Globally, cervical cancer is second only to breast cancer as the leading cause of cancer in women, with a global prevalence of 2.3 million. It is the third most common cause of female cancer-related mortality worldwide, and 82% of new cervical cancer cases occur in developing countries. As stated by WHO, "without screening programs, cervical cancer is detected too late and leads to death in almost all cases." However, even in Europe, the United States, and Canada, where most women have access to routine screening, approximately 30,000 women die each year. Infection with oncogenic types of HPV 16 and 18 is the most significant risk/causative factor in cervical cancer etiology, and worldwide HPV positivity in cervical carcinoma has been documented to be 99.7%. In 2006 Merck's quadrivalent vaccine was approved by FDA. It targets four HPV types (6, 11, 16, and 18) that are involved in cervical cancer, high and low grade squamous intraepithelial lesions, and anogenital warts. Results from combined Phase II/III studies show that the efficacy of vaccine was 95–100% against LGSIL and HGSIL related to HPV 16 and 18 and vaccine use led to a 99% reduction in the incidence of genital warts (related to HPV 6 and 11). Due to morbidity associated with infection with HPV types 6, 11, 16, and 18, a prophylactic quadrivalent HPV vaccine targeting these four HPV types is expected to substantially reduce the burden of HPV-related disease.
Saad Ghazal-Aswad
a Department of Obstetrics and Gynaecology, Tawam Hospital, Al Ain, United Arab Emirates
Address for correspondence: Dr. Saad Ghazal-Aswad, Chair, Dept of Obstetrics and Gynaecology, Tawam Hospital, P.O. Box 15258, Al Ain, UAE. Voice: +00971-3-7677 444. saswad@tawam-hosp.gov.ae
Copyright © 2008 New York Academy of Sciences
KEYWORDS
HPV (human papilloma virus) • cervical cancer • quadrivalent vaccine
Monday, September 29, 2008
Monday, July 7, 2008
Cervical cancer awareness drive launched in UAE
DUBAI — On an average 43 women in the UAE died due to cervical cancer in each of the years 2005 and 2006, according to the annual report published by the Preventive Health Department in the Ministry of Health (MoH).
This number is second only to breast cancer which claims the lives of 100 women every year, said Dr Ali Ahmed bin Shukr, Chief Executive Officer (CEO) for Support Services in the MoH.
The details were announced yesterday at the launch of an educational network by the ministry, the Emirates Cervicare Network (ECN), to raise awareness of cervical cancer and its prevention.
The network has been launched in collaboration with the Health Authority Abu Dhabi and the Emirates Medical Association.
"Cervical cancer is among the leading causes of death amongst women in the UAE. According to recent WHO reports, cervical cancer is the second largest disease amongst women in the United States," Dr Bin Shukr said.
He explained that the UAE campaign for cervical cancer prevention is seeking to spread awareness of the diseases and ways to prevent the spread of the disease and support women who are living with cervical cancer.
Dr Bin Shukr called on the society for additional support to the awareness initiatives by the MoH and private sector groups.
Dr Haifa Hamad Fares, family medicine specialist in the MoH, insisted on the importance of regular check-ups and advice from gynaecologists on early diagnosis for cancer.
The spokesperson for Emirates Cervicare Network (ECN), Dr Mouzah Ghubash, emphasised on the need to correct the misconceptions about the disease to save the lives of thousands of women.
Cervical cancer is cancer in the cervix, the lower, narrow part of the uterus (womb) and is caused by repeated infection with the Human Papillomavirus (HPV) which is usually transmitted through sexual contact.
"Public health networks, such as ECN, are valuable and greatly needed in the UAE today so that important messages may be spread in each community," said Dr Amira Ismail Aladab, a representative of the Emirates Medical Association.
Dr Awatif Al-Bahar, consultant gynaecologist and head of the department at the Canadian Specialist Hospital, said cervical cancer is preventable.
"All women are at risk of contracting cervical cancer and they may not be aware that they have a cervical HPV infection because these infections are generally painless and without symptoms," said Dr Awatif adding that, "regular screening and vaccination can save a woman's life."
