Urinary High risk human papilloma virus.PPTX

HPV

1. Urinary HPV- A promising Screening tool Experience from AIIMS Bhopal Dr Ajay Halder MS, DNB, DMAS, FMAS, IGCS Scholar, Gynae oncology Fellowship Course Coordinator 1

2. The Project discussed in the presentation is ICMR Funded I declare no conflict of interest 2

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4. @MOHFW 2016 4

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8. Comparison Of Cervical Cancer Screening Methods Primary VIA Cytology with HPV triage for ASCUS Primary HPV Primary HPV with VIA triage Primary HPV with Colposcopy triage Cervical cancer case reduction(%) Cervical Cancer Mortality Reduction (%) Precancer treatments required Additional preterm deliveries caused by Precancer treatment NNT to avert one case Cost (Dollars) 8

9. C ervical screening, triage and treatment strategies for women in the general population. (100,000 women LMICs)  Screening Methods Screening Age Cervical Cancer Cases (% reduction) (Cervical Cancer Deaths(% Reduction) No screening - 1950 1456 Primary VIA 3yrs(30-50) 7x 39 47 Cytology/ HPV triage for ASCUS 3yrs( 30-50) 7x 43 52 Primary HPV 5 yrs(30-50) 5x 56 64 Primary HPV ,16/18 Triage 5 yrs(30-50) 5x 55 63 Primary HPV, VIA Triage 5 yrs(30-50) 5x 52 60 Primary HPV, Colposcopy Triage 5 yrs(30-50) 5x 52 61 Simms et aal. Nat Med  2023 9

10. C ervical screening, triage and treatment strategies for women in the general population.(100,000 women LMICs)  Pre cancer Treatment sessions projected Additional Preterm deliveries due to pre cancer treatment (Excision only) NNT prevent one Death (NNS to prevent one Death) Discounted lifetime cost (USD@ 2019) Primary VIA 137,176 167(67) 199(680) 51 Cytology/ HPV triage for ASCUS 20930 43(15) 28(627) 80 Primary HPV 50,214 88(20) 54(358) 52 Primary HPV ,16/18 Triage 34,388 67(19) 37(363) 51 Primary HPV, VIA Triage 30,174 61(19) 34(380) 51 Primary HPV, Colposcopy Triage 33268 64(19) 37(373) 57 Simms et aal. Nat Med  2023 10

11. Perceived Barriers to Screening 11

12. Self Testing ? Avoids unnecessary trips to Hospital Easy Collection Cost effective Keeps the person anonymous Mass screening is possible Vaginal self sampling Urinary HPV 12

13. To study the efficacy of urinary detection of hrHPV DNA (HPV 16,18) in predicting cervical cancer (squamous cell carcinoma and adenocarcinoma) and pre-invasive lesions (CIN-2,3) among women attending colposcopy clinic in AIIMS Bhopal 13

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15. Recruitment chart 15

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18. Concordance Between Urinary HPV and Histopathology 18

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20. Urinary HPV Performance 20

21. Urinary HPV testing begins by Collection of exfoliative cells in First-void Urine Collector ≥ containing nuclease inhibitors preserving DNA ≥ Standardized DNA extraction and amplification methods 21

22. FVU Collector 22

23. What WORKS for Urinary HPV screening 23

24. what Needs to be improved 24

25. Ray of HOPE 25

26. Ray of Hope 26

27. Test, Track, and Treat strategy for COVID - A ray of hope 27

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29. Gwalior - rise to UNESCO city of Music 29

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32. Take Home Message and Way forward Hr -HPV detection in Urine for cervical cancer screening can be a reasonable alternative to Cervical washing Presently recommended for research settings only Monitoring of results for mass vaccination can be done by Hr -HPV detection in urine Unmarried or Women unwilling for Vaginal examination may be offered Urinary Hr -HPV detection for cervical cancer detection 32

33. Thank You Dr Ajay Halder 33

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35. Region specific Incidence and mortality age – standardized rates for cervical cancer in 2020 (GLOBOCAN 2020) 35

36. Concordance for HPV detection between Urinary and Cervical samples Concordance for HPV detection between Urinary and Cervical samples Urinary HPV(16 and/or18) Cervical HPV (16and/or18) Negative Positive % of agreement: 85.96% Cohen’s k: 0.6988 SE of kappa = 0.098 95% confidence interval: From 0.507 to 0.891 Substantial agreement   Negative 17 (31.48%) 3(5.55%) Positive 5 (9.2%) 32 (59.25%) 36

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38. Implication of the results Better patient acceptance No Costly Clinical setup required No requirement of Dedicated Manpower and training for sample collection Pap smear, LBC, VIA, Cervical Washings for HPV Following needs to sorted out first Low urinary excretion Sample timing - Morning sample Vs First Stream Need for preservatives - Yes/No Standardization DNA extraction Procedure Standardization of DNA Amplification Procedure 38

39. Favorable Natural history of cervical cancer 39

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42. C all For Action To Eliminate Ca Cx As A Public Health Problem WHO 2020 S trategy recommends ‘90–70–90’ intervention targets by 2030, which are: 90% human papillomavirus (HPV) vaccine by 15 years of age; 70% screening using a high-performance test by 35 years and 45 years 90% cervical pre-cancer or invasive cervical cancer are adequate treated. E liminated cervical cancer when rates of new cases fall below 4 per 100,000 women-years.  42

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44. Interpretation 44

45. Future milestones that can be expected 45