annex 1. - uiccold.uicc.org/templates/uicc/pdf/cervical/uiccdossierpart3.pdfcervical screening...
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Annex 1. EXAMPLE OF COuntry wOrk On CErviCAL CAnCEr By MEMBErS
AustraliaCancer Council G2
BangladeshBangladesh Cancer Society G4
NigeriaCLASP institute for women’s Health - uCL G6
United States of AmericaOncology nursing Society G8
European Union
UruguayProcedimientos del Programa de Prevención del Cáncer de Cuello uterino de uruguay G10
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AustraliaCancer Council
Best practice in cervical cancer immunisation
Report of a roundtable discussion about the impactof the human papillomavirus vaccine in Australia
Discussion and recommendations March 2008
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HPV vaccination in Australia – report/recommendations of a national policy roundtable
Executive summary
On 18 April 2007, The Cancer Council Australia convened a national roundtable discussion on human papillomavirus (HPV) immunisation and its impact on the National Cervical Screening Program. The aim was to bring leaders in immunisation and screening together to share their expertise, examine the latest evidence and develop recommendations for policy makers. The Australian Government (Commonwealth Department of Health and Ageing) co-sponsored the event.
The roundtable was convened in response to the emergence of a vaccine that prevents two strains of HPV that cause approximately 70% of cervical cancer. While HPV vaccination has the potential to significantly reduce the impact of cervical cancer, its introduction in Australia must be managed in a way that ensures Australia’s successful cervical cancer screening program continues to protect women who, for reasons documented in this report, would not benefit from the vaccine.
The event gathered together the nation’s leaders in cervical cancer policy and implementation, with the key objectives to: identify what information is currently available for health professionals and the community about the HPV vaccine; lead discussion around the impact of HPV vaccination on the National Cervical Screening Program; and generate outcomes and recommendations that can help inform policy and practice.
A key component of the roundtable was a workshop facilitated by Professor Terry Nolan, Head of School, School of Population Health, University of Melbourne, which identified: potential barriers to the successful rollout of the HPV vaccination program; potential barriers to ensuring the National Cervical Screening Program delivers optimal results following the introduction of HPV immunisation; and research questions that need to be addressed in the short and long term. The workshop rated the significance of key interventions under each of these headings, as documented in this report.
The roundtable also featured formal presentations from experts in a range of fields related to cervical cancer control, which are summarised in Attachment 1.
Following lengthy discussion, roundtable participants agreed on five principles around which a set of more detailed recommendations, and agencies with remit to explore them, are documented:
1. Review the National Cervical Screening Program;
2. ‘Central’ overseeing to monitor the HPV vaccine’s impact on the National Cervical Screening Program;
3. Develop an Indigenous ‘package’ for screening and vaccination;
4. Undertake post-implementation evaluation of the National HPV Vaccination Program; and
5. Address information systems issues.
This report lists these recommendations and summarises the discussion and presentations from the roundtable. Publication was deferred to enable additional expert input and to coincide with the subsequent development of the HPV immunisation chapter of The Cancer Council Australia’s National Cancer Prevention Policy.
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Full document: http://www.cancer.org.au//File/PolicyPublications/NCPP/NCPP07-09cervicalca.pdf
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BangladeshBangladesh Cancer Society
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F o r m o r e i n f o r m a t i o n :
Prof.Latifa Shamsuddin - [email protected]
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NigeriaCLASP institute for women’s Health - uCL
The First International Open Day to Raise Awareness of Screening for the Prevention
of Cervical Cancer
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Cervical Cancer Screening Open Day May 16th 2008
BACKGROUND
How the Free Cervical Screening Project Began The idea of setting up a project for cervical screening in Nigeria began when the newly formed Institute for Women’s Health, under the directorship of Prof. Ian Jacobs, received a donation of £500,000, which was to be spent on new projects in developing countries. Adeola Olaitan, Consultant Gynaecologist at University College London Hospital (UCLH) saw an opportunity to use her skills and those of her colleagues to help prevent cervical cancer in Lagos and in November 2005 the project was allocated £50,000. A successful collaboration with Dr Rose Anorlu, Consultant Gynaecologist at the Lagos University Teaching Hospital (LUTH) and Dr Chiara Mezzalira, Medical Director of St Kizito’s Primary Health Care Project saw the launch of a screening program for the prevention of cervical cancer.
Cervical cancer is the second commonest cancer in women world wide, second only to breast. It accounts for half a million cases a year and approximately 80% of these occur in the developing world. 300,000 women die of cervical cancer per annum, more than those who die of complications of childbirth.
There are multiple reasons why cervical cancer is common in Nigeria. There is no effective screening program and awareness of cervical cancer, even among healthcare workers, is low. In addition, HIV infection increases susceptibility to the disease. The majority of women present late and as there is little opportunity for curative treatment and no access to palliative care, most women die a miserable death.
Thus a small, inexpensive intervention such as cervical screening could potentially save numerous lives. It is estimated that screening in the United Kingdom saves 5000 lives per year.
F o r m o r e i n f o r m a t i o n o n C L A S P :
Dr Christine [email protected]
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OncOlOgy nursing FOrum – vOl 35, nO 1, 200817
OncOlOgy nursing sOciety POsitiOn
It Is the Position of ONS That• Oncologynursesprovidecomprehensiveeducationtoindividualsandfamiliesaboutcervicalcancerpreventionandearlydetection,includingeducationonsafersexualpractices,theHPVvaccine,andtheimportanceofannualPaptests.
• Thedecisiontovaccinateafemaleundertheageof18withtheHPVvaccineismadebyherparentsorlegalguardiansinconsultationwiththefamily’spediatricianorotherhealthcareproviders.
• PrivateandpublicsectorpayersprovidefullcoveragefortheHPVvaccine.