Every year 500,000 women are diagnosed with cervical cancer worldwide and nearly 250,000 women die each year as a result of this disease, says WHO.
This number is second only to breast cancer which claims the lives of 100 women every year, said Dr Ali Ahmed bin Shukr, Chief Executive Officer (CEO) for Support Services in the MoH.
The details were announced yesterday at the launch of an educational network by the ministry, the Emirates Cervicare Network (ECN), to raise awareness of cervical cancer and its prevention.
The network has been launched in collaboration with the Health Authority Abu Dhabi and the Emirates Medical Association.
"Cervical cancer is among the leading causes of death amongst women in the UAE. According to recent WHO reports, cervical cancer is the second largest disease amongst women in the United States," Dr Bin Shukr said.
He explained that the UAE campaign for cervical cancer prevention is seeking to spread awareness of the diseases and ways to prevent the spread of the disease and support women who are living with cervical cancer.
Dr Bin Shukr called on the society for additional support to the awareness initiatives by the MoH and private sector groups.
Dr Haifa Hamad Fares, family medicine specialist in the MoH, insisted on the importance of regular check-ups and advice from gynaecologists on early diagnosis for cancer.
The spokesperson for Emirates Cervicare Network (ECN), Dr Mouzah Ghubash, emphasised on the need to correct the misconceptions about the disease to save the lives of thousands of women.
Cervical cancer is cancer in the cervix, the lower, narrow part of the uterus (womb) and is caused by repeated infection with the Human Papillomavirus (HPV) which is usually transmitted through sexual contact.
"Public health networks, such as ECN, are valuable and greatly needed in the UAE today so that important messages may be spread in each community," said Dr Amira Ismail Aladab, a representative of the Emirates Medical Association.
Dr Awatif Al-Bahar, consultant gynaecologist and head of the department at the Canadian Specialist Hospital, said cervical cancer is preventable.
"All women are at risk of contracting cervical cancer and they may not be aware that they have a cervical HPV infection because these infections are generally painless and without symptoms," said Dr Awatif adding that, "regular screening and vaccination can save a woman's life."
Every year 500,000 women are diagnosed with cervical cancer worldwide and nearly 250,000 women die each year as a result of this disease, says WHO.
Sunday, March 16, 2008
Thinking About Testing for HPV?
Information for Women Considering Testing for the Human Papilloma Virus (HPV)
The cervix is the lower part of the uterus (womb). The uterus is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). Changes in the cervix are often caused by infection with a virus called human papilloma virus (HPV). HPV infections can lead to cervical cancer.
When you have a Pap test, your doctor can also check you for HPV. Some women may want to know if they have HPV. Some women may not wish to know.
This document has answers to questions women may ask about the Pap and HPV tests. It discusses:
� the difference between a Pap test and an HPV test
� what to do if you find out you have HPV
� how women can get HPV
� how to talk to your partner about HPV
� what it means if you find out you do not have HPV
Whether you have an HPV test or not, remember to always get your Pap test.
What is the difference between a Pap test and an HPV test?
A Pap test is used to find cell changes or abnormal cells in the cervix. A pathologist (a doctor who has special training in diagnosing diseases by lab tests such as looking at cells under a microscope) will look at a sample of cells from the cervix under a microscope to see if the cells are normal or if changes can be seen. The Pap test is a very good test for finding cancer cells and cells that might become cancer.
HPV is a virus that can cause cell changes in the cervix. The HPV test checks for HPV. The test can be done at the same time as the Pap test, with the same swab or a second swab. You will not notice a difference in your exam if you have both tests.
Should I be tested for HPV?
If you are age 30 or older, you can have an HPV test with your Pap test as part of your normal health visit. If both test results are normal (negative), you should have your next Pap test in 3 years.
You may want to know if you have HPV, or you may not want to know. Talk to your doctor or nurse about having the test. You also may want to ask about the cost and if your health insurance will cover it.
I am not 30 yet. Should I have an HPV test and a Pap test?
Women younger than 30 should not get the HPV test with the Pap test as part of their normal health visit. HPV is so common in women younger than 30 that it would not be helpful to test for it. After age 30, HPV is much less common.
