DETEKSI DINI KANKER LEHER RAHIM DENGAN TES DNA

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DETEKSI DINI KANKER LEHER

RAHIM DENGAN TES DNA HPV DAN INSPEKSI VISUAL ASETAT (CO

TESTING)

DR. dr. P. AGUSTIANSYAH, SpOG. Subsp.Onk. MARS

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PENDAHULUAN

• EPIDEMIOLOGI KANKER SERVIKS

• Global burden : insiden morbidity

& mortality rate tinggi

• No 4 global, Indonesia no 2

• Setiap 2 menit 1 meninggal

• 85% LMIC, Indonesia:70% stadium lanjut, >60% meninggal

• Cakupan deteksi dini rendah,

sosek rendah, infrastruktur

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NATIONAL CANCER SCREENING PROGRAMS for CERVICAL CANCER in ASIAN COUNTRIES

2020

Source: Aoki ES, Yin R, Li K, et al. National screening programs for cervical cancer in Asian countries. J Gynecol Oncol. 2020 May;31(3):e55. https://doi.org/10.3802/jgo.2020.31.e55

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FAKTOR-FAKTOR RISIKO

1. Infeksi HPV risiko tinggi : 99% pd kanker serviks 2. aktivitas seksual pada usia muda: 5x berisiko lama 3. multipartner: berbagai varian HPV rt, PMS

4. merokok: menurunkan imun lokal

5. kontrasepsi oral: pemakaian > 5 th  2,5x berisiko 6. anak banyak: > 3  4,5 berisiko

7. sosial ekonomi rendah,

8. penyakit menular seksual: inisiasi karsinogenesis 9. gangguan imunitas: immunocompromise

Lu J dkk,2020

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NATURAL HISTORY of CERVICAL CANCER

Source: Bharti AC, Singh T, Bhat A, Pande D, Jadli M. Therapeutic startegies for human papillomavirus infection and associated cancers. Front Biosci - Elit. 2018;10(1):15-73. doi:10.2741/e808 METAPLASIA TZ

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HPV INFECTION

Source: Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019;393(10167):169-182. doi:10.1016/S0140-6736(18)32470-X

ZONA TRANSFORMASI

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Treatment of invasive cancer at any age and palliative care

• Surgery

• Radiotherapy

• Chemotherapy

• Palliative care SKRINING “Screen and treat” IVA

– single visit approach

• Point-of-care rapid HPV testing for high risk HPV types

• Followed by immediate treatment

• On-site treatment

All women as needed Women 30 years or

older Girls and boys, as appropriate

• Health information and warnings about tobacco use

• Sex education tailored to age and culture

• Condom promotion and provision for those engaged in sexual activity

• Male circumcision

PRIMARY PREVENTION SECONDARY PREVENTION

Comprehensive Approach

to Cervical Cancer Prevention and Control

Girls 9-14 years HPV vaccination

TERTIARY PREVENTION

https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

Schiffman M, Doorbar J, Wentzensen N, et al. Carcinogenic papilloma virus infection. Nat Rev Dis Primers. 2016;2:120. doi:10.1038/nrdp.2016.86

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Cervical Cancer Screening Strategies

in High- and Low-Resource Settings

Source: Schiffman M, Doorbar J, Wentzensen N, et al. Carcinogenic papilloma virus infection. Nat Rev Dis Primers. 2016;2:120. doi:10.1038/nrdp.2016.86

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Diagnostic Accuracy of HPV DNA Test versus VIA

Source: Mustafa RA, Santesso N, Khatib R, et al. Systematic reviews and meta-analyses of the accuracy of HPV tests, visual inspection with acetic acid, cytology, and colposcopy. Int J Gynecol Obstet. 2016;132:259–265.

HPV Test:

• Sensitivity : 94%

(95% CI: 84 to 98).

• Specificity : 84%

(95% CI: 72 to 91).

IVA:

• Sensitivity : 69%

(95% CI: 54 to 81).

• Specificity : 87%

(95% CI: 79

to 92)

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PEMERIKSAAN DETEKSI DINI

KANKER SERVIKS METODE CO TESTING

• Co-testing ini saat pengambilan sampel sel serviks

dilakukan bersamaan, biasanya menggunakan kit

berbasis cairan.

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TEKNIS PEMERIKSAAN CO TESTING

1. LITOTOMI

2. ASEPTIK ANTISEPTIK 3. KANKER/BUKAN

4. PENGAMBILAN SAMPLE HPV

5. TEST IVA DNA

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