• Federalprograms,suchasVaccinesforChildren,thatsupportvaccinationsforchildrenreceiveincreasedfundingtoprovidefreevaccines,includingtheHPVvaccine.
• AwarenesscampaignsandothereffortstoeducatethepublicaboutavailabilityoftheHPVvaccinebeundertakenandfundedbystateandfederalgovernmentstoensurethatparentscanmakeinformeddecisionsaboutwhethertheirdaughtersshouldreceivethevaccine.
The Human Papillomavirus Vaccine and Prevention of Cervical Cancer
AlthoughtheuseofPapsmearshascontributedtoasharpdeclineincervicalcancerincidenceoverthepast50years,morethan9,700womenwerediagnosedwithcervicalcancerin2007(Jemaletal.,2007).Whendetectedatanearlystage,cervicalcancercanbetreatedeffectively.Cervicalcancerdiagnosedatanadvancedstagemaybefatal;3,700womendiefromcervicalcancerintheUnitedStateseachyear(Jemaletal.).Socioeconomicandracialdisparitiesexistwithrespecttocervicalcancerincidenceandmortality;forexample,themortalityrateofAfricanAmericanwomenismorethandoublethatofCaucasians(U.S.CancerStatisticsWorkingGroup,2006).ResearchersestimatethatthecostofcervicalcancertreatmentintheUnitedStatesis$146.6millionperyear,whiletheannualcostoftreatingprecancerouscervicallesionsis$3.6billion(Chesson,Blandford,Gift,Tao,&Irwin,2004).Infectionwiththehumanpapillomavirus(HPV)isthemostsignificantriskfactorfordevelopingcervicalcancer(Franco&Harper,
2005).EachyearintheUnitedStates,6.2millionpeopleareinfectedwithHPVandatleast50%ofsexuallyactivepeopleareestimatedtobecomeinfectedwithHPVatsometimeintheirlives(CentersforDiseaseControlandPrevention[CDC],2006).In2006,theU.S.FoodandDrugAdministrationlicensedthefirstHPVvaccineforfemalesages9–26years.Gardasil®(Merck),
giventhroughaseriesofthreeinjectionsoverasix-monthtimeperiod,protectsagainstfourHPVtypes,whichtogethercause70%ofcervicalcancersand90%ofgenitalwarts.TheHPVvaccinationdoesnoteliminatetheneedforannualPaptestsanddoesnottreatexistingHPVinfections,genitalwarts,precancers,orcancers(CDC,2006).
ReferencesCentersforDiseaseControlandPrevention.(2006).HPVvaccinequestionsandanswers.RetrievedJuly25,2007,fromhttp://www .cdc.gov/std/hpv/STDFact-HPV-vaccine.htm
Chesson,H.W.,Blandford,J.M.,Gift,T.L.,Tao,G.,&Irwin,K.L.(2004).TheestimateddirectcostofsexuallytransmitteddiseasesamongAmericanyouth,2000.Perspectives on Sexual and Reproduc-tive Health, 36(1),11–19.
Franco,E.L.,&Harper,D.M.(2005).Vaccinationagainsthumanpap-illomavirusinfection:Anewparadigmincervicalcancercontrol.Vaccine, 23(17–18),2388–2394.
Jemal,A.,Siegel,R.,Ward,E.,Murray,T.,Xu,J.,&Thun,M.J.(2007).Cancerstatistics,2007.CA: A Cancer Journal for Clinicians, 57(1),43–66.
U.S.CancerStatisticsWorkingGroup.(2006).United States cancer statistics: 2003 incidence and mortality.Atlanta,GA:U.S.Depart-mentofHealthandHumanServices,CentersforDiseaseControlandPrevention,andNationalCancerInstitute.
Approved by the ONS Board of Directors, 10/07.
ToobtaincopiesofthisoranyONSposition,contacttheCustomerServiceCenterattheONSNationalOfficeat125EnterpriseDrive,Pittsburgh,PA15275-1214(866-257-4ONS;[email protected]).PositionsalsomaybedownloadedfromtheONSWebsite(www.ons.org).
United States of AmericaOncology nursing Society
June 24, 2008 International Union Against Cancer 62 route de Frontenex 1207 Geneva, Switzerland To Our International Union Against Cancer (UICC) Colleagues: On behalf of the Oncology Nursing Society (ONS) and its more than 37,000 oncology nurses and other health professionals, who are dedicated to ensuring and advancing access to quality cancer care, we are writing to express our support for efforts we understand UICC has underway to improve global cervical cancer prevention. ONS has consistently supported advocating for domestic and international policies and programs that seek to enhance and expand prevention and early detection of cancer. To that end, we commend you for recognizing the global public health imperative for renewed and expanded efforts to reduce and prevent the second most common cause of death from cancer in women worldwide. As you know, since its inception in 1941, the Pap smear has reduced cervical cancer deaths by 70% among American women. While the incidence of cervical cancer is relatively low in the U.S., ONS has concerns that 85% of all cervical cancer cases occur in developing countries, where it is the most common cause of death. Infection with the human papillomavirus (HPV) is the most significant risk factor for developing cervical cancer. As such, preventing HPV infection among women and girls can reduce cervical cancer incidence and save hundreds of thousands of lives across the globe. Moreover, when detected at an early stage through the Pap smear, cervical cancer can be treated effectively. ONS believes that availability of the Pap smear and the recent development of new screening and vaccination technologies – including the HPV vaccine – together offer an unprecedented opportunity to reduce the incidence and mortality of this highly preventable disease, particularly in developing countries.
ONS advocates – and stands ready to support – international efforts to increase access to cervical cancer screening, while also ensuring that all women and girls who wish to be immunized against HPV receive vaccination. ONS believes that such efforts must be reflective and respectful of each country’s culture and that the provision of cervical cancer screening and/or HPV immunization should be affordable and include informed consent, education on safer sexual practices, and explanation that vaccination is not a substitute for screening.
