Professional Documents
Culture Documents
TUMOR
TUMOR JINAK TUMOR GANAS
KANKER
75,000
36,000
266,000
143,000
72,000 79,000
33,000 62,000
3500
3000
2500
2000
1500 Series1
1000
500
0
Epidemiology
10 Most Common Cancers in 10 Most Common Cancers in
Women in Jakarta Men in Jakarta
Types of Cancer
Nasopharyngeal 7.29% Skin 5.02%
2,47%
1.3/1000
Dari 342
Puskesmas
Estimated 58 new cases of
Cervical cancer every day
Kusuma F, Jovian R, Pratiwi R, Purwoto G. Characteristic and survival rate of patient with advanced stage cervical cancer that
given adjuvant therapy in cipto mangunkusumo hospital, Jakarta. Poster session presented at: the 4 th Biennial meeting of
Asian society of gynecologic oncology; 2015 Nov 12-14; South Korea.
RISIKO KANKER SERVIKS
• Pendarahan pervaginam
• Keputihan bercampur darah, berbau
• Nyeri panggul
• Tidak dapat
buang air kecil
PENYEBAB
KANKER SERVIKS
Human Papillomavirus (HPV)
Virus DNA , Ø 52-55 nm 100 tipe , ~30–40 menyerang anus dan kelamin2
HPV merupakan penyebab utama kanker serviks ~ 100%
HPV 6
HPV 16
HPV 18 HPV 11
1. Wallboomers JH et al. J Pathol 1999; 189: 129; 2. Bosch FX et al. J Clin Pathol 2002; 55: 244–65.
INFEKSI VIRUS HPV TIDAK DIIKUTI GEJALA
Sexual
Genital-genital
Manual genital
Oral genital
Kondom tdk
melindungi
Penularan ibu-bayi
JUMLAH SAMPLE : 20 000
INSIDEN INFEKSI HPV :
Kanker
mulut
12-70% tenggorok Kanker 60-90%
an3 Vagina1
~100%
Genital Kanker Female
Warts
3
1,
anus1-3 80+% Both sex
Male
Sustained clinical
remission 8-30 M
9,8 months
75-90%
Incubation Active growth Host DNA-ve
(1–6 months) (3–6 months) containment
(3–6 months) Re-infeksi
10-25%
KANKER SERVIKS
Modified from Stanley M. Vaccine 2006;24S1:S1/16–22.
(2). Molden T, et al. Int J Cancer.2005:973-6. (3) Rozendaal L, etal. Int J Cancer 1996;68:766-9 (
4).Franco EL, etal. J Infect Dis 1999;180:1415-23. (5)Munoz N, etal. J Infect Dis 2004;190:234-42
Pracancer Lesion Cancer
Screening !
PECEGAHAN
KANKER SERVIKS
PENCEGAHAN PRIMER
PENCEGAHAN SEKUNDER
PENCEGAHAN TERSIER
SCREENING
PAP IVA DNA-HPV
Disadvantage :
Sampling error
Fixation error
Processing error
Interpretation error
Kriteria adekuasi:
• Preparat utuh, tidak pecah LIMITATION
• Dilengkapi dengan label yang jelas LSIL, ASCUS,
• Informasi klinis yang informatif INCONCLUSIVE
• Jumlah sel yang adekuat, sekitar 8000-12.000 sel Sensitivity < 60%
• Mengandung sel skuamosa dan sel endoserviks
Pap’s Smear
Laboratorium
SCREENING
PAP IVA DNA-HPV
Disadvantage
Management abnormal VIA
Cryotherapy
LETZ, LEEP
SCREENING
PAP IVA DNA-HPV
SCREENING
PAP IVA DNA-HPV
GENOTYPING HC-2
HPV-DNA
POSITIVE
Recently, the FDA approved the HPV-DNA test that can be
used as a stand-alone test without a Pap smear
Tantangan Kesehatan Perempuan Indonesia
adalah KANKER SERVIKS
Cervical canal
Cervical
epithelium
Blood vessel
Epithelial tear
Basement membrane
+ Aluminium
salt
(Al(OH)3)
+ MPL
Immunostimulant
AS04-containing vaccine
QUADRIVALENT
Antigens Adjuvant
+ Aluminium salt
(amorphous aluminium
hydroxyphosphate
sulphate [AAHS])
HPV 16 VLPs HPV 18 VLPs HPV 6 VLPs HPV 11 VLPs
AAHS-containing vaccine
Impact of 4vHPV Vaccine in Public
Vaccination Programs: Select Reportsa Genital Warts
Baandrup Ali Wilson Smith
Sex Transm Dis13 BMC Infect Dis16 Sex Transm J Infect Dis24
Infect20
Read
Sex Transm Leval
