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CERVICAL CANCER - PREVENTION & SCREENING
Mortality due to cervical cancer can be reduced by prevention, early detection & treatment.
Vaccination may be started as early as 9 years old.
Vaccination may reduce the incidence of HPV-related disease.
Screening for cervical cancer after vaccination is still recommended because only 70% of the virus types associated w/ invasive cervical cancer consist of HPV 16 & 18 types & women may not be entirely protected if they have been infected w/ other HPV types prior to vaccination.

Surgical Intervention

  • Choice of therapeutic option depends on patient’s age, parity, child-bearing desire, prior cytology and treatment history and history of follow-up, operator experience, and non-visualization of the transformation zone
  • Both modalities have similar efficacy with respect to eliminating cervical intraepithelial neoplasia (CIN) and decreasing the risk of developing invasive cervical cancer
    • Visual inspection with acetic acid (VIA)-positive women are treated with cryotherapy or, if ineligible, loop electrosurgical excision procedure (LEEP)
  • May have an adverse effect on future pregnancies
  •  Treatment failure rate has been varied from 1-25%, usually occurs within 2 years after treatment
  •  Patients treated for CIN 2/3 have an increased risk of developing invasive cervical cancer with 56 per 100,000 for at least 20 years post treatment; hence, follow-up is recommended

Ablative Methods

  • Eg Cryotherapy, laser ablation, electrofulguration, cold coagulation
    • Cryotherapy can be performed by trained and competent healthcare providers at all levels (eg doctors, nurses, midwives)

Excisional Methods

  • Eg Cold knife conization (CKC),LEEP/large loop excision of the transformation zone (LLETZ), laser conization, electrosurgical needle conization
    • Should only be performed by a trained health personnel (eg gynecologist)
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Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1