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Background
Cervical Cancer Statistics 2012
In the United States 12,170 women diagnosed with invasive
cervical cancer
In the United States, 4220 women died from cervical cancer
USA: 6TH MOST COMMON CANCER BLACK AND
LATINA WOMEN
USA: 13TH MOST COMMON CANCER WHITES
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Background
Cervical Cancer Statistics 2012
In contrast, cervical cancer is the
third most common cancer with
an estimated 530,000 new cases
world - wide
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CASES
DEATHS
World
530
275
76
32
453
242
Africa region
75
50
Americas region
80
36
Eastern Mediterranean
18
11
Europe
61
28
Western Pacific
105
46
188
102
USA
11
China
75
33
India
134
72
European Union
31
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Background
Rationale for Screening
Cervical cancer has a long preinvasive
phase
There are effective and cheap screening
tests for preinvasive and invasive cervical
cancer
Cervical cancer can be prevented with
adequate screening
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50%
10%
30%
10%
# women
6,280
1,260
3,770
1,260
100%
12,560
Risks
Errors in sampling
Errors in transfer of
cells
Errors in interpretation
Errors in evaluation of
abnormal results
Background
The History of Screening
1941 Introduction of Papanicolau Smear
Background
The History of Screening
2012 Lower Anogenital Squamous
Terminology Project (LAST): changes in
terminology for HPV associated lesions
of lower genital tract
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Background
The Consequences of Over-Screening
Treatment of lesions that have a high
probability of spontaneous regression
Treatment of Teenagers
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Treatment of Teenagers
Scarring of cervix
Cervical stenosis
Shortening of cervix
Traumatic
Dyspareunia
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Cervical Stenosis
Infertility
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HPV
DEFINITIONS
NON-ENVELOPED VIRUSES
HPV SUBTYPES
-
45 mucosal/genital subtypes
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GAIN OF CHR 3q IN CX CA
METHYLATION OF HPV DNA
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% OF CANCERS
ATTRIBUTABLE TO HPV
CANCER SITE % HPV
CERVIX
100
70
VAGINA
40
80
VULVA
40
80
PENIS
90
63
ANUS
90
92
ORAL CAVITY 25
95
OROPHARYNX 35
89
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Epidemiology
Human Papillomavirus Infections
Almost all cases of cervical cancer are
caused by Human Papillomavirus (HPV)
infection
However most HPV infections resolve
within a few months to years
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HUMAN
PAPILLOMAVIRUS
TRANSMISSION
to 8 months)
nonsexual (conjunctiva and nose)
vertical (mother - fetus)
laser plume
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15-19
20-24
25-29
30-34
35-39
40-44
45-49
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Epidemiology
Risk factors for Cervical Cancer
Persistent high risk HPV infections is the
main cause of cervical cancer
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EPIDEMIOLOGY OF HPV
PREVALENCE:
45 - 50%
LIFETIME RISK:
79 85%
?100%
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Approximately
1 million new cases
of genital warts3
1. American Cancer Society. Cancer Facts & Figures 2005. Atlanta, Ga: ACS; 2005:160. 2. Schiffman M, Solomon D. Arch Pathol Lab Med.
2003;127:946949. 3. Fleischer AB, Parrish CA, Glenn R, Feldman SR. Sex Transm Dis. 2001;28:643647.
Age group
Total # tested
# positive for hr
HPV
% positive
10-19
162
13
20-29
1137
92
30-39
6898
190
40-49
8137
135
1.6
50-59
7026
112
60-69
2584
39
1.5
70-79
522
10
>80
92
CERVIX
GREATEST NEOPLASTIC DANGER
HORMONAL MILEAU?
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Preinvasive Disease
Terminology
Preinvasive disease is defined as atypical
or neoplastic changes
Old terminology : dysplasia
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Preinvasive Disease
Terminology (see also Module II)
dysplasia
Intraepithelial
neoplasia
definitions
Terminology by
area of lower
gential tract
mild
Lower 1/3 of
epithelium is
dysplastic
CIN: cervical
intraepithelial
neoplasia
moderate
II
Lower 2/3 is
dysplastic
VAIN: vaginal
severe
III
Full thickness
dysplasitc change
VIN: vulvar
Full thickness
dysplastic change
AIN: anal
PIN: penile
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Preinvasive Disease
Review of Lower Genital tract Anatomy
Stratified squamous epithelium lines the vagina and
exocervix
The endocervix is lined by columnar glandular epithelium
The boundary between the squamous and columnar
epithelium is called the squamocolumnar junction. (SCJ)
The SCJ migrates from far out on the exocervix to the
endocervical canal over a womans lifetime.
The boundary between the old SCJ and the current SCJ is
called the transition zone
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Preinvasive Disease
Review of Lower Genital Tract Anatomy
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Preinvasive Disease
Natural History
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HPV(HIGH RISK)
NATURAL HISTORY
CERVICAL CANCER
SCREENING
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CONCLUSIONS