HPV Infection , HPV Vaccination , Cervical cancer , Cancer in India , Dr. SHARDA JAIN
- 1. Burden of HPV Infection / Cervical Cancer & Its Impact in India DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Jyoti Bhaskar
- 2. Review this Lecture and others at: Slideshare.net/lifecarecentre Burden of HPV Infection / Cervical Cancer & Its Impact in India
- 3. 3 Take home messages of 2 symposium on Burden of HPV infection and cervical cancer Delhi 4/7/2015
- 4. Presentation Outlines • Introduction to Human Papillomavirus • Acquisition of HPV infection • Burden of cervical cancer and HPV infection
- 5. Human Papillomavirus • Papillomaviridae family, ds-DNA genome, non- enveloped, icosahedral capsid with major (L1) and minor (L2) structural proteins • Persistent infection by oncogenic HPV types is a prerequisite for the development of cervical cancer • >190 types of HPV, 12 high-risk type for human cancers, type 16 and 18 responsible for ~70% of all cervical cancers in women globally • Natural infection does not offer full protection against new HPV infection L1 protein pentamer L2 supporting protein Circular DNA 55 nm
- 6. 40 7 32 42 39 59 5544 PCV1 13 11 6 73 34 61 27 2a 57 3 28 10 29 51 26 30 53 56 66 RhPV1 70 18 45 58 33 52 1635 31 Papillomavirus Phylogenetic Tree • The alpha-papillomavirus genus of the papillomavirus phylogenetic tree is shown* • Oncogenic types closely related to HPV 16 and 18 are highlighted • HPV 16 is most closely related to HPV 31 • HPV 18 is most closely related to HPV 45 • Selected species and types are shown.
- 7. Acquisition of HPV Infection • HPV infections can be acquired at any age.1-2,5 The risk starts from sexual debut and continues throughout life.3 • Although new infections decrease with age, risk of persistence (necessary condition for cervical cancer) increases.4 It puts adults at risk. • Penetrative intercourse is not necessary to become infected.6-7 HPV may be acquired by genital skin-to-skin contact.6 • Condoms do not fully protect against HPV transmission but reduce the risk of infection.6-9 1. Gravitt PE et al. Infect Dis Clin North Am 2005; 19: 439–58; 2. Bosch FX et al. J Clin Pathol 2002; 55: 244–65; 3. Burk RD. Hosp Pract (Off Ed) 1999; 34: 103–11; 4. Castle PE et al. JID 2005;191:1806-16; 5. Franco EL et al. Vaccine 2005; 23:2388–94; ; 6. McIntosh N. Human papillomavirus and cervical cancer. JHPIEGO 2000; 7. Partridge JM et al. Lancet Infectious Diseases 2006; 6: 21–31; 8. Winer RL et al. NEJM 2006; 354:2645-54; 9. Grainge MJ et al. Emerg Infect Dis. 2005; 11:1680-5.
- 8. Global total HPV-attributable cancers in females, 2002 Site Total cancers Attributable to HPV % all HPV cancer in females Attributable to HPV 16/18 % Cases % Cases Cervix 492,800 ~100 492,800 93.5 70+ 344,900 Anus 15,900 90 14,300 2.7 92 13,100 Oropharynx 9,600 12 1,100 0.2 91 1,000 Mouth 98,400 3 2,900 0.6 97 2,800 Vulva, vagina 40,000 40 16,000 3.0 80 12,800 Total 527,100 374,600 HPV is a Necessary Cause for Cervical Cancer as virtually all cervical cancers are caused by HPV. HPV and Cervical Cancer Adapted from Parkin DM & Bray F. Vaccine 2006; 24:S11–S25; Walboomers JMM, et al. J Pathol 1999; 189:12–19.