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European Union
To obtain a ful l copy please contact the press off ice:
[email protected] http://www.consilium.europa.eu/Newsroom
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UruguayProcedimientos del Programa de Prevención del Cáncer de Cuello uterino de uruguay
Comisión Honoraria de Lucha Contra el Cáncer
Programa Nacional de Control de Cáncer
Ministerio de Salud Pública
Montevideo, 2008
ESTRATEGIAY
MANUAL DE PROCEDIMIENTOS
Programa de Prevenciónde Cáncer de Cuello Uterino
en el Uruguay ”Dr. Enrique Pouey”
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F o r m o r e i n f o r m a t i o n :
Dr. Guillermo Rodríguez www.urucan.org.uy
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El Programa de Prevención del Cáncer de Cuello Uterino (PPCCU) surge en el Uruguay enel año 1994 por iniciativa de la Comisión Honoraria de Lucha contra el Cáncer (CHLCC)como una experiencia piloto en el área de influencia del Hospital Saint Bois en Montevideo,la capital de Uruguay. Esta experiencia se extiende progresivamente a otros departamen-tos del interior del país, con complementación de recursos de los Hospitales del Ministeriode Salud Pública (MSP). Posteriormente se coordinan actividades con algunas Intenden-cias Municipales adquiriendo la forma de una compleja organización con personas quedependen de diversas instituciones, que componen áreas técnicas y administrativas condiferentes niveles de acción.A nivel de la CHLCC se plantea la extensión del PPCCU a todo el Uruguay, en coordinacióncon el Programa Nacional de Control de Cáncer (PRONACCAN). Por este motivo se soli-cita el asesoramiento de la Unión Internacional contra el Cáncer (UICC), realizándose lassiguientes actividades:
• Seminario en Paysandú, Uruguay, sobre Organización, Control de Calidad y Evalua-ción de un programa de prevención del cáncer de cuello de útero, con la participa-ción de las Dras. Hélène Sancho Garnier (Francia), Leticia Fernández Garrote (Cuba)y Lisseth Ruiz de Campos (El Salvador), como profesoras y Maria Stella de Sabata,jefa de Prevención y Detección Temprana de Cáncer, UICC (Unión InternacionalContra el Cáncer) Noviembre, 2005.
• Primera Asesoría local de UICC en Mayo de 2006 con trabajo práctico y analíticosobre la organización del Programa, el sistema de información, visitas a laboratoriosde citología, Unidades de toma de muestra de PAP y Unidades de colposcopía. Dras.Leticia Fernández Garrote (Cuba) y Lisseth Ruiz de Campos (El Salvador).
• Segunda Asesoría local de UICC en Diciembre de 2006 para el desarrollo del siste-ma de información, control de calidad de los laboratorios y elaboración del Manualdel Programa. Visitas a Centros Asistenciales de segundo y tercer nivel. Dras. LeticiaFernández Garrote (Cuba) y Lisseth Ruiz de Campos (El Salvador).
• Tercera Asesoría local de UICC 1º a 15 de Junio de 2007 «Aprobación de la primeraversión del manual del Programa, desarrollo del sistema de información y sistemainformático nacional, implementación de un plan de reclutamiento de la poblaciónobjetivo, instrumentación del sistema de control de calidad de la citología y de cursosde formación de citotécnicos para el PPCCU.» Prof. Hélène Sancho Garnier (Fran-cia), Dra. Leticia Fernández (Cuba) y Dra. Lisseth Ruiz De Campos (El Salvador).
Este documento pretende ubicar al actor, participante activo del Programa dentro del es-quema organizativo, así como conocer todos los módulos que lo componen con la informa-ción mínima indispensable de cada uno de ellos.Para su escritura se utilizó la información epidemiológica internacional y de Uruguay publi-cada por International Agency for Research on Cancer (IARC), y del Registro Nacional deCáncer de Uruguay. Se tomó en cuenta la información obtenida por el PPCCU que desdehace trece años ha implementado la CHLCC en Montevideo y varias localidades del interiordel país.Se realizaron reuniones con amplia participación de técnicos locales.
Prefacio
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Se elaboró un documento preliminar, que fue aprobado en su primera versión, luego continuó perfec-cionándose hasta llegar a la versión actual, que contó con la contribución inestimable de un grupo deexpertos locales en las diferentes áreas temáticas del Programa (cuya lista se adjunta a continuación)y la revisión exhaustiva de las consultoras internacionales.Creemos que es importante destacar que la tarea de cada uno es indispensable y que la suma de lasacciones de todos en el fiel cumplimiento de los objetivos específicos planteados, determina el éxitode esta tarea.
Dr. Guillermo RodríguezCoordinador del Programa de Prevención
de Cáncer de Cuello Uterino
PREF
ACIO
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Anexo 2. EvidEnCE OF COuntry SuPPOrt FOr iMPrOvEd CErviCAL CAnCEr PrEvEntiOn
The dossier will be available at www.rho.org/CCAdossier
this dossier recompiles messages from leaders in the countries most affected by cervical cancer. Cervical cancer is a huge problem worldwide, with about 270,000 deaths every year. Most of those deaths occur in Africa, Asia, and Latin America. the letters, video messages, editorials, and declarations in this dossier express support for improved cervical cancer prevention—screening and vaccination—for women throughout the developing world.in addition to the documents, the dossier includes the names of over 1,200 individuals, representing nearly 700 organizations, who signed an online Global Call to Stop Cervical Cancer in 2007 and 2008.
this evidence was compiled by Cervical Cancer Action (CCA), PAtH, and the international union Against Cancer (uiCC). it may be freely shared for educational and noncommercial purposes. Cervical Cancer Action is an advocacy coalition with the goal of expediting global availability, affordability, and accessibility of new cervical cancer prevention tools; strategic advocacy for expanded political will and financial commitment and civil society mobilization and support. CCA governing council: American Cancer Society, AidS vaccine Advocacy Coalition, Cancer research uk, international Federation of Gynecology and Obstetrics, international AidS vaccine initiative, international Planned Parenthood Federation, Pan American Health Organization, PAtH, and uiCC. For more information, please visit www.CervicalCancerAction.org.
