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Cervical Cancer
Epidemiology of a
Chronic Disease
Exercise
By Mary Murphy April
2008
What is the clinical problem?
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Epidemiological classification:
Cancer/neoplastic disease
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Site: neck of the womb referred to as the
Cervix.
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The outer and inner cells of the cervix
can become cancerous leading to
squamous cell cervical cancer or adenocarcinoma of the cervix. The former,
acccountable for 90-95% cervical
cancers.
The transformation zone is the area
where cells are most likely to be
abnormal and is the site where cervical
screens are taken.
Above: diagram female reproductive system
Source: http://www.cancerhelp.org.uk assessed 28/3/08
POPULATION AT RISK?
How big is the problem?
World: “Cervical cancer accounts for 1 in 10 of all
cancers diagnosed and more than 273,000 deaths in
women worldwide every year……In developing
countries, cervical cancer is the commonest cancer to
affect women, and contributed to 85% of new cases and
deaths worldwide in 2002….”
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Source:http://www.thelancetstudent.com/2007/10/08/reducing-the-burden-of-cervical-cancer-in-thedeveloping-world/The accessed 14/4/08
UK: About 2,700 women are diagnosed with cervical
cancer each year. Overall, 2 out of every 100 cancers
diagnosed in women are cervical cancers. But it is the
second most common cancer in women under 35 years
old. In 2005 UK had 8 in 100,000.
Source:http://www.cancerhelp.org.uk/help/default.asp?page=2755#common accessed 16/4/08
Treatment for Cervical Cancer
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Hysterectomy.
Radical trachelectomy.
Radiation.
Chemotherapy
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Source: http://www.cnn.com/HEALTH/library/DS/00167.html accessed 29/3/08
Risk Factor & Co-factors
Infection with some types of HPV virus
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Low socio-economic status
Long-term use of hormonal contraceptives,
high parity,
tobacco smoking,
co-infection with HIV
Other STD infections
Large number of sexual partners
Sexually active before age 18
Early menarche
…….But the real villain
• 99.7% cases caused by Human papillomavirus (HPV). HPV 16 &
18 especially assocated with cervical cancer.
– HPV is a very common virus transmitted through direct
transmission person to person, to both men and women
– Up to 75% of people of reproductive age will be infected with HPV
at some point in their lives. Majority of women will not get cervical
cancer. Cervical cancer is rare while HPV infection is common.
Source: http://www.jotrust.co.uk accessed 28/03/08
Ten most frequent HPV types in women with invasive cervical
cancer in United Kingdom
as compared to Northern Europe and the World
WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Summary
report on HPV and cervical cancer statistics in United Kingdom. 2007. [6/4/08].
Available at www. who. int/ hpvcentre
Prevalance of Cervical Cancer
Source: http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/?a=5441#age assessed 30/3/08
Incidence Rates of Invasive Cervical Cancer
Source: http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/?a=5441#age assessed 30/3/08
Invasive Cervical cancer incidence by age
Source:http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/?a=5441#age accessed 30/3/2008
Mortality Rates for
Cervical Cancer 2005
Source:http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/?a=5441#age accessed 30/3/2008
UK Cervical Cancer Incidence & Mortality
Source: Office for National Stats. Bulletin: 2007/14/HSCIC –Cervical Screening Programme England 2006-07
Cervical cancer mortality trends
Source:http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/?a=5441#age accessed 30/3/2008
Eastern Africa
Southern Africa
Caribbean
Central America
Western Africa
South America
Middle Africa
South Central Asia
South-Eastern Asia
World
Eastern Europe
Northern Africa
Southern Europe
Western Europe
Northern Europe
Northern America
Eastern Asia
Australia/New Zealand
Western Asia
Age-standardised
incidence &
mortality rates,
Of cervical cancer
by region of the
world, 2002
estimates
Incidence
Mortality
0
10
20
30
40
50
Rate per 100,000 population
Source:http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/?a=5441#age accessed 30/3/2008
European age-standardised incidence of and
mortality,cervical cancer by deprivation category, England
and Wales, 1990-93
Rate per 100,000 women
30
incidence
mortality
25
20
15
10
5
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Affluent
Deprivation category
Deprived
Source: http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/?a=5441#age assessed 30/3/08
The graph below shows the incidence rates in the U.S. for cervical cancer from
1975–2004 by race and ethnicity.
Cervical Cancer
‡Source: Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute, NCI accessed 16/4/08
Secondary prevention -Cervical
Screening
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Screening ages (years) 25-64; (previously 20-65) 3.4m screened 06/07
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Screening interval (years) 3 years for ages 25-49, every 5 years for
ages 50-64
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Lifetime number of recommended smears 12?
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79.2% in 2006 of eligible women had Pap test in last 5 years.
Compared with 79.5% last year and 82% in 1997
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Smear taker - General practitioners or general practice
nurses
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Cervical screening - including the cost of treating cervical
abnormalities - has been estimated to cost around £157 million a year
in England
Sources: Office for National Stats. Bulletin: 2007/14/HSCIC –Cervical Screening Programme England 200607 & http://www.cancerscreening.nhs.uk/cervical/ accessed 6/4/08
Primary prevention – HPV Vaccine
• difficult to prevent HPV infections. Most adults will have had HPV at
some time in their lives. Direct Transmission mode person to person
• Condoms are not effective - because HPV has a field effect, it found
on skin not covered by the condom and skin-to-skin contact
transmits HPV.
• Available vaccines for HPV 16 & 18. They may provide protectection
against a few other types, but not all types of HPV.
• Cost - £100m a year routine programme vaccinate girls 12-13 from
September 2008
• Catch up programme £200m over 2009/10 and 2010/11.
HPV VACCINE ISSUES
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Very expensive
Targeted vs. universal vaccinations
the age and gender of vaccine recipients
the acceptability of this vaccine to health
care providers, adolescents, and parents
• the effect of this vaccine on cervical
cancer screening.
About Data from Cancer
Registries!!
• It is dynamic and only ever a snapshot in time.
• It is mandatory for deaths to be registered within
five days.
• It is not mandatory for incidence data to be
reported. It comes from a number of sources, it
is usually 2 years
• National coverage in UK was not achieved until
1962
……………and lots of other things too!!
New – Invasive Cancer Audit
• Future Developments - For all newly diagnosed
cervical cancers a review will be conducted of a
woman’s complete screening history by Quality
Assurance Reference Centres across England.
• It’s purpose - to measure the effectiveness of
cervical screening programme, to identify areas
of good practice and identify where
improvements can be made
Thank you for listening!