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1 Evening CME Talk of the 8th Beijing / HK Medical Exchange “Prevention of Cervical Cancer” Moderator: Dr. Ko Wing Man Chairman of Hong Kong Anticancer.

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Presentation on theme: "1 Evening CME Talk of the 8th Beijing / HK Medical Exchange “Prevention of Cervical Cancer” Moderator: Dr. Ko Wing Man Chairman of Hong Kong Anticancer."— Presentation transcript:

1 1 Evening CME Talk of the 8th Beijing / HK Medical Exchange “Prevention of Cervical Cancer” Moderator: Dr. Ko Wing Man Chairman of Hong Kong Anticancer Society 11 Nov. 2006

2 2 1. "The effort to prevent cervical cancer in HK in the past five years" by Dr. Fan Yun Sun, Susan 2. "The future of cervical cancer prevention" by Dr. Shiu Cho Tak, Wesely Program: 6:00-7:30pm Lecture 7:30-9:30pm Dinner Speakers:

3 3 Burden of Cervical Cancer (worldwide) Cervical cancer is the second most common cause of cancer death in women worldwide ( 子宮頸癌在全球女性最常見的癌症中居第二位,是導致女性癌 症死亡的第二大原因。 ) 500,000 new cases diagnosed every year ( 估計全球每年約有五十萬人被診斷患有子宮頸癌,近二十四萬 人死於此病。 ) 240,000 deaths/year

4 4 Burden of Cervical Cancer (HK) Cervical cancer ranked as the eighth most common cause of female cancer death ( 子宮頸癌在香港女性最常見的癌症中居第八位。 ) >400 new cases reported, resulting in 128 deaths in 2004 ( 每年有超過四百名女性被診斷患上此癌症。在二零零四年,共 有一百二十八名女性死於子宮頸癌。 )

5 5 Progression of Disease Sexual Activity Transmission of HPV HPV Infection Development of CIN Invasive cervical cancer Safe sex Vaccine Treatmen t (NIL) Pap Smear 100% efficacy against HPV 16 & 18, accounting for >70% of cervical cancer

6 6 For the past 70 years, strategy on prevention of cervical cancer has been focusing on secondary prevention, by cervical screening. This is still important.

7 7 New Break Though Strategy - Past / Present - Future

8 8 Dr Susan Yun Sun FAN A member of UK Royal College of Obstetricians and Gynaecologists Diploma in Child Health from Ireland Master's degree in Public Administration from University of Hong Kong. Dr Fan took up the Executive Directorship of the Family Planning Association of Hong Kong since 1995, and has dedicated to broaden the scope of services from family planning and birth control towards a high- quality comprehensive sexual and reproductive health service Dr Fan serves on numerous government advisory bodies and non- government organizations, particularly those related to health, HIV/AIDS, and gender She also contributes to clinical teaching as Honorary Clinical Associate Professor in University of Hong Kong Dr Fan is a recipient of the Ten Outstanding Young Persons Award in 2000.

9 9 Dr Wesely Cho Tak SHIU Currently, Dr Shiu is a specialist in Medical Oncology in private practice. Chairman of the Department of Clinical Oncology, CUHK from 1982-1992 Hon. Consultant in Oncology  Prince of Wales Hospital 1987-1992  United Christina Hospital 1989-1992  Hong Kong Baptist Hospital (current)  HK Canossa Hospital (current)  HK Central Hospital (current) Hon. Professor in Oncology Shanghai Medical University China Director of Hong Kong Cancer Prevention and Treatment Center Executive committee member of Hong Kong Cancer Fund

10 10 Conclusion

11 11 WHO/UNFPA Guidance Document Preparing for the introduction of HPV vaccines: Policy and programme guidance for countries It is intended to alert a broad array of stakeholders – in sexual and reproductive health, immunization, child and adolescent health, and cancer control programmes – to some of the key issues surrounding the upcoming introduction of HPV vaccines against cervical cancer. In particular, it highlights the contributions that national immunization programmes, sexual and reproductive health programmes, and cancer control programmes can make in preparing for national introduction of the vaccines in the context of the Global Immunization Vision and Strategy. HPV vaccines have the potential to strengthen interactions among different health services and to provide a new way of preventing a common cancer in a very large scale, as well as reducing the more widespread burden of genital dysplasia and warts.

12 12 WHO/UNFPA Service Delivery … Reaching Target Populations Introduce HPV vaccine within an existing school-based immunization program targeting girls aged 9-13 years old? EPI (expanded program on immunization) campaigns provide another service delivery strategy? Including an HPV vaccine in tetanus vaccination efforts may be considered. Experience in America with both tetanus and rubella vaccines shows that vaccination of adolescents and adults is feasible through mass campaigns and that vaccination against these two infections is acceptable. Sexual and reproductive health programmes to assist in the development of school- and EPI-based HPV immunization programmes? Non-school-based service delivery strategies and involvement of community-based health professionals will be required to reach adolescents who do not attend school.

13 13 WHO/UNFPA Service Delivery … Reaching Target Populations Some of these initiatives would require close links with education services. Civil society and community-based health and welfare initiatives working with adolescents can play an important role in reaching out-of-school youth. Sexual and reproductive health services can contribute to information dissemination and increase vaccine coverage by transmitting messages to women older than 26 years who come for cervical cancer screening, about the need for HPV immunization of their children, other young female family members and other girls in their community.

14 14 Reaching Target Populations: Action Points Develop links between the many different implementing stakeholders. Define the primary target population, taking into account the most convenient access points, and the earliest age of sexual debut. Address sociocultural barriers to vaccination of young adolescents. Determine school attendance rates for the 9–13-year age group. Update national cervical cancer control strategies to incorporate the new HPV vaccines. Plan a service delivery strategy for HPV vaccines Develop a comprehensive approach to cervical cancer prevention Determine key process and outcome indicators for monitoring and evaluation.

15 15 Stewardship and Financing: Action Points A broad range of stakeholders should be involved in developing a strategy for a comprehensive and workable introduction of HPV vaccines Models should be developed at country level to forecast demand and to estimate the financing and coverage needed – of women only or of both sexes – to have an impact on disease at the population level  The business case should be developed, both for public funds and for potential private partners, based on up-to-date projections of the burden of cervical and other anogenital cancers (incidence, prevalence, hospitalization rates and mortality) and data on the prevalence of different HPV types, savings produced by vaccination, and overall impact on budget.  Financial implications of introducing HPV, as well as different scenarios of financial sustainability.

16 16 Need to Review and update current strategy on cervical cancer prevention (A)Education / Dissemination (B)Professional guideline basing on medical evidence and public health consideration targets - age - population - sex (C)Service Delivery Strategy - communication - financial model (implication / saving) - cultural consideration - false sense of security ■ sexual practice - role of different agencies Government / HKMA / FPA / ACS / Primary Care Physicians / Secondary Health Service

17 17 Questions (1) Booster does (2) Vaccinating the males (3) Other STD, other viral type (4) Sexual practice – safety / promiscuity (5) Age of vaccination in Hong Kong / China (6) Displacement effect by other viral type

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