If your Pap test shows certain cell changes, your doctor may want to do an HPV test even if you are younger than 30. This is not the same as getting having the HPV test with the Pap test as part of your normal health visit.
I am not 30 yet, but my Pap test came back as "abnormal." Now my doctor wants me to have the HPV test. Why?
The most common abnormal Pap test result seen is called ASC-�US ("ask us"). ASC-US cells usually are not pre-cancer, but they are not quite normal either. If your doctor sees ASC-US cells in your Pap test result, he or she, will want you to have the HPV test to see if HPV is causing the cell changes. Only women with ASC-US who also have HPV need more tests. In these cases the test is used to make decisions about possible treatment. Again, this is not the same as using the HPV test with the Pap test as part of your normal health visit.
If I test positive for HPV, what does this mean for me?
If you have HPV and an abnormal Pap test result, your doctor or nurse will explain what other tests you might need. If you have HPV and a normal Pap test result, this means only that you have the HPV virus. You will most likely be tested again in 6 to 12 months to see if the virus has gone away. If the virus is still there, you may need to have other tests.
If the virus does go away, we are not sure if the virus is completely gone from the body or it just becomes inactive and can't be found.
If I test positive for HPV, how did I get it?
HPV is spread by skin-to-skin contact during sex. It can be spread by all types of sex -- vaginal, oral, and anal.
If I test positive for HPV, when did I get it?
It is usually not possible to know when a person got HPV or who gave it to them. HPV may be found right away or not until many years later. Most men and women with HPV do not know they have it.
If I have HPV and it goes away, can I get it again?
There are many types of HPV. You may have one type that goes away, and you will not get that type again. But you can still get a different type.
This document covers only HPV types that can lead to cervical cancer. Other types of HPV can cause genital warts. The HPV test only tells you if you have HPV types that can lead to cancer.
How is HPV treated?
There is no treatment for HPV. There are treatments for the cell changes in the cervix that HPV can cause. If your Pap test shows cell changes, your doctor or nurse will discuss these treatments with you if you need them.
If I have HPV or cervical cell changes, what can I do?
Remember that HPV is very common and that most HPV infections will go away on their own. See your doctor for your health check-ups. If you have cell changes or if you have HPV and ASC-US cell changes, your doctor will tell you to get other tests.
Will I always have the HPV virus?
We do not know. We do know that HPV either goes away, or cannot be found, within 1 to 2 years. This happens in about 9 out of every 10 women.
Will I give HPV to my partner? Can I prevent this?
Condoms can help prevent HPV, but HPV may be present on skin that is not covered by the condom. It is possible to keep passing HPV back and forth from partner to partner. The only way to completely prevent giving or getting HPV is by not having vaginal, oral, or anal sex.
What should I tell my partner?
You may want to let your partner know that HPV is a very common virus and that most people who have sex will get HPV. Most people do not even know that they have it. If they do, they usually do not know when they got it or from whom.
Most of the time, HPV has no symptoms and goes away by itself within 1 to 2 years.
Can my husband or boyfriend be tested for HPV?
There is no HPV test for men at this time.
What are my chances of getting cervical cancer if I have HPV?
Women who have HPV and a normal Pap test result have a very low chance (about 4%, or 4 in 100) of getting abnormal cells that need to be treated or removed within the next 6 to 12 months. The chance of getting cancer is much lower than that. On the other hand, about 60% (60 out of 100) of women who have HPV and a normal Pap test result will not have HPV 6 months later, and many more will not have HPV after 12 or 18 months.
How common is HPV?
At least 8 out of every 10 women who have ever had sex will get HPV at some time in their lives. HPV is most common in young women who are in their late teens or early 20s.
Will HPV affect my pregnancy or my baby?
HPV does not affect pregnancy or the chances of getting pregnant. If HPV leads to cervical changes that need to be treated, the treatment should not affect your chances of getting pregnant.
HPV is rarely passed from a mother to her baby. The rare cases where this has happened do not involve the types of HPV that can cause cancer.
