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Jennifer S. Smith University of North Carolina JenniferS@unc

Cervical Cancer-Free America Initiative Overview Changing the Dialogue about Cervical Cancer Prevention. Jennifer S. Smith University of North Carolina JenniferS@unc.edu. Carolina Framework for Action against Cervical Cancer.

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Jennifer S. Smith University of North Carolina JenniferS@unc

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  1. Cervical Cancer-Free America Initiative Overview Changing the Dialogue about Cervical Cancer Prevention Jennifer S. Smith University of North Carolina JenniferS@unc.edu

  2. Carolina Framework for Action against Cervical Cancer There are four key challenges to eradication of cervical cancer that a comprehensive public health strategy can address: • HPV infection • Lack of screening • Screening errors • Not receiving follow-up care for abnormal Pap smear results Brewer and Smith

  3. HPV virus-like particles (VLPs): Basis of HPV vaccination • For Prevention of Cervical Cancer: • Persistent HPV 16/18 infections • HPV 16/18 abnormal pap smear

  4. HPV Types by Cervical Status: Potential Impact of 16/18 Vaccine HPV Type Specific Prevalence in All Cases ~70% ~50% ~14-25% ICC data: Smith et al. Int Journal of Cancer, 2007, 121 (3), 621-32. HSIL data: Smith et al. Int Journal of Cancer, 2007, 121 (3), 621-32. LSIL data: Clifford et al. Cancer Epidemiol Biomarkers. 2005;14:1157-1164

  5. 35 Frequency Papillomavirus Infection (all types) 30 25 20 15 10 5 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 Optimal to Vaccinate Adolescent Girls before Sexual Debut % Estimated start of sexual life Age (years) 1- Hypothetical distribution of HPV prevalence in EU modeled after data available in the US and Canada

  6. Prophylactic HPV Vaccine Approved for Adolescent Girls *Routine vaccination for 11-12 year old females

  7. HPV Vaccine Coverage National Immunization Survey-Teen Females aged 13-17 years US 2009: 44.3% (42.4%-46.1%) for 1+ dose 26.7% (25.2%-28.3%) for 3 doses completed August 20, 2010 / 59(32);1018-1023

  8. Continued Need for Screening Following HPV Vaccination HPV Type Specific Prevalence in All Cases ~70% ~50% ~14-25% ICC data: Smith et al. Int Journal of Cancer, 2007, 121 (3), 621-32. HSIL data: Smith et al. Int Journal of Cancer, 2007, 121 (3), 621-32. LSIL data: Clifford et al. Cancer Epidemiol Biomarkers. 2005;14:1157-1164

  9. Decrease in Cervical Cancer Mortality Following Introduction of Pap Test in the United States 1. OBGYN.net. Available at: http://www.obgyn.net/displayarticle.asp?page=/yw/articles/braun_PAP 2. American Cancer Society. Cancer Facts & Figures. Available at: http://www.cancer.org/

  10. Sensitivity of Cervical Cancer Screening Methods Naucler P, et al. JNCI. 2009;101:88-99.

  11. Pap Smear Guidelines: 2009 American College of Obstetrics and Gynecology <21 Years 21-29 Years 30-64 Years ≥65 Years Bi-annual Pap smear Consider discontinuing Pap smear at 65 or 70 years ..if patient has had 3 or more normal Pap results in a row, no abnormal test results in 10 years, and lacks other risk factors.* No routine Pap smear Pap smear every 3 years ..if patient has had 3 or more normal Pap results in a row, no abnormal test results in 10 years, and lacks other risk factors.* *History of cervical cancer or DES in utero, HIV positive, immunosuppression, or other risk factors for acquiring STDs. ACOG Practice Bulletin No. 109. Obstet Gynecol. 2009;114:1409-20.

  12. We can Change the Dialogue We can End Cervical Cancer Policy Makers Vaccination Screening We can Effect Real Change at the State-Level

  13. Age-adjusted Mortality Rates per 100,000, 2001-2005 SEER Data Indiana Kentucky California DC North Carolina Age-adjusted Death Rates per 100,000 Quantile Interval 3.0 – 3.7 2.8 – 2.9 2.5 – 2.7 2.2 – 2.4 1.9 – 2.1 1.5 – 1.8 Alabama HAWAII Texas ALASKA US Rate 2.5 1. Surveillance, Epidemiology and End Results (SEER) Cancer Stats NCI, 2001-2005. SEER = Surveillance, Epidemiology, and End Results

  14. Cervical Cancer Free AmericaCommon State Goals To increase HPV vaccination among young female adolescents ages 10-18 To increase cervical cancer screening among women ages 25-70 who have not been screened in the last four years .

  15. Cervical Cancer Free California California Medical Association Foundation Sara Cook, Carol Lee, Elissa Maas

  16. Cervical Cancer Free Alabama University of Alabama Mona Fouad, Warner Huh, Theresa Wynn

  17. Cervical Cancer Free Kentucky University of Kentucky Baretta Casey, Rick Crosby, Robin Vanderpool

  18. Cervical Cancer Free Indiana University of Indiana Gregory Zimet Kirk Forbes

  19. Cervical Cancer Free North Carolina University of North Carolina Noel Brewer, Pamela Entzel, Jennifer Smith

  20. How Can We Work Actively Together? January: Cervical Cancer Awareness Month is right around the corner.

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