- 9. CIN3 is the immediate precursor of invasive cancer- Used as a better proxy indicator for HPV vaccine efficacy . Invasive carcinoma Normal epithelium HPV infection koilocytosis CIN1 3m CIN2 6m CIN3 12-24m YearsMonths PROGRESSION* LSIL/ASCUS HSIL REGRESSION ( ~1-2 Yrs) HPV Infection to Cervical Cancer 57% 43% 32% Burd. Clin Microbiol Rev 2003;16:1–17; Solomon et al. JAMA 2002;287:2114–2119
- 10. Burden of cervical HPV infection HPV prevalence (%) in the general population (among women with normal cytology) 7.9 Prevalence (%) of HPV 16 and/or HPV 18 among women with: Normal Cytology 6 Low-grade cervical lesions (LSIL/CIN-1) 28.2 High-grade cervical lesions (HSIL//CIN-2/CIN-3/CIS) 56..5 Cervical cancer 84.1 Data sources: Bhatla N, Int J Gynecol Pathol 2006;25:398; Franceschi S, Int J Cancer 2003;107:127; Gheit T, Vaccine 2009;27:636; Munirajan AK, Gynecol Oncol 1998;69:205; Nagpal JK, Eur J Clin Invest 2002;32:943; Peedicayil A, Int J Gynecol Cancer 2006;16:1591; Sowjanya AP, MBC Infect Dis 2005;5:116. http://apps.who.int/hpvcentre/statistics/dynamic/ico/country_pdf/IND, p 28. Accessed on Nov 30, 2014 Burden of HPV Infection in India- CIN, cervical intraepithelial neoplasia; LSIL, low-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion; CIS, changes in situ 1
- 11. Burden of HPV Infection in India- Adapted from Bruni L et al. Summary Report 2014-12-18 p.39. Available at: http://www.hpvcentre.net/statistics/reports/IND.pdf (Accessed on Feb 08, 2015). Site Study Prevalence (%) New Delhi Gupta 2009, Bhatla 2008, Arora 2005 16.6, 7.6, 10.0 North India Singh 2009 10.1 Chandigarh Aggarwal 2006 36.9 Lucknow Pandey 2012 (d) 11.7 Varanasi Srivastava 2012 (d) 9.7 Kolkata Mittal 2014 (d), Sankaranarayanan 2004 4.6, 7.8 WB Basu 2013 (d), Sarkar 2011 (e), Laikangbam 2007 5.8, 9.7, 11.6 Mumbai Kerkar 2011, Sankaranarayanan 2004 8.1, 6.3 TN Vinodhini 2012, Franceschi 2015 30.4, 14.0 East India Dutta 2012 9.2 Sikkim Laikangbam 2007 11.1 Manipur Laikangbam 2007 6.7 Prevalence of HPV among women with normal cytology in India, by study d=Women from the general population, including some with cytological cervical abnormalities. e=Few HPV types tested: 16, 18 only. 2
- 12. An Airbus-320 full of WOMEN crashing every day in India Deaths Due to CaCx - Just Think !
- 13. Burden of Cervical Cancer- in India 0 10CervicalCancerMortalityper100,000 20 30 50 15-19 Age Group in Years 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 =>75 India South Asia World Estimated age-specific mortality of cervical cancer in India, 2012 40 • Globally 528,000 cases of cervical cancers (CaCx). It kills 266,000 women each year • In India, every year 122,844 cases and 67,477 deaths • 334 cases per day and 185 deaths everyday • HPV 16 and/or 18 is responsible for 83% • It ranks as 2ND most common cancer in women aged 15 to 44 years in India 1 Bruni L et al. Summary Report 2014-12-18. Available at: http://www.hpvcentre.net/statistics/reports/IND.pdf (Accessed on Feb 08, 2015).
- 14. Burden of Cervical Cancer- in India Incidence of cervical cancer compared to other cancers in women of all ages in India 2 Bruni L et al. Summary Report 2014-12-18. Available at: http://www.hpvcentre.net/statistics/reports/IND.pdf (Accessed on Feb 08, 2015).
- 15. Burden of CaCx from Cancer Registry Bruni L et al. Summary Report 2014-12-18 (p6-7). Available at: http://www.hpvcentre.net/statistics/reports/IND.pdf (Accessed on Feb 08, 2015).
- 16. Burden of CaCx: Latest Publication, 2015 Sreedevi A et al. Int J Womens Health 2015;7:405-14 Age adjusted incidence rates of CaCx in female (rate per 100,000)
- 17. Appeal to Govt. Of India CaCx: The Forgotten Killer in India Annual Deaths Mortality Trend Priority in MDG Current Investment in Developing World Maternal Mortality* Cervical Cancer ** 50,000 Annually 67,000 Annually - 38%, 1990-2008 + 50%, 1990-2008 YES, MDG-5 NO USD 12 Billion, Globally ??? MDG, Millennium Development Goal. *Trends in maternal mortality: 1990 to 2013Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division
- 18. 18 NOW !!!
- 19. 19 THANK YOU SYMPOPSIUM DELHI 4/7/2015 DR. SHARDA JAIN DR. SHYAM KUKREJA
- 20. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 CONTACT US 9650588339, 011-22414049, WEBSITE : www.drshardajain.com www.lifecarecentre.in www.lifecareivf.com www.globalstemgenn.com E-MAIL ID Lifecarecentre21@gmail.com info@lifecareivf.com Contact@globalstemgenn.com &