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Highlights of the congress

Explore the comprehensive conclusions and roadmap from EUROGIN 2007 regarding cervical cancer prevention through HPV vaccination. Discover insights on vaccination age groups, prior exposure efficacy, monitoring, cross-protection, molecular markers, and unresolved vaccine issues.

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Highlights of the congress

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  1. Highlights of the congress L. Ameryckx

  2. EUROGIN 2007: conclusions ROADMAP on cervical cancer prevention • Age of HPV vaccination: • 9 to 14: YES - collectively • Up to 18: YES - if resources allow collectively • 15 to 26: POSSIBLE on an individual basis • > 26: NO current support sexual activity is NOT a criterion that is easy to use in setting public health policies

  3. Prior exposure by age group to HPV 16/18

  4. Efficacy in seropositive women • Cervarix phase III trial • 16612 women • Seropositive or seronegative for HPV 16/18 • DNA PCR negative • Nl/low grade pap • Efficacy against CIN2+ • Results: 91% effective • Regardless of exposure prior to vaccination; there is still a high level of protection against CIN2+

  5. EUROGIN 2007: conclusions ROADMAP on cervical cancer prevention • Is viral status needed before vaccination? • NO Not under any circumstance with any currently available method • Screening following HPV vaccination? • Continue now • PROBABLY WILL BE MODIFIED

  6. Screening in a vaccinated population • Cytology: PPV will  (~  lesion prevalence) • HPV test: unlikely to be as effected • Recommended: • HPV test • Pap cytology triage • Problem: cost: BUT longer screening intervals • Benefits: self test  workforce cytology detection glandular lesions monitoring vaccine protection

  7. Screening in a vaccinated population • Research: • Cost effectiveness • Age of 1st screening • Screening interval? • RCT!!

  8. EUROGIN 2007: conclusions ROADMAP on cervical cancer prevention • Monitoring HPV vaccination: • Collectively by public health authorities • Different in developed & developing countries • Monitoring is necessary but should not prevent vaccine introduction

  9. Cross-protection against CIN/AIS caused by non vaccine types? • First analysis FUTURE I/II study group: Gardasil • HPV naïve population, nl pap test • > 20000 women aged 16-26 • Follow up: 4 years • Results: • vaccination reduced combined incidence of HPV 31/33/35/39/45/51/52/56/58/59-related CIN2/3 & AIS by 38% • especiallydisease related to HPV 31/45: 62 % • Cross neutralising antibodies to HPV 31/45 have beendemonstrated

  10. Cross-protection against CIN/AIS caused by non vaccine types? • Phase IIb RCT: Cervarix • Infection with HPV 45  by 90 % • HPV 31  by 50%

  11. Cross-protection against CIN/AIS caused by non vaccine types? • Some level of cross protection against infection and infection related disease • Especially to HPV 31/45 • Results = promising • ?? Duration of protection • Priority = second generation vaccines that cover the other oncogenic HPV types

  12. Molecular markers • Cytology: poor sensitivity high FPR: 8.7 % • HPV-test: high sensitivity increase FPR • Histopathology: over- underdiagnosis CIN2+ • Need new markers to overcome limitations

  13. Molecular markers:p16 • ASCUS/LSIL : HPV test • BUT: LSIL: 83% = HPV-HR + only 25%  CIN 2/3 ? Which lesions will persist, progress, regress?

  14. Molecular markers: • HPVexpr E6/E7 neoplastic progression • E6  p53 • E7  pRb  overexpr p16  cell proliferation • HPV E6/E7 m-RNA • P16-INK4A antigen •  expr ~ risk of progression LSIL/ASCUS •  expr ~ CIN 2/3

  15. Molecular markers:p16 • Immunohistochemistry on cytology/biopsy • Overall sensitivity for CIN 2+ : 96% specificity : 83% ASCUS sensitivity : 95% specificity : 84% LSIL sensitivity : 100% specificity : 81%

  16. STOP presentatie

  17. EUROGIN 2007: conclusions ROADMAP on cervical cancer prevention • Age of vaccination • Is viral status needed before vaccination? • Screening following HPV vaccination • Monitoring HPV vaccination

  18. Age and vaccination • Prim target: girls prior to sexual contact:9-12y • Catch up vaccination till age 26? • Older women?

  19. HPV vaccines: unresolved issues • How long will protection last? • Is there any therapeutic efficacy? • Will virus type replacement occur in an immune population? • Will the vaccine viruses mutate? • How will we redesign our screening programs? • Should women who had Rx be offered vaccination? • Is it cost effective to immunise men?

  20. HPV vaccines: unresolved issues • Protection against other HPV related cancers? • Pregnant mothers with HPV associated disease? • Will vaccination reduce HIV transmission? • Effectivity in immunosuppressed patients? • Combination with other vaccines? • Can we immunise young children? • How can we make the vaccines available in the developing world? • How can we introduce new genotypes in future vaccines?

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