PAtH, a founding member of CCA, is an international nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. For more information, please visit www.path.org.
the international union Against Cancer is the leading international, non-governmental organization dedicated exclusively to the global control of cancer. its vision is that of a dynamic, global community of connected cancer control organizations, professionals and volunteers working together to eliminate cancer as a major life-threatening disease for future generations. its mission is to connect, mobilize and support cancer organizations and individuals with the knowledge and skills they need to be effective. uiCC also has produced a “special edition” of the dossier of support, focusing on letters from uiCC members, and has created French and Spanish versions. For more information, please visit www.uicc.org/cervicalcancer.
Special thanks to Princess nikky Onyeri for help gathering letters from leaders in Africa.For more information about cervical cancer, visit rHO Cervical Cancer at www.rho.org.
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Anexo 3. ECCA EurOPEAn CErviCAL CAnCEr ASSOCiAtiOn.
dEtEnEr el cánce Cérvico-uterino en Europa
Cada año en Europa 50,000 y 25,000 mujeres contraerán cáncer cérvico-uterino y morirán respectivamente debido a la misma causa. Exámenes de evaluación organizados y efectivos pueden prevenir hasta en un 80% el cáncer cérvico-uterino.Las nuevas tecnologías, si son implementadas adecuadamente dentro de un marco de programas organizados, tienen el potencial de reducir los índices de cáncer cérvico-uterino aún más y prevenir casi cada caso de esta enfermedad en Europa.nosotros, los suscritos, hacemos un llamado al Parlamento Europeo, la Comisión Europea y a todos los Gobiernos nacionales de Europa para:
trabajar conjuntamente en la implementación de programas de prevención del cáncer cérvico-1. uterino efectivos, de conformidad con las recomendaciones del Consejo de la unión Europea y de las normas Europeas para el Control de la Calidad en los Exámenes de Evaluación del Cáncer Cérvico-uterino
dar apoyo al establecimiento de programas de educación en salud pública para asegurarse que 2. todas las mujeres estén informadas acerca de la importancia de la prevención del cáncer cérvico-uterino y tomar completa ventaja de todos los servicios que están a su disposición
Facilitar el intercambio de la mejor práctica entre los países de Europa para que así todos se 3. puedan beneficiar del conocimiento de categoría mundial que existe dentro Europa.
dar apoyo a investigaciones independientes para establecer los medios más apropiados en la 4. implementación de nuevos métodos de exámenes de evaluación y vacunación contra el virus de papiloma humano (vPH) para asegurar una reducción significativa en el cáncer cérvico-uterino a través de Europa
reconocer y dar apoyo al importante rol que desempeñan eventos benéficos, organizaciones no 5. gubernamentales, grupos de apoyo a pacientes y voluntarios en la continua reducción del cáncer cérvico-uterino en Europa
P a r a m a y o r I n f o r m a c i ó n :
http://www.ecca.info/webECCA/en/
http://www.cervicalcancerpetition.eu/
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What is cervical cancer?
Cervical cancer develops in the cervix, the part of the
uterus that opens into the vagina. It occurs when cells
of the cervix become abnormal and start to grow in an
uncontrolled fashion.
It takes many years for abnormal cells in the early stages to
progress to cervical cancer. Fortunately, these stages are
easy to treat. However, they show no obvious signs and
can only be found by screening.
Why get screened?
Cervical screening is designed to find abnormal cervical
cells in the early stages when they can be removed so
they do not develop into cervical cancer. Once cancer has
developed, treatment becomes much more difficult and less
successful.
Who should be screened?
All women from 25 to 65 years of age should be screened.
Women who are 25 to 49 years of age should be screened
once every 3 years, while those from 50 to 64 years of age
should be screened every 5 years.
You can stop screening at the age 65 if you have been
regularly screened since you were 50 and have not had any
recent abnormal results.
What do you need to do?
If you are registered with a GP, you should receive a letter
when it is time for you to have your cervical smear.
If it has been more than five years since your last smear,
contact your GP to make sure that you are registered. You
will then need to make an appointment; this should be at the
middle of your menstrual cycle, about 2 weeks after the end
of your last period.
When you call to book, they will tell you what you need to do
to prepare. In general, you should avoid using any treatments
inside your vagina for 2 days before your appointment and
avoid having sex the night before.
How does screening work?
Cervical screening is done using the cervical
smear test which is taken at your GP
practice or family planning clinic. This is a
simple procedure that only takes about
ten minutes and involves little more
than a vaginal examination. During the
examination, a sample of cells will be
taken from your cervix using a small
spatula or brush.
Cervical cancer is caused by certain types of HPV. There
are more than 100 types of HPV and about 15 of these
can cause cervical cancer.
Most adults will have had a HPV infection at some time
in their lives, but it usually disappears on its own without
any problem. If the HPV does not disappear, it can
increase the risk of cervical cancer developing.
Vaccination is now available to protect women against
the 2 most common types of HPV, types 16 & 18, which
cause about 2/3rds of all cervical cancers and many
abnormal Pap tests. The current vaccines will be most
effective if given before you have had HPV 16 or 18, and
they will not effectively protect against all HPV types.
Therefore, even if you have been vaccinated, you should
still be screened. Together, screening and vaccination
will offer the most effective protection against cervical
cancer.Human Papilloma Virus (HPV) and Cervical Cancer
cervical smear result?
