World Cervical Health Awareness Month: A Closer Look on Screening, Management, and Prevention

Opening: World Cervical Health Awareness Month 2022

Host  00:04 Hello, good evening to all doctors across Southeast Asia. Tonight, this webinar is streamed in six countries. I will say hello to the Philippines, Indonesia, Malaysia, Thailand, Singapore, and Vietnam. I will introduce myself. My name is Patrick Indradjaja. I represent Docquity Global and will be the host of tonight's event. Tonight, we commemorate World Cervical Health Awareness Month 2022 by hosting a multinational webinar entitled "A Closer Look on Screening, Management, and Prevention." We are honored to have two distinguished speakers that will enlighten us more on the new development in cervical cancer and will be introduced by our also distinguished moderator, Dr. Aileen Tomboc.

Host  00:52 A brief history about Dr. Aileen so everyone can know who's Dr. Aileen. Dr. Aileen Tomboc graduated from the University of Santo Tomas. She is right now working as a member and Board of Trustee in the Philippine Society of Cervical Pathology and Colposcopy. She is also the Chief Training Officer for the Residents at the Department of Obstetrics and Gynaecology, Cardinal Santos Medical Center. Also, Section Head of Gynecologic Oncology at Rizal Medical Center and Chief Training Officer at Cardinal Santos Medical Center. Without further ado, Dr. Aileen Tomboc, you may proceed.

Introduction

Dr. Aileen Tomboc  01:41 Good evening, everyone. Welcome to our regional webinar during this January's World Cervical Health Awareness Month 2022: A Closer Look on Screening, Management, and Prevention. Tonight we will be taking a closer look at the disease, cervical cancer, its incidence, the burden of the disease, and the preventive strategies in the impact of our present global situation, which is COVID-19. We are graced with the presence of our two esteemed speakers, Dr. Marivic C. Agulto-Mercadal and Dr. Gatot Purwoto.

Dr. Aileen Tomboc  02:16 To introduce our first speaker, she had her medical training at the University of Santo Tomas, Faculty of Medicine and Surgery. She had her postgraduate internship and residency in Obstetrics and Gynecology in the Medical City in Pasig City. In 2014, she completed her fellowship in Gynecologic Oncology and Robotic Surgery at the National University Hospital Singapore, Section of Gynecologic Oncology in Singapore. In 2019, she likewise completed her fellowship in Gynecologic Oncology and Colposcopy at Jose R. Reyes Memorial Medical Center, Section of Gynecologic Oncology and Trophoblastic Disease in Manila. Currently, she's taking her Master's studies in Business Administration and Health at the Ateneo Graduate School of Business, Rockwell, Makati City. Presently, she's a Consultant Staff of the Medical City, Taytay Doctors Multispecialty Hospital, and Ortigas Hospital and Healthcare Center. She's the Head of the Department of Obstetrics and Gynecology of Metro Rizal Doctors Hospital and the Medical Specialists in the Rizal Medical Center. Likewise, she is a Year Level 8 Faculty Staff at the Ateneo School of Medicine and Public Health. May I call on, Dr. Marivic C. Agulto-Mercadal. Okay, yes, we could see your slides now.

World Incidence: Cervical Cancer

Dr. Marivic Mercadal  03:56 The global burden of cervical cancer has continued to increase during the past years, with about 604,127 new cervical cancer cases diagnosed annually in the world in the 2020 estimation, ranked as the 4th leading cause of female cancer among women of all ages and the second most common female cancer in women aged 15 to 44 years.

Dr. Marivic Mercadal  04:27 The vast majority of these increases will be among women in low and middle-income countries. In Asia, about 351,720 new cervical cancer cases were diagnosed annually in the 2020 estimation. Also, it ranks 4th as the leading cause of female cancer among women of all ages and the 3rd most common female cancer in women aged 15 to 44 years among Asian countries.

Cervical cancer in Asia

Dr. Marivic Mercadal  05:06 Cervical cancer in Asian nations remains to be high. Focusing on Southeast Asian countries, the age-standardized rates (ASR) of cervical cancer measured per 100,000 women per year are highest in Indonesia, Myanmar, Brunei, Thailand, and the Philippines. The annual number of cases and age-specific mortality rates of cervical cancer in Asia was estimated to be highest among women aged 40 to 64 years old, recorded at 118,494 cases, out of the 196,776 deaths worldwide in the same age group. Also, about 14,000 mortality among the younger population is 15 to 39 years old were estimated out of the 31,743 deaths worldwide among the young population.

