Preventing the preventable cancer

Zero Cervical Cancer in

RAK / UAE by 2020

Fact is ……. While it is possible for a

Global Burden of Cervical Cancer

Courtesy Dr Jalaa Taher, HAAD

Cytology based screening for Cervical Cancer

Limitations of cytology

Reproducibility of Cervical cytology after reviewing 5000 slides

Cytology Screen categoriesBethesda Scoring

Management of women with LSIL

Draw backs of cytology screening(Roche submission to US FDA March 2014)

Harald zur Hausen 1984 isolated HPV 16 from Cx tissue

Awarded Nobel Prize 2008

Relative sensitivities of cytology & HPV testing

Co Testing

Genotypes separately & simultaneously reported by Star Metropolis Clinical Lab

Primary HR HPV Screening with reflux cytology

Courtesy Dr Jalaa Taher, HAAD

Courtesy Dr Jalaa Taher, HAAD

Courtesy Dr Jalaa Taher, HAAD

UAE study Age distribution

n = 314

2

33

84

63

48 46

21 18

0

10

20

30

40

50

60

70

80

90

< 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 > 51

number

number

HPV Genotypes in UAEn = 126

8 LR genotypes 14 HR genotypes

Genotype distribution in different age groups (n = 126)

Age group Genotypes

< 20 [39, 59]

21 - 25 [6, 6, 11,51] [16, 51,61,66] [53] [11,18,31,39,58][42]53, 66, 66, [66,59,52], [52,73], 31, [66,35,54,6]

26 - 30 [16] [42,43,51,66] [6] [16,39.52,61,68] [6,39,61,68,73][56,42,43], 33, [35,53], [52,70], 42, 16, 6, [51,39,42,6]

31 - 35 [52] [43,58,59,66] [11,16,42,43,53,61,61] [16,73,82] [6,52]66, 51, [58,16], [33,6], 44

36 - 40 [16,70] [6] 54, [59,31,42,11], [18,54], 18

41 - 45 [42,51,68] [42,53,59] [42,59] [16,16,18,52] [53,53,68,70]53,58,51

46 - 50 [16] [6, 42], 33

> 51 [16], 53, [33,82], 33, 53, [51,33,35,42,6]

HPV genotypes in UAE

02468

10121416

geno

type

6 L

g 11

Lg

16 H

g 18

Hg

31 H

g 33

Hg

35 H

g 39

H

g 42

Lg

43 L

g 44

L

g 51

Hg

52 H

g 53

H

g 54

Lg

56 H

g 58

H

g 59

Hg

61 L

g

66 H

g 68

Hg

70 L

g

73 H

g 82

H

14 HR genotypes : 808 LR : 46

HPV Genome

• E1-E7 = “Early” genes (nonstructural)

• L1, L2 = Capsid genes• URR = upstream regulatory

region

• E6 & E7 proteins play major role in immortality & malignant transformation of infected cells

• E5 has role, but not required to maintain cancer phenotype

Munoz et al. 2006.

Why Cervical Cancer is preventable ?Natural History of HPV infection

HPV-containing double stranded DNA

‘Empty’ non-infectious virus-like particle (VLP)

mimics the virus

Virus-like particles (VLPs) as HPV vaccine antigens mimic the virus structure

Stanley M, et al. Vaccine 2006; 24(suppl 3):S3/106–113.

Vaccines

• Gardasil (2006) : – Contains HPV 16, 18, 6, 11

• Cerverix (2009): Contains HPV 16, 18– Females 10 through 25– For:

• Ca Cx• CIN• Adenocarcinoma in situ

– Gardasil for males too and for Ca Anus, warts etc

Two Opportunities to prevent Cx Ca

Normal cervix

HPV infection

Cervical Intraepitheilial neoplasia

CIN

Cervical Cancer

HPV vaccine

HPV & Cx screen & t/t

10- 18 18 – 25 > 30

Collection of Cx Swab

Cervical Cancer is entirely preventable

1.Vaccination before exposure2.Screening after 30 yrs (every 5 yrs)

Though STI, it does not imply un-faithfullness

Cancer free RAK / UAE by 2020 Become a national achievable goal

Insurance be instructed to approveVaccination & Co-testing

Please Join, Support & Promote

Scientists have the tools, but cannot do it alone

Thank you for your attention