HPV is the cause of cervical cancer. There is a long lag between infection and development of cancer. There are two major opportunities to prevent this entirely preventable cancer.

1. Preventing the preventable
cancer
Zero Cervical Cancer in
RAK / UAE by 2020

2. Fact is ……. While it is possible for a

3. Global Burden of Cervical Cancer

4. Courtesy Dr Jalaa Taher, HAAD

5. Cytology based screening for
Cervical Cancer

6. Limitations of cytology

7. Reproducibility of Cervical cytology
after reviewing 5000 slides

9. Cytology Screen categories
Bethesda Scoring

10. Management of women with LSIL

11. Draw backs of cytology screening
(Roche submission to US FDA March 2014)

12. Harald zur Hausen 1984 isolated HPV 16
from Cx tissue
Awarded Nobel Prize 2008

14. Relative sensitivities of cytology &
HPV testing

17. Co Testing

18. Genotypes separately &
simultaneously reported by
Star Metropolis Clinical Lab

19. Primary HR HPV Screening with
reflux cytology

20. Courtesy Dr Jalaa Taher, HAAD

21. Courtesy Dr Jalaa Taher, HAAD

22. Courtesy Dr Jalaa Taher, HAAD

23. UAE study
Age distribution
n = 314
2
33
84
63
48 46
21 18
0
10
20
30
40
50
60
70
80
90
< 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 > 51
number
number

24. HPV Genotypes in UAE
n = 126
8 LR genotypes 14 HR genotypes

25. Genotype distribution in different
age groups (n = 126)
Age group Genotypes
< 20 [39, 59]
21 - 25 [6, 6, 11,51] [16, 51,61,66] [53] [11,18,31,39,58][42]
53, 66, 66, [66,59,52], [52,73], 31, [66,35,54,6]
26 - 30 [16] [42,43,51,66] [6] [16,39.52,61,68] [6,39,61,68,73]
[56,42,43], 33, [35,53], [52,70], 42, 16, 6, [51,39,42,6]
31 - 35 [52] [43,58,59,66] [11,16,42,43,53,61,61] [16,73,82] [6,52]
66, 51, [58,16], [33,6], 44
36 - 40 [16,70] [6]
54, [59,31,42,11], [18,54], 18
41 - 45 [42,51,68] [42,53,59] [42,59] [16,16,18,52] [53,53,68,70]
53,58,51
46 - 50 [16] [6, 42], 33
> 51 [16], 53, [33,82], 33, 53, [51,33,35,42,6]

26. HPV genotypes in UAE
0
2
4
6
8
10
12
14
16
genotype6L
g11L
g16H
g18H
g31H
g33H
g35H
g39H
g42L
g43L
g44L
g51H
g52H
g53H
g54L
g56H
g58H
g59H
g61L
g66H
g68H
g70L
g73H
g82H
14 HR genotypes : 80
8 LR : 46

27. HPV Genome
• E1-E7 = “Early” genes
(nonstructural)
• L1, L2 = Capsid genes
• URR = upstream regulatory
region
• E6 & E7 proteins play
major role in immortality &
malignant transformation of
infected cells
• E5 has role, but not
required to maintain cancer
phenotype
Munoz et al. 2006.

28. Why Cervical Cancer is preventable ?
Natural History of HPV infection

30. HPV-containing double
stranded DNA
‘Empty’ non-infectious
virus-like particle (VLP)
mimics the virus
Virus-like particles (VLPs) as HPV vaccine
antigens mimic the virus structure
Stanley M, et al. Vaccine 2006; 24(suppl 3):S3/106–113.

31. Vaccines
• Gardasil (2006) :
– Contains HPV 16, 18, 6, 11
• Cerverix (2009): Contains HPV 16, 18
– Females 10 through 25
– For:
• Ca Cx
• CIN
• Adenocarcinoma in situ
– Gardasil for males too and for Ca Anus, warts
etc

33. Two Opportunities to prevent Cx Ca
Normal
cervix
HPV
infection
Cervical
Intraepitheili
al neoplasia
CIN
Cervical
Cancer
HPV
vaccine
HPV & Cx
screen & t/t
10- 18 18 – 25 > 30

35. Collection of Cx Swab

50. Cervical Cancer is entirely preventable
1.Vaccination before exposure
2.Screening after 30 yrs (every 5 yrs)
Though STI,
it does not imply un-faithfullness
Cancer free RAK / UAE by 2020
Become a national achievable goal
Insurance be instructed to approve
Vaccination & Co-testing

51. Please Join, Support & Promote
Scientists have the tools, but cannot do it alone
Thank you for your attention