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WELCOME TO
Vaccination, Screening, Treatment and Cervical Cancer Elimination
Sinéad Cleary
Advanced Nurse Practitioner
Women’s Health
Nurse Colposcopist / Nurse
Sonographer / Nurse
Prescriber
Tallaght University Hospital
Cervical Cancer Elimination
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AGENDA
HPV
Cervical Screening
Vaccination
Colposcopy
Cervical Cancer Elimination programme
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Human Papilloma Virus
• Cause of over 90% of cervical cancer cases and is responsible for an important fraction of other anogenital and oropharyngeal cancers
• 90% anal cancer
• 40% vulval and vagina cancers
• 35% oropharyngeal cancers
• 90% of genital warts
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Human Papilloma Virus
• 9th leading cause of cancer in women
• 4th most common cancer is women age 15 – 44yrs
• HPV subtypes tested: 16,18,31,33,35,39,45,51,52,56,58,59,66,68
• HPV subtypes found in cancers diagnosed in Ireland are subtypes 16,18,31,33,52 and 58
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Transformation Zone
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Disease progression
Time
Months Invasive cervical cancer Normal epithelium HPV infection; koilocytosis CIN I CIN II CIN III Progression 10-20 years CIN I 57% CIN II 43% CIN III 32% Approx. likelihood of regression 9
Years
HPV vaccination
05/02/12 10
HPV vaccination
• HPV vaccination alongside screening will reduce the risk of cervical cancer further than screening alone (by up to 90%), and will also significantly reduce the number of abnormal screening results requiring follow-up
• 2010 vaccinating girls – quadrivalent vaccine (6,11,16 & 18)
• 2019 vaccinating boys too – nonavalent vaccine (6,11,16,18,31,33,45,52 & 58)
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HPV vaccination
• School based vaccination programme (1st yr students)
• NIAC recommendations
• One dose 9 – 24yrs
• Two doses 25 – 45yrs (6 – 12mths apart)
• Three doses @ 0, 2 and 6mts – specific cohorts considered to be immunocomprised
• GBMSM and trans women can be vaccinated up to 45yrs of age free in many public STI clinic and HIV clinics
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Cervical Screening
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HPV primary screening
• March 2020: 25-34yr olds 3yrly 35-65yr olds 5yrly
• 80% of men and women will come in contact with HPV by the age of 50 and 80% of those will clear HPV within 1-2yrs
• Recent study reported 93% have had a screen 80% within the last 5yrs
65% within the last 3yrs
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Colposcopy
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Normal colposcopy
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Low grade Colposcopy (CIN1)
• Usually Conservative management as most resolve spontaneously
• Return to Primary care for retesting in 12 months
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Colposcopy: CIN2
• Majority have Treatment – often ablation
• Conservative Mx is possible within strict limits
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Colposcopy: CIN3 & cGIN
• CIN 3 & cGIN: treatment is always recommended
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Colposcopy: Cancer
• Diagnostic biopsy to confirm pathology
• Refer to Gynae-Oncology service
05/02/12 20
Ireland’s Cervical Cancer Elimination Programme
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