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Elements of the scenario of cervical cancer prevention based on HPV technology

Elements of the scenario of cervical cancer prevention based on HPV technology. Turkey May 2014 F. Xavier Bosch Catalan Institute of Oncology. The HPV implication in cancer burden applicability to the situation in Turkey . ICO HPV & Cancer surveys: HPV in cervical cancer in TURKEY.

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Elements of the scenario of cervical cancer prevention based on HPV technology

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  1. Elements of the scenario of cervical cancer prevention based on HPV technology Turkey May 2014 F. Xavier Bosch Catalan Institute of Oncology

  2. The HPV implication in cancer burden applicability to the situation in Turkey ICO+centre. Servei/Unitat

  3. ICO HPV & Cancer surveys: HPV in cervical cancer in TURKEY Usubutun et al, Int J GynecolPathol (2009)

  4. HPV Relative Contribution of the 5 most common types to cervical cancer Relative Contribution (%) GLOBAL 70.8 74.5 84.2 77.6 79.7 88.4 72.0 74.7 87.1 76.4 79.7 91.8 16+18 +31 +33+45 CENTRAL EUROPE* *Central Europeincludes Bosnia-Herzegovina, Croatia, CzechRepublic, Poland ; **MENAincludesAlgeria, Kuwait, Lebanon, Turkey 16+18 +31 de Sanjosé et al, Lancet Oncology (2010); Usubutun et al, Int J GynecolPathol (2009). +33+45 MENA** 16+18 +31 +33+45 TURKEY 16+18 +31 +33+45 100% 50% 60% 70% 80% 90%

  5. Cervical Cancer prevention: Social Partners • Pediatricians • GP’s • Vaccinologists • Clinical researchers • Vaccine industry • Gynecologists • Pathologists • Screening programs, GP’s • HPV screening technologies • Treatment • Public health • Centralized programs • Communication & education • Financing & equity • Phase IV

  6. VACCINATION AND SCREENING: TECHNOLOGICAL OPTIONS in 2014 /5 • Gardasil- 6, 11, 16, 18 • Cervarix- 16, 18 • V503- 6, 11, 16, 18, 31, 33, 45, 52, 58 70%+ cancer 50% (-93%) pre cancer (Gardasil 90%+ GW) 90%+ cancer > 80 % pre cancer (90%+ GW) • ANY OF THE (5/6) VALIDATED SCREENING TECHNOLOGIES

  7. The HPV Screening Scenario ICO+centre. Servei/Unitat

  8. HPV Test vs. Cytology: Summary of randomized controlled trials Cuzick J et al Int J Cancer 2006

  9. The Netherlands: recommendations of the Health Advisory Board 2011/2012.

  10. Self sampling for HPV tests • Better participation among non participants in regular screening calls • Better participation of reluctant social groups • Decreases overload of health services • Higher identification of CIN2+ lesions as compared to cytology • Proven results in RCT in The Netherlands, Sweden and Mexico ICO+centre. Servei/Unitat

  11. The HPV Vaccination Scenario ICO+centre. Servei/Unitat

  12. Antibodiesinduced by vaccination reach the cervix by transudation and exudation Blood vessel Connective tissue Basal membrane Cervix Squamous epithelium CVS Antibodies HPV Vagina VLP-specific IgG in CVS ~10-fold lower than in the serum after intramuscular vaccination Schwarz TF, et al. Vaccine 2009; 27:581-887; Nardelli-Haefliger D, et al. J Natl Cancer Inst 2003; 95:1128–1137 Program Research Epidemiology of Cancer

  13. Hpv vaccines and phase III trials: Efficacy in populations naïve to HPV Adapted from Bosch FX, et al. Br J Cancer. 2008;98(1):15-21, Therapy 2009and Schiller et al Vaccine 2012 vol. 30 Supp 5, 123-138 CancerEpidemiologyResearchProgram

  14. Hpv vaccines and phase III trials: Efficacy 2 Adaptadode Bosch FX, et al. Br J Cancer. 2008;98(1):15-21 and Therapy 2009. CancerEpidemiologyResearchProgram

  15. CERVARIX Cumulativeincidence of CIN2+ (A) and CIN3+ (B) irrespective of HPV DNA in thelesion, in the TVC M Lethinen et al. Lancet Oncol. 2012; 13:89-99 CancerEpidemiologyResearchProgram

  16. HPV vaccines and phase III trials: efficacy 3 Adapted from Bosch FX, et al. Br J Cancer. 2008;98(1):15-21, Therapy 2009and Schiller et al Vaccine 2012 vol. 30 Supp 5, 123-138 CancerEpidemiologyResearchProgram

  17. First results from Phase IV studies Population impact: reduction in HPV prevalence & HPV lesions Herd immunity: Protection to non- vaccinated females non-vaccinated males ICO+centre. Servei/Unitat

  18. GARDASIL Relative contribution of genital warts to the total number of visits in subjects below 21.SexualHealth clinic in Melbourne (53 000 new visits / 5 000 GW) Vaccination ages12to 18; ( to 26 in 2007/9) 12 to 13 in 2009+ Readet al Sex Transm. Infect 2011 Program Research Epidemiology of Cancer

  19. Early qHPV vaccine population impact data:Summary CancerEpidemiologyResearchProgram

  20. Summary: Relative contribution of HPV types to Cervical Cancer by region 31/33/45/52/58/(6-11) 16/18 Other HPV types 71% 19% World(n=8,977) 10% 11% Europe(n=2,058) 9% Asia(n=2,641) 13% Africa(n=544) North America(n=160) 5% LatinAmerica(n=3,404) 12% 11% Oceania(n=170) 90 0 10 20 30 40 50 60 70 80 100 Serrano et al. Infect Agent Cancer.2012 Dec 29;7(1):38

  21. Summary: Absolute contribution of selected HPV types to anogenital and oropharyngeal cancers 83% 60% 42% 31% 22% ANUS VAGINA PENIS Coveredbynonavalentvaccine VULVA OROPHARYNX 0% 20% 40% 60% 80% 100% 16/18 31/33/45/52/58/(6-11) Other HPV types Sources: HPV VVAPO study, Martel et al. LancetOncol.2012 Jun;13(6):607-15

  22. Current cervical cancer prevention model: early vaccination & adult screening Vaccinated girls Grown-up vaccinated girls + catch-up vaccine program 25y 85y 10y 15y 65y Repeated cervical cytology Irrespective of vaccination status Repeated HPV testing

  23. Current cervical cancer prevention model: early vaccination & adult screening Vaccinated girls Grown-up vaccinated girls + catch-up vaccine program 25y 85y 10y 15y 65y Repeated cervical cytology Irrespective of vaccination status Repeated HPV testing HPV Vaccination

  24. Thinking outside the box: integrated preventive strategy against cervical (and other) cancers Stage 1 Vaccinationcampaign 9-10y 30 + y 45/50y Stage 2 one / ? HPV Test one / ? HPV test v

  25. Thank you very much for your interest

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