November 2009

November 30, 2010

The roundtable, produced in collaboration with Haymarket Medical Education, is designed to build consensus – and collaborative strategies – on preventive measures that reduce the risks for and, ultimately, the sequelae of cervical cancer. The roundtable participants will address the need for comprehensive education, community mobilization, prevention and primary care programs on cervical cancer awareness and control, particularly in underserved countries and those of low socioeconomic status.

The discussion also will address ongoing HPV immunization surveillance and durability, and implementing guidelines and data sources to support evidence-based decision-making about vaccine introduction. This program will also focus attention on early detection of precursor lesions by Pap smear-based and other screening methodologies and their treatment, which remain vital diagnostic measures for cervical cancer control.

Worldwide, cervical cancer is the second leading cause of cancer death in women.^{1, 2} Every year approximately 500,000 women worldwide develop cervical cancer,³ with up to 80% of global incidence and fatalities occurring in low-resource countries where screening programs are virtually nonexistent.^3-6 This proportion is expected to increase to 90% by 2020.7

Given that early detection of HPV precursor lesions remain the most important measure of control of cervical cancer, there is an urgent need to develop and make commercially available simple, effective, and low-cost diagnostic tests in many communities worldwide.^3,8 In 2005, the World Health Organization (WHO) stated that HPV DNA testing was at least as effective as cytology for primary cervical cancer screening,⁹ findings that have been confirmed in recent clinical investigations.¹⁰
The introduction of the bivalent¹¹ and quadrivalent¹² HPV vaccines represents the most effective prophylactic modality to prevent cervical cancer. Indeed, the availability of a vaccine to protect against certain types of HPV that cause cervical cancer and genital warts has changed the clinical landscape and provided an important new tool for disease prevention.

Several global initiatives are underway to heighten awareness of HPV and cervical cancer and to foster licensure and introduction of the bivalent and quadrivalent vaccines. These include the alliance for Cervical Cancer Prevention, The Cervical Cancer Vaccine Project, and the Global Alliance for Vaccines and Immunization (GAVI).¹³

The members of the European Union are considering a proposal to simultaneously introduce HPV vaccination into their national immunization schedules. That effort has been facilitated by the Vaccine European New Integrated Collaboration Effort (VENICE) project, a network designed to help execute the process to support countries making decisions about vaccine introduction.¹⁴

A global initiative is of vital importance because there is an urgent need for comprehensive education on the link between HPV and cervical cancer, healthcare mobilization at the international level, prevention and primary-care programs on cervical cancer awareness and control, and practical and economical screening immunization strategies targeted to underserved communities.¹⁵

At the conclusion of this CME activity, participants should be better able to:

• Discuss effective, low-cost and low-technology alternatives to Papanicolaou screening on an international level
• Outline the impact of cervical cytology screening programs and ongoing HPV surveillance initiatives
• Describe how HPV immunization reduces the incidence of cervical cancer worldwide and the burden of other HPV-related disorders
• Identify international guidelines and data sources to support evidence-based decision-making about HPV vaccination

This CME activity is intended for Primary Care Physicians, OBGYNS, Pediatricians.

Kenneth Alexander, MD, PhD (Program Chair)
Associate Professor of Pediatrics
Chief, Pediatric Infectious Diseases
University of Chicago Medical Center
Chicago, Illinois

Prof Alison Fiander, MD, FRCOG
Chair Obstetrics & Gynaecology
Wales College of Medicine
Cardiff University
Heath Park, Cardiff, UK

Prof. Sergio Pecorelli, MD, PhD
Chairman, Department of Obsterics and Gynecology
Director, Gynecologic Oncology and Pelvic Surgery
University of Brescia, Italy
Advisor, Scientific Director of the European Institute of Oncology
Milan, Italy

Luisa Lina Villa, PhD
Branch Director
Ludwig Institute for Cancer Research
São Paulo, Brazil

Thomas C. Wright, Jr., MD
Director
Division of Gynecologic and Obstetrical Pathology
Head, Colposcopy Services
Columbia University Medical Center
New York, NY

CME Course Director
Colin Marchant, MD
Associate Professor, Pediatrics
Boston University and Tufts University
Director, Center for Pediatric Vaccine Research
Pediatric Infectious Disease
Boston Medical Center – Tufts Medical Center
Boston, MA

Boston University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Boston University School of Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

There are no fees for participating and receiving CME credit for this activity. During the period November 2009 through November 30, 2010, participants must:

• Register for the program where prompted on the CD
• Complete the posttest by recording the best answer to each question in the answer key
• Complete the activity evaluation and submit directly online
• A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.

Estimated time to complete the activity: 2.0 hours

For CME questions, please contact Boston University School of Medicine www.bu.edu/cme

BUSM CME private policy http://www.bu.edu/cme/policies/privacy_policy.html

Course Code: E.HPVGLOBALHAY09

Boston University School of Medicine asks all individuals involved in the development and presentation of Continuing Medical Education (CME) activities to disclose all relationships with commercial interests. This information is disclosed to CME activity participants. Boston University School of Medicine has procedures to resolve any apparent conflicts of interest. In addition, faculty members are asked to disclose when any discussion of unapproved use of pharmaceuticals and/or devices occurs.

Kenneth Alexander, MD, PhD, has received grant/research support from Merck & Co., and is a member of the speakers' bureaus for GlaxoSmithKline and Merck & Co, Inc.

Professor Alison Fiander, MD, FRCOG, provides research support for Sanofi-Pasteur and GlaxoSmithKline

Professor Sergio Pecorelli, MD, has nothing to disclose

Luisa Lina Villa, PhD, is a consultant for Merck & Co., Inc.

Thomas C. Wright, Jr., MD, is a consultant for GenProbe, Roche Molecular, GlaxoSmithKline and Merck & Co, Inc.

Colin Marchant, MD, Boston University School of Medicine, has nothing to disclose.

Elizabeth Drury, Boston University School of Medicine, has nothing to disclose.

Nick Zittell, Haymarket Medical Education, has nothing to disclose.

Susan M. Basilico, Haymarket Medical Education, has nothing to disclose.

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA.

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