Both my Pap test and my HPV test results were normal. Why should I wait 3 years to get tested again? Is that safe?
Cell changes in the cervix happen very slowly. It usually takes more than 10 years for cell changes to become cancer. Women with normal Pap and HPV test results have almost no chance of getting cervical cancer within at least 3 years.
One of the benefits of testing for HPV is that women may not need a Pap test as often. Getting the Pap test and HPV test every 3 years means fewer tests, follow-up visits, and treatments may be needed. There is no added safety to getting both the Pap test and the HPV test more often than every 3 years.
American Cancer Society Guidelines for Early Detection
� You should begin cervical cancer testing about 3 years after you start having sex, but no later than age 21. Testing should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
� At age 30, if you have had 3 normal yearly Pap test results in a row, you may get tested every 2 to 3 years. Or you may get tested every 3 years with the Pap test plus the HPV test. Some women with certain risk factors may still need to be tested every year.
� If you are 70 years of age or older and have had 3 normal Pap tests in a row and no abnormal Pap test results in the last 10 years, you may stop getting tested. Discuss this with your doctor or nurse.
� If you have had a hysterectomy with removal of the uterus and cervix, you may stop testing, unless the surgery was done as a treatment for cervical cancer or pre-cancer. If you still have your cervix, you should still be tested.
� Some women believe that they do not need exams by a health care professional once they have stopped having children. This is not correct. They should continue to follow the Society�s guidelines.
Remember:
� HPV is a very common virus. Most men and women who have ever had sex will get HPV at some time in their life.
� Some women over age 30 may choose to be tested for HPV as a part of their normal health visit.
� Having the HPV test will NOT tell you if you have cervical cancer. The Pap test is the best test for finding cervical cancer or changes in the cervix.
� There is no treatment for HPV. There are treatments for changes in the cervix that may be caused by HPV.
� Women who get an HPV test with their Pap test and find that both tests are normal do not need to get tested again for 3 years.
� Having HPV does NOT mean you will get cancer. Most of the time the HPV virus goes away by itself.
Other resources on HPV and cervical cancer
American Cancer Society
For a copy of our publication What Women Should Know About Cervical Cancer and the Human Papilloma Virus, call 1-800-ACS-2345 or view it online.
Other organizations
American Social Health Association
Telephone: 919-361-8400
Web site: http://www.ashastd.org (http://www.ashastd.org/hpvccrc/)
Centers for Disease Control and Prevention (CDC)
Toll-free number: 1-800-CDC-INFO (1-800-232-4636)
Web site: http://www.cdc.gov ( http://www.cdc.gov/std/HPV/STDFact-HPV.htm)
National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
Web site: http://www.cancer.gov (http://www.cancer.gov/cancerinfo/types/cervical/)
National Cervical Cancer Public Education Campaign
Telephone: 312-578-1439
Web site: http://www.cervicalcancercampaign.org
Women�s Cancer Network
Telephone: 312-578-1439
Web site: http://www.wcn.org
No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-ACS-2345 or visit www.cancer.org.
The cervix is the lower part of the uterus (womb). The uterus is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). Changes in the cervix are often caused by infection with a virus called human papilloma virus (HPV). HPV infections can lead to cervical cancer.
When you have a Pap test, your doctor can also check you for HPV. Some women may want to know if they have HPV. Some women may not wish to know.
This document has answers to questions women may ask about the Pap and HPV tests. It discusses:
� the difference between a Pap test and an HPV test
� what to do if you find out you have HPV
� how women can get HPV
� how to talk to your partner about HPV
� what it means if you find out you do not have HPV
Whether you have an HPV test or not, remember to always get your Pap test.
What is the difference between a Pap test and an HPV test?
A Pap test is used to find cell changes or abnormal cells in the cervix. A pathologist (a doctor who has special training in diagnosing diseases by lab tests such as looking at cells under a microscope) will look at a sample of cells from the cervix under a microscope to see if the cells are normal or if changes can be seen. The Pap test is a very good test for finding cancer cells and cells that might become cancer.
HPV is a virus that can cause cell changes in the cervix. The HPV test checks for HPV. The test can be done at the same time as the Pap test, with the same swab or a second swab. You will not notice a difference in your exam if you have both tests.