Dr. Marivic Mercadal  06:11 This NCD in women has been in existence for so many years and was reported to be due to many factors, like poverty, and sexual practices, along with lack of access to women's health care, including vaccination and screening. According to the Director-General of the World Health Organization, one woman dies of cervical cancer every two minutes. And so, in May 2018, Dr. Tadros issued a call for all countries to take action and help end the suffering caused by cervical cancer, encouraging all countries and all stakeholders to unite behind this common goal with renewed political will.

Cervical Cancer and HPV in Women

What is cervical cancer?

Dr. Marivic Mercadal  06:55 But what is cervical cancer, and what causes it? The cervix is the lower portion of the uterus, and cancer of the cervix is closely associated with a cervical viral infection, particularly the high-risk types of human papillomavirus or HPV. HPV infection has been implicated in about 99.7% of cervical squamous cell carcinoma worldwide.

HPV types and disease association

Dr. Marivic Mercadal  07:29 HPV is one of the most common causes of sexually-transmitted diseases in both men and women worldwide, with more than 200 types of HPV recognized. This table shows the different types of HPV and their associated diseases. Based on their association with cervical cancer and precursor lesions, HPV can be grouped into high-risk and low-risk HPV types, of which HPV 16 and 18 are the most commonly associated type for cervical cancer.

Who is at risk for HPV infection?

Dr. Marivic Mercadal  08:04 So what are the risk factors for HPV infection and eventually cervical cancer? Having multiple sexual partners at any time, or if she is a partner of someone who has had multiple sexual partners, increases the risk for the disease. Sexual activity at an early age and the presence of cofactors like smoking, long-term contraceptive use, and a history of sexually transmitted diseases contribute to an increased risk of HPV infection and cervical cancer. Social-economic factors, including poverty, lack access to education, and health care, including screening and vaccination, were associated with the diseases.

Cervical Cancer Symptoms

Dr. Marivic Mercadal  08:57 A typical cervical cancer patient is a woman 40 to 60 years of age coming to the clinic complaining of abnormal vaginal bleeding or brownish discharge, often noted after intercourse or occurring spontaneously between menstruation. As the cervical cancer tumor increases its size and outgrows its blood supply, tumor necrosis may lead to complaints of foul-smelling vaginal discharge. Later, they may also complain of pelvic and back pain, loss of appetite, changes in bowel or bladder habits, weight loss, and leg edema.

How to confirm the diagnosis of cervical cancer?

Dr. Marivic Mercadal  09:41 But how do we diagnose cervical cancer? A Pap smear is a screening test for cervical cancer among women with a normal-looking cervix. Colposcopy, on the other hand, may also be done in some centers, depending on its availability. While in some low-resource settings, visual inspection with acetic acid or solution may also be done. But a diagnosis of cervical cancer is established by biopsy of the tumor and the history pathologic findings of malignancy on analysis.

How do we stage cervical cancer?

Dr. Marivic Mercadal  10:22 Currently, restage patients with biopsy-proven cervical cancer using the 2018 FIGO staging system. In the 2018 FIGO staging for cervical cancer, imaging and pathologic findings were already allowed to be used in allocating the stage of the disease and assessing the size and extent of the tumor, lymph node involvement, and other metastatic sites. It is contrary to the purely clinical staging used in the previous years.

Treatment and Prognosis of Cervical Cancer

What is the treatment for cervical cancer?

Dr. Marivic Mercadal  10:58 So what is the treatment for cervical cancer? Treatment depends on the stage of the disease and may be given surgery for early stages in the form of radical hysterectomy. For locally advanced diseases, management is given by a combination of chemotherapy and radiotherapy with brachytherapy. For metastatic or recurrent disease, targeted therapy may be an option.

What is the prognosis of cervical cancer?

Dr. Marivic Mercadal  11:29 The prognosis of cervical cancer is dependent on the stage of the disease. In the SEER database with the Surveillance Epidemiology and end-result databases chap women diagnosed with cervical cancer between 2010 to 2016. It found that the five-year relative survival rate for those patients with the localized disease was 92%. Those with the regional and distant stages have a lower five-year relative survival rate at 58 and 17%, respectively.

Global Strategy Towards Eliminating Cervical Cancer as a Public Health Problem

Dr. Marivic Mercadal  12:06 Cervical cancer is a preventable disease and is curable if detected early and adequately treated. However, it remains one of the most common cancers and causes of cancer-related deaths in women across the globe. Cervical cancer is a reflection of global inequities in health care. In low middle-income countries, its incidence is nearly twice as high, and its death rates are three times as high as in high-income countries. That is why our call for a global strategy toward eliminating cervical cancer as a public health problem was made by the World Health Organization.

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