Most women will have a normal result.
In this case, your risk for cervical cancer is low and you
should continue your regular screening.
Is screening reliable?
No screening test is perfect and the cervical smear test may
miss some cases of disease. This is why you need to be
screened regularly, so that anything that has been missed
on one screen may be picked-up at the next, before it has
time to progress.
High-quality, organised screening programs are very
effective, but will not prevent all cervical cancers.
Normal
cervical smear result?
Some women will have an abnormal result. This simply
means that some abnormal cervical cells have been found
on the cervical smear test; it is very rare for cancer to be
detected.
Depending on the result, you will be advised to have one
of the following:
• another cervical smear in three to six months
• a colposcopy, which is a procedure that allows the doctor
to examine your cervix more closely.
Certain abnormalities should be removed so that they will
not develop into cancer. This usually requires only a simple
procedure that can be done in the hospital gynaecology
outpatient clinic. Treatment rarely affects your sex life or
ability to have children.
Abnormal
Uterus
Cervix
Vagina
These cells will be sent to the laboratory, where they will be
examined under a microscope to search for any abnormal
cervical cells.
Why get vaccinated?
Vaccination has been shown to effectively prevent:
• infection with HPV types 16 and 18, the two most
common cancer-causing types of HPV,
• the development of abnormal cervical cells caused by
these types.
Because of this, vaccination will reduce the risk of needing
treatment for abnormal cervical cells and it should reduce
the risk of cervical cancer.
One vaccine also protects against HPV 6 and 11 that cause
most cases of genital warts.
Vaccination prevents HPV infection occurring in the first
place. However, HPV is very common and many women
are infected soon after the start of sexual activities.
Because of this, vaccination will provide the best protection
if given before the start of sexual activities, and may be less
effective in sexually active teens or women.
How long does vaccination protect?
Should boys or men be vaccinated?
Although men cannot get cervical cancer, they can pass-
on HPV to their partner.
However, vaccination is not recommended for males in
the UK as we do not yet know if it will effectively prevent
HPV infection in males. This is now being studied and the
vaccines may be recommended for use in boys and men
in the future.
Is vaccination safe?
Vaccination appears to be safe. The clinical trials show only
minor reactions typical of any vaccination (swelling, itching,
redness at the injection site and less frequently fever, nausea,
and dizziness).
HPV vaccination is not recommended for pregnant women.
Does vaccination provide complete
protection against cervical cancer?What is cervical cancer?
Cervical cancer develops in the cervix, the part of the
uterus that opens into the vagina. It occurs when cells of
the cervix are infected with HPV, become abnormal and
start to grow in an uncontrolled fashion.
Vaccination effectively prevents the development of
abnormal cervical cells due to the HPV types in the vaccine.
However, it has not been shown to protect women who
have HPV 16 or 18 at the time they are vaccinated. Also,
vaccination does not protect against all of the other HPV
types that can cause cervical cancer.
For these reasons, vaccination does not provide
complete protection against cervical cancer. Even
if you have been vaccinated, it is
important to continue with regular
cervical screening so that any
abnormal cervical cells can be found
at an early stage when they can be
easily removed to prevent a cancer
developing.
There are about forty different types of Human Papilloma
Virus (HPV) that can infect the genital tract. Some of these
may cause abnormal cervical cells that can progress to
cervical cancer. HPV types 16 & 18 are among the most
common types associated with cervical cancer, causing
about 2/3 of cases and many abnormal Pap smears.
Other types of HPV can cause genital warts. HPV types
6 and 11 cause the majority of cases of genital warts but
are not associated with cervical cancer.
Genital HPV can be spread by any form of sexual
contact. It is very common and can occur at any time, but
most people will get HPV soon after the start of sexual
activities. Fortunately, most of them will fight-off their
HPV and it will clear within 24 months without causing
any problems. While a woman has HPV, it can produce
the abnormal cells found on her cervical smear, but these
also usually disappear once the virus has gone.
The problem occurs when some women do not clear their
HPV. In these cases, the abnormal cervical cells may, over
time, develop into cervical cancer if they are not detected
through screening and removed. Currently, there is no way
to tell who will clear their virus and who will not.Human Papilloma Virus & Cervical Cancer
Vagina
Uterus
Cervix
Who should be vaccinated?
In the UK, one HPV vaccine has been licensed for use
in children and adolescents aged 9 to 15 years, and in
adult females aged 16 to 26 years. In addition, the Joint
Committee on Vaccination and Immunisation (a committee
of the Department of Health) has advised that girls aged 12
to 13 should be vaccinated on the NHS. However, official
recommendations are not expected until later in 2007.
The current vaccine is given as three injections over six
months. At present, we know that vaccination offers good
protection against the HPV types in the vaccine and disease
caused by these types for at least 5 years, which is the
length of time women have been followed up in the clinical
trials so far. Studies are underway to see how much longer
the protection will last.
Human Papilloma Virus (HPV):
the cause of cervical cancer
• What is cervical cancer?
• Why get vaccinated?
• Who should be vaccinated?
• Does vaccination provide complete protection against cervical cancer?
• How long does vaccination protect?
• Should boys or men be vaccinated?
• Is vaccination safe?
Vaccination againstHPV and cerVical cancer
• Vaccination provides very effective protection against the 2 most common types of HPV, HPV 16 & 18, that are responsible for about 2/3 of cervical cancers and many abnormal Pap smears, but does not protect against all the HPV types associated with the development of cervical cancer.
• Vaccination prevents HPV infection occurring in the first place. Therefore it provides the greatest protection if given before the start of sexual activities.
• Vaccination has not been shown to offer protection against disease if you have HPV 16 or 18 when you are vaccinated. Therefore, the benefits of vaccination may be less in women who are already sexually active as some will be infected with one or both of these types.