Should I be tested for HPV?
If you are age 30 or older, you can have an HPV test with your Pap test as part of your normal health visit. If both test results are normal (negative), you should have your next Pap test in 3 years.
You may want to know if you have HPV, or you may not want to know. Talk to your doctor or nurse about having the test. You also may want to ask about the cost and if your health insurance will cover it.
I am not 30 yet. Should I have an HPV test and a Pap test?
Women younger than 30 should not get the HPV test with the Pap test as part of their normal health visit. HPV is so common in women younger than 30 that it would not be helpful to test for it. After age 30, HPV is much less common.
If your Pap test shows certain cell changes, your doctor may want to do an HPV test even if you are younger than 30. This is not the same as getting having the HPV test with the Pap test as part of your normal health visit.
I am not 30 yet, but my Pap test came back as "abnormal." Now my doctor wants me to have the HPV test. Why?
The most common abnormal Pap test result seen is called ASC-�US ("ask us"). ASC-US cells usually are not pre-cancer, but they are not quite normal either. If your doctor sees ASC-US cells in your Pap test result, he or she, will want you to have the HPV test to see if HPV is causing the cell changes. Only women with ASC-US who also have HPV need more tests. In these cases the test is used to make decisions about possible treatment. Again, this is not the same as using the HPV test with the Pap test as part of your normal health visit.
If I test positive for HPV, what does this mean for me?
If you have HPV and an abnormal Pap test result, your doctor or nurse will explain what other tests you might need. If you have HPV and a normal Pap test result, this means only that you have the HPV virus. You will most likely be tested again in 6 to 12 months to see if the virus has gone away. If the virus is still there, you may need to have other tests.
If the virus does go away, we are not sure if the virus is completely gone from the body or it just becomes inactive and can't be found.
If I test positive for HPV, how did I get it?
HPV is spread by skin-to-skin contact during sex. It can be spread by all types of sex -- vaginal, oral, and anal.
If I test positive for HPV, when did I get it?
It is usually not possible to know when a person got HPV or who gave it to them. HPV may be found right away or not until many years later. Most men and women with HPV do not know they have it.
If I have HPV and it goes away, can I get it again?
There are many types of HPV. You may have one type that goes away, and you will not get that type again. But you can still get a different type.
This document covers only HPV types that can lead to cervical cancer. Other types of HPV can cause genital warts. The HPV test only tells you if you have HPV types that can lead to cancer.
How is HPV treated?
There is no treatment for HPV. There are treatments for the cell changes in the cervix that HPV can cause. If your Pap test shows cell changes, your doctor or nurse will discuss these treatments with you if you need them.
If I have HPV or cervical cell changes, what can I do?
Remember that HPV is very common and that most HPV infections will go away on their own. See your doctor for your health check-ups. If you have cell changes or if you have HPV and ASC-US cell changes, your doctor will tell you to get other tests.
Will I always have the HPV virus?
We do not know. We do know that HPV either goes away, or cannot be found, within 1 to 2 years. This happens in about 9 out of every 10 women.
Will I give HPV to my partner? Can I prevent this?
Condoms can help prevent HPV, but HPV may be present on skin that is not covered by the condom. It is possible to keep passing HPV back and forth from partner to partner. The only way to completely prevent giving or getting HPV is by not having vaginal, oral, or anal sex.
What should I tell my partner?
You may want to let your partner know that HPV is a very common virus and that most people who have sex will get HPV. Most people do not even know that they have it. If they do, they usually do not know when they got it or from whom.
Most of the time, HPV has no symptoms and goes away by itself within 1 to 2 years.
Can my husband or boyfriend be tested for HPV?
There is no HPV test for men at this time.
What are my chances of getting cervical cancer if I have HPV?
Women who have HPV and a normal Pap test result have a very low chance (about 4%, or 4 in 100) of getting abnormal cells that need to be treated or removed within the next 6 to 12 months. The chance of getting cancer is much lower than that. On the other hand, about 60% (60 out of 100) of women who have HPV and a normal Pap test result will not have HPV 6 months later, and many more will not have HPV after 12 or 18 months.
