CERVICAL CANCER A GLOBAL PERSPECTIVE Andrs Poveda, MD ACOG, - - PowerPoint PPT Presentation

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CERVICAL CANCER A GLOBAL PERSPECTIVE Andrs Poveda, MD ACOG, - - PowerPoint PPT Presentation

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CERVICAL CANCER A GLOBAL PERSPECTIVE Andrs Poveda, MD ACOG, Fundacin Instituto Valenciano de Oncologa GCIG Chair Cervical Cancer Education Symposium. Bucharest , Feb 2018 Gynecological Cancer Gynecological Cancers represent around

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CERVICAL CANCER A GLOBAL PERSPECTIVE

Andrés Poveda, MD

ACOG, Fundación Instituto Valenciano de Oncología

GCIG Chair

Cervical Cancer Education Symposium. Bucharest , Feb 2018

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SLIDE 2

www.esmo2012.org

Gynecological Cancer

  • Gynecological Cancers represent around 15%
  • f all cancers
  • Trends in incidende:

– Endometrial Cancer 6% (slightly increase) – Ovarian Cancer 4% (stable) – Cervical cancer 3% (stable in Western world, increasing in Developing countries) – Vulva, vagina and others: 1,2% (increasing)

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SLIDE 3

www.esmo2012.org

  • “… 65% of cancer deaths occuried in lower income

countries.”

  • A prototype of this distinct distribution:

Cervical Cancer : In Developing Countries it is the leading cause of cancer death

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Estimated Age-Standardised rates per 100,000 ü Globocan 2012 - WHO

A Prototype: Estimated Cervical Cancer Mortality Worldwide

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Siegel CA CANCER J CLIN 2013;63:11–30

= 1000

Cervical Cancer in the United States

Incidence Rate is 12,000 and Mortality Rate 4,000 per year

Presented by: Gottfried E. Konecny, M.D.

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= 1000

Cervical Cancer in the World

Incidence rate is 530,000 and Mortality Rate 275,000 per year

Presented by: Gottfried E. Konecny, M.D.

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Cervical Cancer in Latin America

ü Life expectancy - Average age at death = Number of years of life lost by each death ü Number of years of life lost by each death X total number of deaths per period= Number of years of life potentially lost. ü A loss of 633,000 potential years of life in Latin America

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SLIDE 8

Gynaecological Tumors

Cervical Cancer

u

Second most common cancer among women worldwide.

u

Second most common cause of cancer-related mortality in women globally.

u

Human papillomavirus (HPV) infections are the cause of nearly all cervical cancers.

u

Preventable through screening and vaccination

u

If not prevented → surgery for early stage disease

u

If not diagnosed at early stage → radiation therapy (RT) and concomitant chemotherapy.

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Cervical cancer issues

(GCIG Brain storming, Melbourne 2014)

  • WESTERN COUNTRIES (mainly early stages)

– Fertility sparing/preserving – Sentinel node mapping – IMRT – Molecular Biology/Novel targeted therapies/predictive markers

  • DEVELOPING COUNTRIES (mainly locally-advanced & advanced stages)

– Pap smear screening – Vaccines – Accesibility to radiotherapy – Accsesibility to medical treatment

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GCIG

Current situation and Challengues

  • Currently 29 groups are GCIG members.

– 15 Europe – 7 US and Canada – 5 ASIA – 1 Australia/New Zealand – 1 Latin America – 0 Africa

www.gciggroup.com

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  • r many others

Countries represented in the GCIG future?

www.gciggroup.com

640 million people >1.800 million

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GCIG

MISSION and VISION STATEMENT

  • MISSION: to promote and facilitate high quality clinical trials

in order to improve outcomes for women with gynecological cancer.

  • VISION: Improving quality and duration of life for women with

gynecologic cancers will be accomplished through a

– focused common purpose, – shared expertise – mutual respect among members – with recognition and accommodation of cultural, geographic, and clinical diversities amongst and between members and patients.

www.gciggroup.com

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GCIG

Current situation and Challengues

  • One of the keys to improve outcomes for women

with gynecological cancer is to expand research in gynecologic cancer.

– Increasing the ammount of cooperative group performing clinical trials in a global network as GCIG.

www.gciggroup.com

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Locally Advanced Stages Cervical Cancer

Key Issues

  • Pap smear screening
  • Vaccines
  • Accesibility to radiotherapy
  • Accesibility to medical treatment

Cervical Cancer Education Symposium. Mexico, Jan 2017

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Locally Advanced Stages Cervical Cancer

Key Issues

  • Pap smear screening
  • Vaccines
  • Accesibility to radiotherapy
  • Accesibility to medical treatment

Cervical Cancer Education Symposium. Mexico, Jan 2017

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Pap Smear Screening Dificulties in Developing Countries

  • Costs:

–Logistics for implementation of Cytology:

  • Infrastructure for collection; Cost of reading
  • Distribution of results (higher cost)
  • Social:
  • Population (level of education, social status, access to

health centers)

  • Unable to adhere to the population screening programs
  • Difficulty to identify lacks of coverage

Courtesy from Dr M Paiva Batista

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Pap Smear Screening Dificulties in Developing Countries

  • Executing:
  • Quality of cytology (collecting and reading)
  • Satisfactory samples as a limiting factor

– Lack of standardization for reading – False negatives: 3-30%

  • Excess of abnormal cytology generating costs and

undetermined significance.