• The current vaccine appears to be safe with the clinical trials showing only minor reactions typical of any vaccination.
• Vaccination against HPV reduces the risk of cervical cancer but does not eliminate it. Even if you have been vaccinated, it is important to continue with regular cervical screening.
Vaccination against HPV and cerVical cancer
The ECCA supports the reduction of cervical cancer in Europe by promoting awareness of cervical cancer and the means by which it can be prevented. Drawing upon the expertise of researchers, clinicians and public health organisations from across Europe, the ECCA has prepared:
The leaflets • Cervical cancer screening• Human Papilloma Virus (HPV) and cervical cancer• Follow-up and treatment of an abnormal cervical smear• Vaccination against HPV and cervical cancer
The booklets • Everything you need to know to help you avoid cervical
cancer• Everything you need to know if you have an abnormal
cervical smear
For additional information:Visit our website: www.ecca.info+Send your questions to: [email protected]
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• What is cervical cancer?
• Why get screened?
• Who should be screened?
• What do you need to do?
• How does screening work?
• Normal cervical smear result?
• Abnormal cervical smear result?
• Is screening reliable?
CerviCal CanCer sCreening
• Cervical cancer develops in the cervix, the part of the uterus that opens into the vagina. It occurs when cells of the cervix become abnormal and start to grow in an uncontrolled fashion.
• Cervical screening is designed to find abnormal cervical cells in the early stages when they can be easily removed so they do not develop into cervical cancer. Cervical screening is currently done using the cervical smear test.
• All women from 25 to 65 years of age should be screened. Women who are 25 to 49 years of age should be screened once every 3 years, while those from 50 to 64 years of age should be screened every 5 years.
• Vaccination is now available to reduce the risk of cervical cancer, but it will not eliminate need for screening. Together, screening and vaccination will offer the most effective protection against cervical cancer.
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BRITISH SOCIETY FOR COLPOSCOPY AND CERVICAL PATHOLOGY
British Association for Sexual Health & HIV
The ECCA supports the reduction of cervical cancer in Europe by promoting awareness of cervical cancer and the means by which it can be prevented. Drawing upon the expertise of researchers, clinicians and public health organisations from across Europe, the ECCA has prepared:
The leaflets • Cervical cancer screening• Human Papilloma Virus (HPV) and cervical cancer• Follow-up and treatment of an abnormal cervical smear• Vaccination against HPV and cervical cancer
The booklets • Everything you need to know to help you avoid cervical
cancer• Everything you need to know if you have an abnormal
cervical smear
For additional information:Visit our website: www.ecca.info+Send your questions to: [email protected]
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Anexo 4. EnLACES utiLES
Alianza para la Prevención del Cáncer Cérvico-uterino
Sociedad Americana del Cáncer Cánceres relacionados con el SidA
Sociedad Americana del Cáncer : guia para la detección
Sociedad Americana del Cáncer: recomendaciones para la vacunación contra el vPH
Centros para la prevención y Control de Enfermedades EE.uu
Acción contra el Cáncer Cérvico-uterino
ECCA
Comisión Europea
infección Genital del vPH
vacunación contra el vPH: Preguntas y respuestas para el público
virus del Papiloma Humano y el Cáncer
Agencia internacional para la investigación del Cáncer
JHPiEGO
Organización Panamericana de la salud
PAtH
rHO Cérvio-uterino
Que es el virus vPH?
Organización Mundial de la Saludhttp://www.who.int/hpvcentre/en/
Agence Internacional para la Investigación del Cáncer (AIIC)http://screening.iarc.fr/digitallearningserie.php
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áfrICABurundidr rosa Paula [email protected]
Congo republica Democratica Alphonse [email protected]
Etiopiawww.mathycancersoc.org
Nigerdr Hadiza nathalie [email protected]
Nigeriahttp://www.copebc.com/www.socron.net/socron/ (Society of oncology and cancer research of nigeria)
Túnezwww.atcc.org.tn
Ugandadr Gertrude [email protected]
AUSTrAlASIA/ASIAAustraliaCancer councilhttp://www.cancer.org.au/Home.htmQueenslandwww.qldcancer.com.auSouth Australia www.cancersa.org.au victoriawww.cancervic.org.au
BangladeshProf.Latifa Shamsuddin [email protected]
IndiawiA dr rajkumar [email protected] Gujaratwww.cancerindia.orgtAtAhttp://tmc.gov.in/
Indonesiawww.kankerindo.org
Malasiawww.radiologymalaysia.org/breasthealth/bcwaindex.htm
Pakistánhttp://www.shaukatkhanum.org.pk/
Taiwánhttp://ecancer.org.tw
EuropaBélgicahttp://www.cancer.be/index.cfm?fuseaction=home&Lang=nL
Dinamarcahttp://www.cancer.dk/Cancer/forside+cancerdk.htm
Estoniahttp://www.cancer.ee/?op=&id=&cid=
franciahttp://www.ligue-cancer.net/http://www.cjp.fr/
Alemaniahttp://www.dkfz.de/index.html
ItaliaAiOMhttp://www.aiom.it/AiMaChttp://www.aimac.it/
Irlanda del Norte http://www.ulstercancer.org/
Noruegahttp://www.kreftforeningen.no/
Portugalhttp://www.ligacontracancro.pt/
Slovaquiadr Eva [email protected]
EspañaAEEC .http://www.todocancer.org/FECEChttp://www.fecec.org/contents/home.phpiCOhttp://www.iconcologia.net/
Suizahttp://www.swisscancer.ch/index.php?id=314
www.turkcancer.org
Para mayor información acerca de los firmantes :
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Turquíawww.turkcancer.org
reino Unido Crukhttp://www.cancerresearchuk.org/CLASPdr Christine [email protected]
AMérICA lATINAArgentinaHenry moorewww.hmoore.com.arSLACOMhttp://www.slacom.org/LALCEChttp://www.lalcec.org.ar/
republica [email protected]
Hondurashttp://www.ccancer.hn/
MexicoAMLCChttp://www.amlcc.org/instituto nacionalhttp://www.incan.edu.mx/
Uruguayhttp://www.urucan.org.uy/
MEDIO OrIENTE
Israelhttp://www.cancer.org.il/
libanohttp://www.cancer.org.lb/
américa dEl nortE CanadáBCCAhttp://www.bccancer.bc.ca/default.htmnova Scotiahttp://www.cancercare.ns.ca/CHuMhttp://www.chumontreal.qc.ca/Québequehttp://www.fqc.qc.ca/PHA Canadahttp://www.phac-aspc.gc.ca/index-eng.php
Estados Unidos de Norte AméricaASCOhttp://www.asco.org/iPOShttp://www.ipos-society.org/about/org/mission.htmOnShttp://www.ons.org/
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dürst, M. et al. Proc. natl. Acad. Sci. uSA, 80: 3812-3815, 19831.