How common is HPV?
At least 8 out of every 10 women who have ever had sex will get HPV at some time in their lives. HPV is most common in young women who are in their late teens or early 20s.
Will HPV affect my pregnancy or my baby?
HPV does not affect pregnancy or the chances of getting pregnant. If HPV leads to cervical changes that need to be treated, the treatment should not affect your chances of getting pregnant.
HPV is rarely passed from a mother to her baby. The rare cases where this has happened do not involve the types of HPV that can cause cancer.
Both my Pap test and my HPV test results were normal. Why should I wait 3 years to get tested again? Is that safe?
Cell changes in the cervix happen very slowly. It usually takes more than 10 years for cell changes to become cancer. Women with normal Pap and HPV test results have almost no chance of getting cervical cancer within at least 3 years.
One of the benefits of testing for HPV is that women may not need a Pap test as often. Getting the Pap test and HPV test every 3 years means fewer tests, follow-up visits, and treatments may be needed. There is no added safety to getting both the Pap test and the HPV test more often than every 3 years.
American Cancer Society Guidelines for Early Detection
� You should begin cervical cancer testing about 3 years after you start having sex, but no later than age 21. Testing should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
� At age 30, if you have had 3 normal yearly Pap test results in a row, you may get tested every 2 to 3 years. Or you may get tested every 3 years with the Pap test plus the HPV test. Some women with certain risk factors may still need to be tested every year.
� If you are 70 years of age or older and have had 3 normal Pap tests in a row and no abnormal Pap test results in the last 10 years, you may stop getting tested. Discuss this with your doctor or nurse.
� If you have had a hysterectomy with removal of the uterus and cervix, you may stop testing, unless the surgery was done as a treatment for cervical cancer or pre-cancer. If you still have your cervix, you should still be tested.
� Some women believe that they do not need exams by a health care professional once they have stopped having children. This is not correct. They should continue to follow the Society�s guidelines.
Remember:
� HPV is a very common virus. Most men and women who have ever had sex will get HPV at some time in their life.
� Some women over age 30 may choose to be tested for HPV as a part of their normal health visit.
� Having the HPV test will NOT tell you if you have cervical cancer. The Pap test is the best test for finding cervical cancer or changes in the cervix.
� There is no treatment for HPV. There are treatments for changes in the cervix that may be caused by HPV.
� Women who get an HPV test with their Pap test and find that both tests are normal do not need to get tested again for 3 years.
� Having HPV does NOT mean you will get cancer. Most of the time the HPV virus goes away by itself.
Other resources on HPV and cervical cancer
American Cancer Society
For a copy of our publication What Women Should Know About Cervical Cancer and the Human Papilloma Virus, call 1-800-ACS-2345 or view it online.
Other organizations
American Social Health Association
Telephone: 919-361-8400
Web site: http://www.ashastd.org (http://www.ashastd.org/hpvccrc/)
Centers for Disease Control and Prevention (CDC)
Toll-free number: 1-800-CDC-INFO (1-800-232-4636)
Web site: http://www.cdc.gov ( http://www.cdc.gov/std/HPV/STDFact-HPV.htm)
National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
Web site: http://www.cancer.gov (http://www.cancer.gov/cancerinfo/types/cervical/)
National Cervical Cancer Public Education Campaign
Telephone: 312-578-1439
Web site: http://www.cervicalcancercampaign.org
Women�s Cancer Network
Telephone: 312-578-1439
Web site: http://www.wcn.org
No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-ACS-2345 or visit www.cancer.org.
Saturday, February 2, 2008
Abu Dhabi to vaccinate girls against cervical cancer
Abu Dhabi will implement a controversial cervical cancer vaccine programme for all teenage girls in the emirate within months, reported Gulf News. Cervical cancer reportedly kills about 300,000 women worldwide annually and is caused by Human Papilloma Virus, a common sexually-transmitted disease that also causes genital warts. The issue of vaccination against the cancer is controversial in some countries, with opponents claiming it encourages promiscuity.
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