Courtesy from Dr M Paiva Batista

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Locally Advanced Stages Cervical Cancer

Key Issues

  • Pap smear screening
  • Vaccines
  • Accesibility to radiotherapy
  • Accesibility to medical treatment

Cervical Cancer Education Symposium. Mexico, Jan 2017

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SLIDE 19

South- Eastern Asia 1.7 4.7 7.1 8.8 9.0 9.2 10.0 10.7 11.7 13.0 14.0 15.3 17.4 19.6 21.4 33.6 35.4 Western Asia Northern America Southern Asia Southern Europe Western Europe Northern Africa Northern Europe Eastern Asia WORLD Central America South America Southern Africa Western Africa Eastern Europe Eastern Africa Caribbean

Adjusted HPV prevalence (%)

Meta-analysis of 1,016,719

  • women. Adjusted HPV

prevalence standardized by the regional geographical structure

HPV Prevalence Among 1 Million Women With Normal Cytology

Bruni L, et al. J Infect Dis. 2010;202(12):1789-1799.

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HPV Vaccination Programs to 2014/2015

64 COUNTRIES, 4 REGIONS, & 12 TERRITORIES

Bruni L, et al. Lancet Glob Health. 2016;4(7):e453-e463.

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Locally Advanced Stages Cervical Cancer

Key Issues

  • Pap smear screening
  • Vaccines
  • Accesibility to radiotherapy
  • Accesibility to medical treatment

Cervical Cancer Education Symposium. Mexico, Jan 2017

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Number of People Served by Each Radiotherapy Center by Country

Jemal A et al CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90.

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Locally Advanced Stages Cervical Cancer

Key Issues

  • Pap smear screening
  • Vaccines
  • Accesibility to radiotherapy
  • Accesibility to medical treatment

Cervical Cancer Education Symposium. Mexico, Jan 2017

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Recurrent/Metastatic Cervical Cancer

Key Issues

  • Accesibility to medical treatment
  • Few options to cure
  • Standard of care: platinum combination (≤2013)

Cisplatin + paclitaxel

Cervical Cancer Education Symposium. Mexico, Jan 2017

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Cervical Cancer Education Symposium. Mexico, Jan 2017

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Recurrent/Metastatic Cervical Cancer

Cervical Cancer Education Symposium. Mexico, Jan 2017

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SLIDE 27

bradley.monk@chw.edu

Progress in Survival in Advanced and Recurrent Cervical Cancer

Months Year

GOG 64 Cisplatin

é ê é

GOG 179 Cisplatin + Palcitaxel + Bevacizumab

ê

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Recurrent/Metastatic Cervical Cancer

Accesibility to medical treatment

  • Few options to cure
  • Standard of care: platinum combination

(2013) − Cisplatin + paclitaxel + Bevacizumab

  • Clinical Practice Changing

Cervical Cancer Education Symposium. Mexico, Jan 2017

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Cervical Cancer Education Symposium. Mexico, Jan 2017

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Expectations

  • The institute of Medicine, Global Task Force on Expanded

Access to Cancer Care and Control in Developing Countries, the WHO:

“Stepping Stones in improving the fight against cancer in Low-, Middle-, and High- Income Countries.”

Souza et al, JCO vol34, Jan 2016

Special Series Global Cancer Medicine

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Thinking about numbers...

  • In 2010:

– Long term costs of patients with cancer and their families - US$ 2.5 trillion annually worldwide.

  • The

implementation

  • f

prevention, early detection, and treatment strategies:

– Potentially save 2.4-3.7 million lives annually – The majority of this lives in Low- and Middle- Income countries – Economic benefit in excess of US$400 billion.

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“Stepping stones against cancer in Low and Middle- Income countries”:

üFocus on prevention and risk reduction strategies

  • National Cancer Control Plan
  • Basic Health Care infrastructure and education

üPrevention and WHO list of essential medications

  • Prevention and early detection programs
  • Access to basic pathology and imaging services
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Gynecological Tumors Cervical Cancer Remarks

  • First world advances in both diagnosis and treatment

should be applicable to developing countries.

  • To establish networks to improve survival in cervical

cancer is a priority

Cervical Cancer Education Symposium. Bucharest, Feb 2018

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SLIDE 34

Please look to the future

Cervical Cancer Education

  • Symposium. Bucharest, Feb 2018