You are on page 1of 17

25/04/2016

Konsep Terkini Pencegahan Kanker Serviks Dwiana Ocviyanti Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Indonesia, Jakarta
Konsep Terkini Pencegahan Kanker Serviks Dwiana Ocviyanti Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Indonesia, Jakarta

Konsep Terkini Pencegahan Kanker Serviks

Dwiana Ocviyanti

Departemen Obstetri dan Ginekologi

Fakultas Kedokteran Universitas Indonesia, Jakarta

Infeksi HPV dan Kanker Serviks

Infeksi HPV dan Kanker Serviks Infeksi HPV ditemukan pada 99.7% penderita Kanker Serviks Walboomers JMM et
Infeksi HPV ditemukan pada 99.7% penderita Kanker Serviks

Infeksi HPV ditemukan pada 99.7% penderita Kanker Serviks

Walboomers JMM et al. 1999. Journal of Pathology 189(1): 12 19.

25/04/2016

HPV Natural History-Infeksi HPV

HPV Natural History -Infeksi HPV

HPV Natural History-Infeksi HPV

75/100
75/100

25/04/2016

Global Prevalence of HPV

USA 11.4% 8ad 41.1% 4b 16.8% 2a 16.8% 2a British Columbia, Canada British Columbia, Canada 6.5%
USA
11.4% 8ad
41.1% 4b
16.8% 2a
16.8%
2a
British Columbia, Canada
British Columbia, Canada
6.5% 910b
6.5%
910b
USA
50.8% 6a
17.1% 3b
17.1%
3b
Texcoco Sanitary
Texcoco Sanitary
District, Mexico
District, Mexico
Estimated global prevalence is between 9% and 13%, or ~630 million people 1
Estimated prevalence of HPV infection in selected geographic areas:
Conakry, Guinea
5a
6a
4b
8ad
Indonesia
Indonesia
Rio de Janeiro, Brazil
Rio de Janeiro, Brazil
South Wales, UK
South Wales, UK
7ac
Conakry, Guinea
Zhejiang Province, China
Zhejiang Province, China
13.3%
41.1%
11.4%
50.8%
13.5%
13.3% 7ac
13.5% 5a

a Includes female data only; b Includes male and female data; c No visual cervical lesions or history of abnormal cytology or HPV; d Only married, widowed, or divorced women.

1. World Health Organization. Vaccine research and development. www.who.int/vaccines/en/hpvrd/shtml. Accessed December 10, 2010. 2. Moore RA et al. Cancer Causes Control. 2009;20:1387–1396. 3. Parada R et al. BMC Infect Dis. 2010;10:223. 4. Carestiato FN et al. Braz J Infect Dis. 2006;10:331–336. 5. Hibbitts S et al. Br J Cancer. 2008;99:1929–1933. 6. Keita N et al. Br J Cancer. 2009;101:202–208. 7. Ye J et al. Virol J. 2010;7:66. 8. Vet JNI et al. Brit J Cancer. 2008;99:214–218. 9. Centers for Disease Control and Prevention (CDC). Fact Sheet: Genital HPV. www.cdc.gov/std/HPV/STDFact-HPV.htm. Accessed March 1, 2011. 10. US Census Bureau. US population estimates. http://factfinder.census.gov/servlet/DTTable?_bm=y&-geo_id=01000US&-ds_name=PEP_2009_EST&-mt_name=PEP_2009_EST_G2009_T001. Accessed March 1, 2011.

5

HPV Natural History- Lesi PraKanker

75/1000
75/1000

25/04/2016

HPV Natural History

6/10.000
6/10.000
HPV Natural History 1.2/10.000
HPV Natural History
1.2/10.000

25/04/2016

Insidens Kanker Serviks di Indonesia 13.6-20.6/100.000

Insidens Kanker Serviks di Indonesia

13.6-20.6/100.000

Kematian akibat Kanker Serviks di Indonesia 5.8-9.8/100.000 (7800/tahun)
Kematian akibat Kanker Serviks di
Indonesia 5.8-9.8/100.000 (7800/tahun)

25/04/2016

25/04/2016 WHO (2013) Guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls
WHO (2013) Guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls and

WHO (2013) Guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls and women

25/04/2016

Program Skrining didasarkan pada Natural History infeksi HPV

Untuk mendeteksi apakah seorang perempuan:

saat diperiksa terinfeksi oleh HPV onkogenik (hrHPV)

Atau Memiliki lesi prakanker Menderita Kanker Serviks stadium awal

TES PAP/PAP SMIR
TES PAP/PAP SMIR

25/04/2016

SKRINING DENGAN TES PAP/PAP SMIR

Dilakukan pada pasien sehat (tidak ditemukan lesi / kecurigaan kanker pada serviks)

Bila hasil positif (ditemukan sel yang dicurigai lesi prakanker atau kanker ASCUS/+) harus dilakukan kolposkopi dan bila ditemukan lesi dilakukan biopsi pada lesi tersebut

Diagnosis akhir didasarkan pada hasil biopsi, dan tindakan lebih lanjut hanya dilakukukan bila Lesi Derajat Tinggi ( NIS 2/+)

Colposcopy

Colposcopy

25/04/2016

25/04/2016 WHO 2013 . WHO guidelines for screening and treatment of precancerous lesions for cervical cancer
25/04/2016 WHO 2013 . WHO guidelines for screening and treatment of precancerous lesions for cervical cancer
25/04/2016 WHO 2013 . WHO guidelines for screening and treatment of precancerous lesions for cervical cancer
25/04/2016 WHO 2013 . WHO guidelines for screening and treatment of precancerous lesions for cervical cancer
WHO 2013 . WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention.

