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    Epidemiology and Natural History Cervical Cancer

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    muhammadnurul asmi
    Cervical cancer is a major public health problem, especially in developing countries like Indonesia. It is the second most frequent cancer in women worldwide. Human papillomavirus (HPV) infection is the necessary cause of cervical cancer. While many HPV infections resolve spontaneously, some can persist and progress to precancerous lesions and eventually invasive cervical cancer if undetected and untreated. Screening programs using Pap smears can detect precancerous lesions early and prevent the development of invasive cancer through treatment. However, screening alone cannot prevent HPV infection. HPV vaccination in combination with screening provides the most effective strategy for reducing the burden of cervical cancer worldwide.

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    Epidemiology and Natural History Cervical Cancer

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    muhammadnurul asmi
    19 views30 pages
    Cervical cancer is a major public health problem, especially in developing countries like Indonesia. It is the second most frequent cancer in women worldwide. Human papillomavirus (HPV) infection is the necessary cause of cervical cancer. While many HPV infections resolve spontaneously, some can persist and progress to precancerous lesions and eventually invasive cervical cancer if undetected and untreated. Screening programs using Pap smears can detect precancerous lesions early and prevent the development of invasive cancer through treatment. However, screening alone cannot prevent HPV infection. HPV vaccination in combination with screening provides the most effective strategy for reducing the burden of cervical cancer worldwide.

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    Epidemiology and Natural History Cervical Cancer

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    Cervical cancer is a major public health problem, especially in developing countries like Indonesia. It is the second most frequent cancer in women worldwide. Human papillomavirus (HPV) infection is the necessary cause of cervical cancer. While many HPV infections resolve spontaneously, some can persist and progress to precancerous lesions and eventually invasive cervical cancer if undetected and untreated. Screening programs using Pap smears can detect precancerous lesions early and prevent the development of invasive cancer through treatment. However, screening alone cannot prevent HPV infection. HPV vaccination in combination with screening provides the most effective strategy for reducing the burden of cervical cancer worldwide.

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    19 views30 pages

    Epidemiology and Natural History Cervical Cancer

    Uploaded by

    muhammadnurul asmi
    Cervical cancer is a major public health problem, especially in developing countries like Indonesia. It is the second most frequent cancer in women worldwide. Human papillomavirus (HPV) infection is the necessary cause of cervical cancer. While many HPV infections resolve spontaneously, some can persist and progress to precancerous lesions and eventually invasive cervical cancer if undetected and untreated. Screening programs using Pap smears can detect precancerous lesions early and prevent the development of invasive cancer through treatment. However, screening alone cannot prevent HPV infection. HPV vaccination in combination with screening provides the most effective strategy for reducing the burden of cervical cancer worldwide.

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    of 30

    Epidemiology and Natural

    History Cervical Cancer

    Nugraha UP
    Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012

    International Journal of Cancer


    Volume 136, Issue 5, pages E359-E386, 9 OCT 2014 DOI: 10.1002/ijc.29210
    http://onlinelibrary.wiley.com/doi/10.1002/ijc.29210/full#ijc29210-fig-0004
    The most frequent cancers in Asian women:
    incidence and mortality
    Incidence Mortality
    Breast 22.6 Lung 9.6

    Cervix 15.3 9.1


    Stomach

    Stomach 12.2 Breast 8.9

    Lung 11.1 Cervix 8.4

    Colon/ 9.4 Liver 7.3


    Rectum

    Liver 7.8 Oesophagus 5.9

    Oesophagus 7.1 Colon/ 5.2


    Rectum
    0 5 10 15 20 25 0 2 4 6 8 10 12
    Age-standardized rate per 100,000 Age-standardized rate per 100,000

    Ferlay J, et al. GLOBOCAN 2002 Cancer Incidence, Mortality and Prevalence Worldwide. Lyon: IARC CancerBase, 2004.
    Introduction
    Introduction
    Indonesia
    Age-specific incidence • Every day, in Indonesia:
    and mortality of cervical cancer1 – 40-45 women are diagnosed
    with cervical cancer2
    – 20-25 will die from the
    disease2
    • Every 1 hour, one woman dies
    of cervical cancer in Indonesia2

    1. Castellsagué X, et al. 2007 Report. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). C105
    Available at: www.who.int/hpvcentre (accessed 25 June 2009). 2. Ferlay J, et al. GLOBOCAN 2002 Cancer Incidence, Mortality and
    Prevalence Worldwide. Lyon: IARC CancerBase, 2004.
    HPV is the necessary cause of cervical
    cancer1,2

    Cancer and causative agent Relative Risk2


    Cervical cancer from HPV 300–500

    Liver cancer from HBV (Taiwan) 100

    Liver cancer from HCV (Italy) 20

    Cigarette smoking 10

    1. Wallboomers JH, et al. J Pathol 1999; 189:1219; 2. Bosch FX, et al. J Clin Pathol 2002; 55:244–265.
    Progression of cervical disease after HPV infection
    11% 1%
    22% 5%
    Progression* >12%
    Months Years
    Time

    Normal HPV infection CIN1 CIN2 CIN3 Invasive


    epithelium koilocytosis carcinoma
    Low-grade squamous intraepithelial High-grade squamous intraepithelial
    lesion (ASCUS/LSIL) lesion (HSIL)
    Regression
    57%
    43%
    32%
    Burd EM. Clin Microbiol Rev 2003; 16:1–17; Solomon D, et al. JAMA 2002; 287:2114–2119.
    PREVENTION OF CERVICAL CANCER
    • Primary prevention
    – measures used in people with no
    clinical evidence of disease to
    prevent disease from developing e.g.
    Education, Vaccines

    • Secondary prevention
    – interventions used in people with
    evidence of a disease
    – actions to slow or stop the progress
    of a disease during its early stages
    e.g. Screening: Pap Smear
    Cancer Prevention Strategies

    Primary Prev

    Tertiary Prev

    To detect a preneoplastic process or a


    neoplasia at the earliest stages through
    Screening
    Secondary Prevention
    HPV Vaccine

    • Screening can not prevent HPV infection


    • Combination with screening highly effective to
    reduce morbidity & mortality
    • Selective client
    Take Home Message

    • Incidence of cervical cancer


    • Natural history of HPV infection
    • Prevention and detection HPV infection
    • Management : see and treat, follow up
    Thank you

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