Cervical Cancer: Past, Present and Future

Cervical Cancer: Past, Present and Future

CERVICAL CANCER: PAST, PRESENT AND FUTURE PROF. DR. OLIVERA MARKOVIC LECTURE ON MAY 18, 1013 AT THE EGYPTIAN AMERICAN GROUP MEETING 01/26/2020 CERVICAL CANCER LECTURE MAY 18, 2013 1 FOREWARD The Global Academy for Womens Health , located at JHU, MCC has a mission to advance education and science in womens health globally. The

Academy is particularly devoted to the disease prevention of gynecological malignancies. Thousands of women die and millions are afraid of getting ultimately fatal diseases that could be easily prevented. The Academy is devoted to improving womens health and the quality of their lives, decreasing womens suffering and saving womens lives around the world. Global Academy with its activity is hoping to contribute to the alleviation of health disparity between developed and developing countries. DEFINITION Cervical cancer is a malignant disease affecting cervix of the uteri The disease is an unstoppable growth of malignant cells which destroy tissue around the lesion, spreads to lymph nodes and can metastasize around the

body If this natural history is not interrupted by preventive or curative measures the outcome is ultimately fatal within few years of the detection of first symptoms OVERVIEW OF THE DISEASE LOCATION FOR CANCER DEVELOPMENT LESION OPERABLE SCREENING AND REMOVAL

FOR CURE ADVANCED INOPERABLE DIAGNOSIS THERAPY INEFFECTIVE Diagnosis Cytology Histology CLINICAL STAGING AND THERAPY CURE

CIS: Conization, LOOP, Partial cervicotomy Curable ICC-- 1A: Diagnostic intervention Surgery Surgery + Local Radiation All are curable IMPROVEMENT

ICC--1B & up: Local surgery Radical surgery, Radiation, Chemotherapy Combination therapy Alternative therapy None is curable Cervical cancer is preventable The disease is preventable and curable IF

detected on time. Women in developed countries are well protected with regular screening and early removal of suspect lesions. Cytological screening (Pap test) remains the best cervical cancer prevention. EPIDEMIOLOGY US [STANDARD]: 350 million Per 10e6 Women at risk: 110 million P: 11; M:4 Screening outreach: >80%

CC (2012) prevalence: 12,000; mortality: 4,000 WORLD: 7.3 BN Per 10e6 Women at risk: 2.5 bn P: 2.4; 1.44 Screening outreach: < 20% CC(2012) prevalence: 600,000; mortality: 360,000 Egypt: 84 million Per 10e6 Women at risk: 28 million Screening outreach: ? Diagnosis??? P:1.7; 1.06

CC (2010) prevalence: 514; mortality: 299 COMPARISON USA VS. EGYPT USA > 1950: PAP TEST launched with 80% disease reduction PRESENT: PAP TEST + ADDITIONALS (LBP, HPV, DNA) 2012 >: IMPROVED PAP THERAPY: STILL OBSOLETE EGYPT PRE PAP SITUATION DISEASE NOT RECOGNIZED

AS SERIOUS PENDING PROBLEM NEEDS: BETTER DIAGNOSIS BETTER PREVENTION OF RISK FACTORS AND CANCER CONTROL SCREENING US Example Before Pap test in the first half of the 20th Century, US had almost no organized cervical cancer control (screening) and the rates for cervical cancer prevalence and mortality were increasing steadily. In the middle of that Century the American Cancer Society promoted a cytological screening developed by Dr. Papanicolaou ( Pap test). The outreach

from about less than 5% was raised to 80% and the prevalence and mortality was decreased for 80%. There are about 50 mil Pap test done each year in this country, and cervical cancer prevalence and mortality decreased below the red line of 10 most frequent diseases in the US. OUTREACH & DISEASE STRATEGY TO REVERSE CC TRENDS EGYPT NEEDS STRATEGY FOR FIGHT AGAINST CERVICAL CANCER IMPROVE AWARENESS PREVENT

DEVELOPMENT PROFERSSIONAL EDUCATION REDUCING RISKS SCHOOL EDUCATION SCREENING FOR EALY LESIONS AND REMOVAL

TOOLS TO ENABLE NEW STRATEGY COLLECTION TOOL - OTC SELFCOLLECTING KIT eConnection POC-Expert center Biomarker visualization and image capturing

TELEMEDICNE TEST PROCESSING KIT DIAGNOSIS CYTOLOGY TELEMEDICINE EXPECTED RESULTS: FUTURE OF CC IN EGYPT INCREASE AMONG PROFESSIONALS, POLICY MAKERS, INSUARANCE, AND

PUBLIC INCRESE TO 50% OF WOMEN AT RISK WITHION 10-15 YEARS OF IMPLEMENTATION AWARENES SCREENING DISEASE TRENDS

HEALTH STATISTICS REVERSE FROM INCRESSING THE MORTALITY AND PREVLALENCE TO DECRESING TREND UPADATE FUTURE New improvement are needed to make Pat test like screening affordable, accessible, infrastructure independent and equitable for developing countries On the International Congress of Cytology that will

be held on the May 28, 2013 in Paris, there will be lot of discussion on this subject Our presentation: Evaluation of cytology screening strategies for cervical cancer in resource poor settings. Iyer VK, Mathur SR, Bhatla N, Markovic O. FURTHER READINGS First Edition, Springer, 2008 Second Edition, Springer, 2010 Updated and extended Edition, Springer, 2014 www.amazon.com www.markpap.com www.bioscicon.com

No effort is too big, nor investment too large to save one human life. CONTACT FOR ADDITIONAL INFORMATION PLEASE CONTACT: GLOBAL ACADEMY FOR WOMENS HEALTH 9601 MEDICAL CENTER DRIVE, RM 111 JOHNS HOPKINS UNVERSITY, MCC PROF. DR. OLIVERA MARKOVIC P/F: 1.301.610.9130 Web-site: www.markpap.com

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