WHO 2013. WHO guidelines for screening and treatment of precancerous lesions for cervical

cancer prevention.

25/04/2016

Evaluasi metode skrining Kanker Serviks di Amerika saat ini

Bila pemeriksaan tes hrHPV negatif, ternyata kemungkinan kejadian CIN3/+ akan lebih rendah dibandingkan hasil tes sitologi/Pap Smir

Karena efektifitas pemeriksaan skrining dengan tes hrHPV lebih baik atau setidaknya setara dengan pemeriksaan sitologi/Pap Smir, maka saat ini tes hrHPV dapat dijadikan pemeriksaan primer untuk skrining

Pap Smir saja atau kombinasi Pap Smir dengan hrHPV tetap dapat digunakan sebagai pilihan

Warner K Huh. et.al. In:Gynecologic Oncology 136 (2015) 178 182

Warner K Huh. et.al. In:Gynecologic Oncology 136 (2015) 178 182

Warner K Huh. et.al. In:Gynecologic Oncology 136 (2015) 178 182

25/04/2016

Program Pencegahan Kanker Serviks di negara lain di dunia

Berdasarkan pada:

Sitologi Pap smir, atau

Inspeksi Visual dengan Aplikasi Asam Asetat (IVA), atau

Tes Human Papilloma Virus (HPV)

Tatalaksana:

Pap Smir positif or tes HPV positif kolposkopi biopsi histopatologi terapi , or

Pap Smir positif or tes HPV positif kolposkopi eksisi dengan eksisi diatermi / loop dan histopatologi(see and treat)

IVA positif (?) terapi Bedah Krio

Tes hrHPV positif (?) terapi Bedah Krio

25/04/2016 Program Pencegahan Kanker Serviks di negara lain di dunia Berdasarkan pada: • Sitologi Pap smir,
25/04/2016 Program Pencegahan Kanker Serviks di negara lain di dunia Berdasarkan pada: • Sitologi Pap smir,
25/04/2016 Program Pencegahan Kanker Serviks di negara lain di dunia Berdasarkan pada: • Sitologi Pap smir,
25/04/2016 Program Pencegahan Kanker Serviks di negara lain di dunia Berdasarkan pada: • Sitologi Pap smir,

25/04/2016

WHO 2013 . WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention.

WHO 2013. WHO guidelines for screening and treatment of precancerous lesions for cervical

cancer prevention.

Skrining Kanker Serviks

Sitologi dan kolposkopi tidak boleh digunakan sebagai teknik skrining tunggal, sehingga harus dilanjutkan dengan kolposkopi +biopsi dalam program skrining Kanker Serviks

Di negara dengan fasilitas pelayanan kesehatan terbatas maka IVA atau tes HPV dapat digunakan sebagai teknik skrining tunggal dalam program skrining Kanker Serviks

25/04/2016

Suggestion from WHO 2013

Use a strategy of screen with an HPV test and treat, over a strategy of screen with VIA and treat

In resource-constrained settings, where screening with an HPV test is not feasible, the panel suggests a strategy of screen with VIA and treat

WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. 2013

Effective cervical cancer prevention programs in low-resource settings

Can be implemented and should focus on three critical factors:

achieving high screening coverage offering an effective and acceptable test ensuring appropriate treatment of test- positive women.

WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. 2013

25/04/2016

HPV in Indonesia

4.0% of women in the general population are estimated to harbour cervical HPV- 16/18 infection at a given time

87.7% of invasive cervical cancers are attributed to HPVs 16 or 18

Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, Brotons M, Mena M,

Cosano R, Muñoz J, Bosch FX, de Sanjosé S, Castellsagué X. ICO Information Centre on HPV and

Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Indonesia.

Summary Report 2015-03-20. [Data Accessed]

Cervical Cancer Prevention in Indonesia

Cervical Cancer Prevention in Indonesia • Over the course of the 5-year project began at 2007

Over the course of the 5-year project began at 2007, a total of 45 050 women received VIA screening. They represented 24.4% of the total female population aged 30 50 in the catchment area of the 17 health centers.

A total of 145 women, or 0.3% of those screened over the 5-year period, were suspected of having cervical cancer.

• 1.8% tested positive for cervical dysplasia (VIA positive) 83.1% of VIA-positive women sought cryotherapy •
1.8% tested positive for cervical dysplasia (VIA positive)
83.1% of VIA-positive women sought cryotherapy

25/04/2016

HPV Vaccine in Indonesia

HPV vaccine licensure:

Bivalent vaccine (Cervarix) Quadrivalent vaccine (Gardasil)

Cost of the vaccine:

one injection Rp. 700.000,- ( 50 USD)

Government pilot program in Jakarta

Girl 10-13 years Rp. 1.000.000,- (70 USD) for 2 (two) injection

HPV Vaccine acceptance in Indonesia

HPV Vaccine acceptance in Indonesia Methods : 746 parents, with at least 1 daughter aged 0

Methods: 746 parents, with at least 1 daughter aged 0 14, were interviewed using questionnaires based on published and adjusted interviews. Interviews were done in sub district public health centers, general governmental hospitals, and via house-visits, in 5 Indonesian provinces.

Results: Parental HPV vaccine acceptance was 96.1%.

25/04/2016

HPV Vaccine Program in Indonesia

HPV Vaccine Program in Indonesia
Indonesia Adolescent data until 2013 31 million girls age 10-24 years 11.3 miilion girls age 10-14
Indonesia Adolescent data until 2013
31 million girls age 10-24 years
11.3 miilion girls age 10-14 years (450 thousands in Jakarta)

25/04/2016

25/04/2016 Join the Indonesian forum at AOGIN! 17
Join the Indonesian forum at AOGIN!
Join the Indonesian forum at AOGIN!