Script

Good afternoon sir Echo, teachers of the school of Public Health and to Batch Hiraya.

Today as we continue to talk about the Basics of Epidemiology and its Key Features, we shall in
the next 45 minutes discuss in detail these three important topics: 1. Natural History of Disease;
2. Disease Prevention; 3. Disease Causation or Causality.
ILO….
Part of the introduction is a review of the definition of Epidemiology; in the first session we
defined it as a study (LOGOS) of groups of people (DEMOS) – UPON A PEOPLE (EPI DEMOS),
living within a population or a community and the COLLECTIVE Health status of this people, the
DISTRIBUTION (or frequency and pattern) of HEALTH PHENOMENA and the DETERMINANTS of
these health phenomena meaning the causes and other factors influencing the occurrence of
the health phenomenon or event in the specified population, this study aimed and applied to
CONTROL health problems in the population concerned.
Key elements are : Population, Health phenomena, Distribution, Determinants , Control of
health problem or DISEASE

to lead us in the discussion and understanding of the HEALTH PHENOMENON OF DISEASE is the
first group (a grp of four physicians who call themselves the BTLQ Cloverleaf Team)- two pedia
and two Ob connecting and blending together like the four leaves of the clover.

CERVICAL CANCER
- REMAINS ONE OF THE LEADING CAUSES OF CANCER-RELATED DEATHS AMONG WOMEN
WORLDWIDE.
- MAY 2018 WHO SOUNDED A GLOBAL CALL TO ACTION TOWARDS ELIMINATION OF CX CA,
PARTICULARLY IN LOW-INCOME & MIDDLE-INCOME COUNTRIES (MORE THAN HALF A MILLION
NEW CASES & MORE THAN 300,000 DEATHS IN 2018).
- ETIO: HIGH-RISK HPV TYPE

PRECLINICAL PHASE- from BIOLOGIC ONSET OF THE DISEASE TO SYMPTOM MANIFESTATION;

CLINICAL PHASE – S/S THEN TREATMENT IS COMPLETED.

1ST TYPE PRIMARY PREVENTION IS STOPPING THE ONSET OF DISEASE, SO that the PERSON
NEVER DEVELOPS THE DISEASE IN THE 1ST PLACE;
PRIMARY PREVENTION STARTS EVEN BEFORE THE BIOLOGIC ONSET OF DISEASE, through
= HEALTH PROMOTION/LIFESTYLE MODIFICATION or CHANGE
*HPV VACCINATION VS HPV (PRIMARY PREVENTION STRATEGY)

SECONDARY PREVENTION DELAYS PROGRESSION OF DSE, WHILE ASYMPTOMATIC-

Done BET. BIOLOGICAL PHASE & BEFORE S/S OCCUR
SCREENING TO IDENTIFY EARLY DSE STAGE (eg. PAP FOR CA CX)
*SCREENING IS ONLY EFFECTIVE WHEN DSE HAS PROGRESSED ENOUGH TO BE DETECTABLE;
BEFORE DETECTABLE PRECLINICAL PHASE, NEG SCREEN! …
ROUTINE SCREENING IS IMPORTANT IN SECONDARY PREV!

*Because, the available vaccines will not be protective for all HPV types, duration of
immunity is unknown, ROUTINE CERVICAL SCREENING is still recommended in vaccinated
women.

TERTIARY PREVENTION – TREATMENT AND PREVn of COMPLIC & DETERIORATION AFTER DX;
TO IMPROVE OVERALL OUTCOMES IN DIAGNOSED PATIENTS (LIFESTYLE CHANGE is NOT
ENOUGH); CHEMORAD FOR CA CX needed.
- Recovery
- Residual disability
- Chronicity
- Death
Ca cx - RECOMMEND LONG TERM FOLLOW UP for at least 25 years.

NOTE: The success of this screening method , relies on the fact that it takes many years for
invasive cervical cancer to develop after a persistent HPV infection and development of
dysplasia ( 10 yr). The ones who develop CA had never had testing.
CIN 2 and 3- Annual HPV or cotesting until 3 negative, for at least 25 years as long patient in
good health.
VIA- low resource/ precancerous lesions-
note: VIA decreases mortality of cervical CA by 30%
HPV testing is also effective as a SCREENING for cervical cancer.

ablative treatment-secondary prevention,