitzer, Am J Obstet Gynecol, 1998

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More sensitive than pap smear

Negative PV testing provides reassurance of not developing CIN3

over the next 5-10 years

High HPV permits a safe and cost effective lengthing of the interval

5 years

HPV test has an high NPV

HPV test is ideally suited to reassure the negative HPV individual

and to increase interval between two subsequent screens

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PAP HPV

55.6% 94.6% Sensitivity

96.8% 94.1% Specificity

Mayrand et al.;

compare the relative efficacy of HPV DNA testing and Pap cytology

in primary screening for cervical cancer and its high-grade precursors.

Pap screening followed by HPV (hc 2) vs hc2 testing followed by

HPV in women 30-69

9,667 women

HPV testing is significantly more sensitive to detect CIN 2+

NEJM 2007

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Sankaranarayanan,R: Total of 131,746 healthy women

ages of 30 and 59 years RCT ,4 Arms of screening tool in India

HPV test vs. Pap test vs. VIA vs. Observation

Cervical cancer as an endpoint

32000 women in each arm

Screen positive received colposcopy and treatment

Only significant screening method to reduce deaths from cervical

cancer was HPV testing

Significant reduction in Ca Cervix in the HPV negative compared to

negative Pap and VIA NEJM Apr2009 360(14)1385-94

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National Programmers Pilot Studies

Argentina Germany Nicaragua

Mexico China Paraguay

The Netherlands Colombia Peru

USA El Salvador Georgia

Spain Rwanda

India Uganda

Italy United Kingdom

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CYTOLOGY

Lab

Organizer

GP

Time/travel

Program

Total

Cost €

21.77

11.23

11.76

6.01

2.08

52.85

HPV

Lab

Organizer

GP

Time/travel

Program

Total

Cost €

33.83

11.23

11.76

6.01

2.08

64.9

BJOG. 2012 May;119(6):699-709. doi: 10.1111/j.1471-0528.2011.03228.x. Epub 2012 Jan 18

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Proposal with help of international advisor and Local

Epidemiologist

Decision to use HPV testing HC2 (high risk) in collaboration

of local virology lab

Design unique data base for the program with recalling

system

Quality assurance and frequent monitoring

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Targeted Population:

There are a total of 944816 women at age of 30-65

in Jeddah region.

Married for 3 yearr ??

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Dr. Nisrin Anfinan

Early Detective

Unit and JCSP Coordinator

Rowaida Al Mehy

GOU Secretary

Maribi Marqueses

GOU Office Assistant

Dr. Faten Gazzaz

Director of

Virology Laboratory

Eman Tayba

JCSP Laboratory Team

Aseel Alsobehi

JCSP Laboratory Team

Soheel Melebari

JCSP Laboratory Team

Prof. Jim Bentley

International Advisor

Prof. Khalid Sait

Director of Scientific Chair of Professor Abdullah

Hussain Basalamah

Prof. Abdullah Hussain Basalamah

General Advisor

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Age 30-65 year.

Married for three years.

Saudi & non Saudi.

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Use the high sensitivity of HPV test initially

Digene Hybrid capture 2 test is suitable

Positive HPV test has reflex pap testing

If both positive colposcopy is performed

If HPV neg repeat screen in 5 years

If HPV +ve and pap neg, repeat HPV and pap in 1 year

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Provider competency was maintained by medical

supervision in the field and by periodic supervision to monitor

their performance, along with

rates of positive results on screening, correlation

between colposcopy and histologic findings, and positive

predictive values for CIN.

Internal and external quality-control measures were in place

for colposcopy and pathological analysis

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Campaign (malls)

School (approval from ministry of education )

Media and news papers

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collecting sampling in our hospital )

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Collecting Sample At PHC

Collecting Sample In Our Hospital

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Collecting sample at PHC

Collecting sample in our hospital

Dr. Sami Badawwod

To start in 40 PHC in Jeddah

King Abdulaziz university

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HPV self sampling

Collecting sample at PHC

Collecting sampling in our hospital

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البراهين على المبنيه الصحيه للرعايه السعودي المركز

Guideline meeting for cervical cancer screening

Agreed among panel members that HPV testing will be used as primary screening for cervucal cancer in SA

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START DATE:

Total Number:

Our aim to achieve :

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HR-HPV DNA in women 30 + years old

Negative

Negative

Negative

Pap test

Positive

Positive

Colposcopy

Positive

Repeat HR-DNA

testing @ 5 year

intervals till age

65

Repeat HR-

HPV testing at

12 months

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0

50

100

150

200

250

300

350

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

10 22

98

148 168

56

30 18

46

196

330

212

New Registration for Year 2012

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0

50

100

150

200

250

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

128

188

162

196

126

88

8

60

208

96

60

8

New Registration for Year 2013

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0

50

100

150

200

250

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

4 14

54

108

154

48

16 14 22

152

218

144

6 8

44 40

14 8 14 4

24

44

112

68

New Registration for Year 2012 – Saudi vs. Non-Saudi

Saudi Non-Saudi

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0

20

40

60

80

100

120

140

160

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

98

124

80

156

78

64

2

16

86

66

36

8

30

63

82

40 44

24

6

44

122

30 24

0

New Registration for Year 2013 – Saudi vs. Non-Saudi

Saudi Non-Saudi

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In January 2014 will release

our positive HPV data.

Official opening of the

program will be hosted by

Dr. Khoshaim Mohmade.

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National

Cervical

Screenin

Program


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