Boshart, M. et al. EMBO J. 3, 1151-1157, 19842.
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Lele, S.M. et al. Arch. Pathol. Lab. Med. 126: 1184-1188, 200219.
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Sawaya, G.F. and washington, A.E. Clin. Obstet. Gynecol. 42: 922-938, 199921.
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winer, r.L. et al. n. Engl. J. Med. 354:2645-2654, 200627.
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Cates, w. Jr. Sex. transm. dis. 26 (suppl.): 2-7, 199929.
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Myers, E.r. et al. Am. J. Epidemiol. 151: 1158-1171, 200031.
Anexo 5. rEFErEnCiAS dE LA uiCC
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koutsky, L. et al. n. Engl. J. Med. 347: 1645-1651, 200232.
Harper, d.M. et al. Lancet 364: 1757-1765, 200433.
villa, L.L. et al. Lancet Oncol. 6: 271-278, 200534.
the Future ii Study Group n. Engl. J. Med. 356:1915-27, 2007 35.
uS Food and drug Administration. Product Approval information-Licensing Action: 36.
GArdASiL. http://www.fda.gov/cher/products/hpvmer060806qa.htm
Ho, G.y. et al. n. Engl. J. Med. 338: 423-428, 199837.
Ho, G.y. et al. Cancer Epidemiol. Biomarkers Prev. 13: 110-116, 200438.
winer, r.L. et al. Am. J. Epidemiol. 157: 218-226, 200339.
Peyton, C.L. et al. J. infect. dis. 183: 1554-15643, 200140.
Partridge, J.M. et al. J. infect. dis. 196(8):1117-9, 2007 41.
Garland, S.M. et al. n. Engl. J. Med. 356: 1928-43, 200742.
Barnabas, r.v. et al. PLOS Med. 3: e138, 200643.
Sanders, G.d. and taira, A.v. Emerg. infect. dis. 9: 37-48, 200344.
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Squamous intraepithelial Lesions triage Study Group. J. infect. dis. 194: 1291-1299, 2006
Schiffman, M. et al. Lancet 370, 890-907, 200746.
Shankar, r et al. Lancet 370(9585):365-6, 200747.
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Annex 6 MOdEL LEttErS
if you would like to add your voice to the global effort for improved cervical cancer prevention worldwide, please send us a signed letter on your organization’s letterhead by mail, fax or email.
Si vous désirez apporter votre soutien a l’effort mondial pour une prévention organisée contre le cancer du col de l’utérus dans le monde, faites nous parvenir une lettre signée sur papier en-tête par courrier, fax ou e-mail.
Si usted desea apoyar el esfuerzo de movilización de la uiCC a favor de una prevención integral del cáncer cervicouterino, envíenos una carta membreteada y firmada por correo, fax o e-mail
Cervical Cancer initiativeinternational union Against Cancer uiCC62 rte de Frontenex1207 GenevaSwitzerlandFax: +41 (0)22 809 18 10E-mail: [email protected]
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to the international union Against Cancer (uiCC),
we understand the uiCC is gathering evidence for improved cervical cancer prevention. By means of this letter, we would like to show our commitment to the global effort to eliminate cervical cancer worldwide and provide those who need it most with affordable and effective prevention strategies.
Cervical cancer is the second largest cause of death from cancer in women worldwide. For women in developing countries, it is the biggest cancer killer. virtually all cervical cancer is caused by infection with human papilloma virus (HPv), the most common viral infection of the reproductive tract.
in industrialized countries, expanded screening and treatment have dramatically reduced cervical cancer rates over the last 60 years. But in developing countries, where the vast majority of women never have a pap smear, the incidence and death rates from cervical cancer continues to rise.
recognizing the potential of the new HPv vaccines to prevent cervical cancer, the world Cancer declaration calls for HPv vaccination programmes in low and middle-income countries where the burden of cervical cancer is high and calls for specific actions to reduce costs and provide public and professional education, public policy and research.
we recognize that vaccination programmes need to be based on what is affordable, feasible, and culturally acceptable in our country and that vaccination is not a substitute for screening.Cervical cancer is preventable and we are now in an unprecedented position where new technology provides us with the means to make a difference. HPv vaccines given to young girls now can prevent future infections and save numbers of lives for decades to come. Furthermore, improved screening methods could make efficient screening a reality, even in the most remote settings.
we share your commitment to work with governments and other sectors to make cervical cancer prevention work.
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À l’attention de l’union internationale Contre le Cancer – uiCC
nous soutenons l’effort de mobilisation de l’uiCC au niveau mondial et local en faveur d’une prévention organisée contre le cancer du col de l’utérus. Cette lettre témoigne de notre engagement dans l’effort pour éliminer le cancer du col dans le monde et donner accès à des stratégies de prévention efficaces et abordables aux femmes qui en ont le plus besoin.
