Download Cervix Cancer History - Massachusetts Medical Society

4/8/2010
Cervix Cancer History
Najmosama Nikrui,
Nikrui, MD
Chief of Gynecology, Boston VA Health Care System
Chair , MMS Committee on Women in Medicine
04/12/2010
Disclosure
I have no disclosure to report.
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Objectives
Correlate the timeline effect of different
di
diagnostic
ti ttools
l and
d cervical
i l cancer




USA incidence
Worldwide incidence
Mortality rate
New tools for diagnosis and prevention
Tools of Diagnosis






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

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1826
1933
1933
1933,
1933
1921
1926-- 48,
1926
1950--60
1950
1980--1990
1980
1990
2006
Lugol
schiller staining
patients
ti t history
hi t
physical examination and biopsy.
Colposcope, (USA 1960)
Cervical cytology or Pap smear
Organized screening with cervical cytology
HPV etiology and cause for cancer
established
Molecular screening
Vaccination for eradication
Meigs book, page 9; 1933
Schiller W. Early Diagnosis of
Carcinoma of the Cervix, Surg Gyn
and Obs, 56:21056:210-22, 1933
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Diagnostic Tools to Stage Cancer
Stage
 1
 2
 3
 3a
 3b
 4a
4
 4b
Time
1800
18001933
1940
1950-80
1980
90-00
2000
Tools
stage of Ca
history / P E
3-4
staining
↓
cytology
↓
screening
↓
HPV
↓
P +HPV
Pap
↓
vaccine
1-0
Meigs Theory in 1933
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Early diagnosis is the key to cure
cure..
Pay attention to the symptoms especially
discharge >6 months.
Surgery or radiation is the 2nd key to cure
What is the cause of cervical cancer?
Meigs book 1933
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Advocated for Early Detection
DR Meigs strategy
“Propaganda surpasses its harm”.
Meigs book IN 1933
Cancer and Schiller Staining


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Carcinoma of the cervix uteri can be diagnosed
in the preinvasive stage and in the early invasive
stage before the appearance of any symptoms
and before the development of ulceration or
tumor.
The Schiller (Lugol) test is a definite aid in
l
locating
ti th
the optimal
ti l site
it ffor cervical
i l bi
biopsy.
Cancer detection should be an integral part of
every gynecological examination.

Permanente Foundation Medical Bulletin. 1944 Oct;2(4):165Oct;2(4):165-74
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Schiller

Mortality from cancer can be reduced only
on a large
l
scale.
l Thi
This presupposes th
thatt
the public will be made to realize the
importance of periodic examinations and
that every one of them will be given a
complete examination to detect cancer,
regardless of the patient's complaint.
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The First Screening in USA
American Society for Control of Cancer
and
d NCI grantt
 1940
1940--1943 two clinics did screening
 Memorial hospital
 Philadelphia
Incidence Over Time
Cervical cancer is the most common cancer in the world
2nd cause of death in developing but #12 cause in developed countries
with cervix cancer screening
screening.
Sites
Cervix
Breast
Time period
1900 -1933
2008
1900
1900-- 1933
% /100,000
24.1 to 37.1
7.5
22.5
Meigs book of gynecology 1933’ 1
ACS statistic 2008
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Incidence of Cancer
450
Year
1900
400
350
# of
300
Cases
250
200
34-46
47-56
57-66
67-76
77-86
77-2000
/100,000.150
100
50
0
insitu
invasive
all cases
Stage of cancer
Parsons and Sommers chapter 5mcabcer if cervix pages 1303; 1978
ACS 2008 statistics
Incidence Worldwide/100,000.
North Africa
south Africa
America
North.
Central
South
11.3
40.4
9.1
44.4
30.1
10
Asia and
Europe
18 6
18.6
31.9
South East Asia
Polynesia
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Incidence in Canada
After screening
Canadian screening task force for cervical
cancer prevention showed the similar drop
in the cancer incidence
American J Ob - GYN 1974
Canadian and Scottish Task Force
From 1960 to 1970

The mortality rate from Cervical cancer
dropped in 50%
CMA JOURNAL/JUNE 5,
1976/VOL. 114
Lancet 1: 1221; 1974
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Cancer Death
%
Time
5 Years Survival
80
70
60
%
5y%
50
40
30
20
10
0
1900
1920
1940 1990
Time period
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HPV
Has changed our focus on how to manage
Cervical cytology.
 It can guide the clinician and has lowered
the # of office colposcopies
 Vaccination may eradicate cancer all
together.
together
 HPV can be used for treatment?

Summary
Cervical cytology has decreased the
incidence M & M from cervical cancer
incidence,
 The HPV discovery has shed light on
cervical cancer etiology, detection,
possible treatment and eradication.
 Our goal should focus on cancer
prevention
ti
 Door is open for future discovery of
molecular and individualized treatment.

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Additional References

Papanicolaou GN; Traut HF. Diagnosis of Uterine
Cancer by Vaginal Smear. New York, Commonwealth
Fund,1943.
 Meigs VV, et al. Value of the Vaginal Smear in the
Diagnosis of Uterine Cancer, Surg,
Surg, Gyn and Obs,
Obs,
77:449--61, 1943.
77:449
 Schiller W.
W Early Diagnosis of Carcinoma of the Cervix
Cervix,
Surg Gyn and Obs,
Obs, 56:210
56:210--22, 1933.

ACS website
Thank you
Any questions?
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