Infect8 J Infect *Blomberg Ali Chow *Droletc
Dis11 Clin Infect BMJ17 BMJ21 Lancet Infect
Dis14 Dis25
Fairley Donovan
Sex Transm Lancet
Flagg Harrison
Introduction of 4vHPV vaccine1–6 Infect7 Infect Dis9 Bauer
*Leval
Am J Public
*Petráš
JNCI3 PLoS One22 Vaccine26
Am J Health18
Public
Health12
Oliphant
Mikolajczyk Nsouli-Maktabi Liu *Dominiak-Felden
NZMJ10
Czech Republic Sex Transm MSMR19 Sex Transm PLoS One6
Dis15 Infect23
Cervical
Australia Abnormalities *Baldur-Felskov *Crowe *Smith
Cancer Causes BMJ31 Pediatrics33
*Gertig Control30
Brotherton *Powell BMC Med29
New
Canada Lancet27 Vaccine28
Zealand *Baldur-Felskov *Mahmud *Hariri *Herweijer
Sweden
JNCI4 J Clin Oncol32 Vaccine34 Int J
Cancer35
Belgium
United Denmarkb HPV Prevalence
States *Tabrizi Markowitz *Tabrizi Deleré *Dunne *Markowitz
J Infect J Infect Dis37 Lancet BMC Infect J Infect Pediatrics41
Germany Dis40
Dis36 Infect Dis38 Dis39
2006 2007 2008 2009 2011 2012 2013 2014 2015 2016
*Study links effectiveness data to vaccination statusaIncludes reports published in the peer-reviewed scientific literature, and does not encompass reports at scientific conferences. bBeginning on February 1,
2016 the childhood vaccination program includes the 2vHPV vaccine.42 cMeta-analysis of data from 20 studies in 9 countries (United States, Australia, England, Scotland, New Zealand, Sweden, Denmark,
Canada, and Germany), including both 4vHPV vaccine and 2vHPV vaccine.25
Please see corresponding slide note for references.
Australia: Cervical Abnormalities
reduction
Australia: Population-based analysis of % reduction in cervical Australia: Population-based analysis of percentage reduction in
abnormalities among vaccinated (at least 1 dose) vs contemporaneous cervical abnormalities among vaccinated vs contemporaneous
unvaccinated screened females in Victoria unvaccinated screened females in Queensland
Garland et al; Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of
Real-world Experience: CID, 2016
Canada & Denmark: Cervical Abnormalities
reduction
Sweden: % reduction in CIN2+ and CIN3+ among females fully United States: % reduction in HPV 16/18-related cervical
vaccinated with 4vHPV vaccine (3 doses) vs unvaccinated abnormalities among females vaccinated with 4vHPV vaccine (at
/partially vaccinated females, by age at first dose least 1 dose) vs contemporaneous unvaccinated females
Garland et al; Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of
Real-world Experience: CID, 2016
HALAL
Age at first marriage1 Pre-marital sex and aged of sexual
activity2
•Survey taken from 63.428 respondent aged 10-24
years. 86.7% of them haven’t been married2
•Among those who haven’t been married, 3% man
and 1.1% women said they already sexually active2
Proportion of
respondent aged
10-24 years who
haven’t been married
based on first age
sexually active 2
1).Dirjen Pelayanan Medik Departemen Kesehatan RI. Badan Registrasi Kanker IAPI,
Yayasan Kanker Indonesia. Kanker di Indonesia Tahun1998. Data Histopatologik.
2). Mochtarom M. Data registrasi Kanker Ginekologik. Bagian Obstetri dan Ginekologi.RSUPN /FKUI, Jakarta 1992
3). IARC, Globocan 2002 database; Summary table by Cancer 2002. http://www-dep.iarc.fr/top.htm.Accessed Feb 1, 2007
PREVALENSI RESPONDEN YG PERNAH
DINYATAKAN KANKER SERVIKS 1,1%
PERNAH IVA