Le cancer du col est la deuxième cause de mortalité par cancer pour les femmes du monde entier. Pour les femmes des pays en voie de développement, c’est le cancer le plus meurtrier. Pratiquement tous les cas de cancer du col sont dus à une infection par le virus Papilloma humain (HPv), l’infection des organes génitaux la plus fréquente
dans les pays industrialisés, l’extension des dépistages et les traitements des lésions précancéreuses a contribué à une baisse spectaculaire des taux de cancer du col de l’utérus durant les soixante dernières années. Cela contraste avec la situation des pays en voie de développement qui sont lourdement touchés par 85% des cas de cancer du col et où les taux continuent d’augmenter, alors que la majeure partie des femmes de ces régions ne sont jamais ni dépistées ni traitées.
Après évaluation du potentiel préventif des nouveaux vaccins contre le cancer du col, la déclaration Mondiale Contre le Cancer réclame des programmes de vaccination contre le HPv pour les pays à faibles et moyens revenus. Elle réclame également des mesures spécifiques pour réduire les coûts, former les professionnels de la santé, et informer la population.
néanmoins, il est clair que les programmes de vaccination doivent être développés en fonction de ce qui est abordable, réalisable et culturellement acceptable dans chaque pays, de plus, la vaccination ne se substitue pas au dépistage.
Le cancer du col de l’utérus n’est pas une fatalité et les nouvelles technologies fournissent désormais les moyens nécessaires pour modifier le cours de ces cancers. Aujourd’hui, la vaccination des jeunes filles contre le HPv permet d’éviter les conséquences d’infections futures et de sauver bon nombre de vies durant les décennies à venir. de plus, une adaptation des méthodes de dépistage peut faire du dépistage une réalité, même dans les pays les plus défavorisés.
nous soutenons votre engagement auprès des gouvernements et des autres institutions pour faire de la prévention contre le cancer du col de l’utérus une réalité.
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A la unión internacional Contra el Cáncer (uiCC),
Apoyamos el esfuerzo de movilización de la uiCC a nivel mudial y local a favor de una prevención integral del cáncer cervicouterino. Por medio de esta carta, queremos demostrar nuestro compromiso en el esfuerzo para eliminar a nivel mundial el cáncer cervicouterino y dar acceso a estrategias de prevención accesibles y efectivas a las mujeres que tienen la mayor necesidad.
Para las mujeres en países en desarrollo el cáncer cervicouterino es la primera causa de mortalidad por cáncer en mujeres y la segunda causa a nivel mundial. Prácticamente todos los casos de cáncer cervicouterino se deben al virus de papiloma humano (vPH), la infección viral más común del tracto reproductivo femenino.
En países industrializados, la implementación de la detección temprana, programas de tamizaje y tratamiento ha reducido dramáticamente las tasas de cáncer cervicouterino en los últimos 60 años. Pero en los países en desarrollo, donde la gran mayoría de mujeres nunca se han hecho un control, la incidencia y tasas de mortalidad de cáncer cervicouterino continúan creciendo.
reconociendo el potencial de las nuevas vacunas contra el vPH para prevenir el cáncer cervicouterino, la declaración Mundial del Cáncer reclama programas de vacunación de vPH en países de bajos y medianos ingresos, donde la incidencia del cáncer cervicouterino es alta. La declaración también reclama acciones específicas para reducir los costos de la vacuna y proveer educación pública y profesional, normas públicas e investigación.
reconocemos que los programas de vacunación necesitan estar basados en lo que es asequible, factible, y culturalmente aceptable en nuestro país y que la vacunación no substituye al tamizaje.
El cáncer cervicouterino es prevenible y estamos ahora en una posición sin precedentes donde las nuevas tecnologías nos proveen con los medios para un cambio significativo. Las vacunas de vPH aplicadas a mujeres jóvenes ahora pueden prevenir infecciones futuras y salvar gran cantidad de vidas por décadas a venir. Más aún, una mejor adaptación de los métodos de tamizaje pueden hacer realidad la detección eficaz, aún en los escenarios más remotos.
Compartimos vuestro compromiso de trabajar con los gobiernos y otros sectores para hacer que la prevención del cáncer cervicouterino sea una realidad.
nombre:título/posición:Organización:País:E-mail:
Supporting improved cervical cancer prevention worldwide
D O S S I E R O F S U P P O RTAugust 2008
About UICC
the international union Against Cancer (uiCC) is the leading international non-governmental organization dedicated
exclusively to the global control of cancer. it is a dynamic global community of connected cancer control organizations,
professionals and volunteers working together to eliminate cancer as a major life-threatening disease for future
generations.
uiCC is a non-profit organization. its objective is to connect,mobilize and support cancer organizations and individuals with
the knowledge and skills to be effective.Members are voluntary cancer leagues and societies, cancer research and treatment
centres and, in some countries, ministries of health.
uiCC focuses on cancer prevention and control, tobacco control, knowledge transfer, capacity building, and patient advocacy
and support. it organizes the world Cancer Congress held every two years, and annual symposia, workshops and training
courses with extensive expert networks.
it launched a world Cancer Campaign in 2005 and coordinates world Cancer day on 4 February each year.
uiCC fellowships help train researchers, clinicians, health professionals and cancer workers across the world. Between them,
GLOBALink (the online tobacco control community) and the Global Cancer Control Community service over 7,000 researchers
and professionals.
uiCC publishes the international Journal of Cancer, books in the tnM and prognostic factors series, a calendar of international
cancer conferences, and technical reports, newsletters and manuals.
uiCC is governed by its members through a general assembly, which meets every two years, and an elected board of
directors. with over 300 members in more than 100 countries, uiCC is a resource for action and a voice for change.
T H A N K Y O U