So, thank you, I'm delighted to be able to join you tonight, and I wanted to talk a little bit about the WHO Cervical Cancer Initiative. First, I have no disclosures, my wife is a consultant to GSK, Inovio, Merck, Franz Viral Therapeutics for her work on HPV vaccines and treatment of pre-cancer. So, I wanted to talk about, first, the importance of strengthening health data and health communication systems, and some brief comments on HPV vaccination screening, diagnosis, and symptom management. And I'll ask Susan to share the slides with anybody who wants them. There's nothing secret. So, Dr. Tedros is the Director General of the World Health Organization, issued a challenge in 2018 for a global initiative for cervical cancer. And this was set out goals for 2030, which included vaccination of 90% of girls by age 15, that at least 70% of women would be screened with a high performance test, preferably twice in a lifetime, if not more. And it was women found to have pre-cancer and women found to have invasive cancer, that 90% of them would get timely and effective treatment, and that we would see a 30% reduction in deaths from cervical cancer. The key information that we need is who's been vaccinated, who's been screened, do people who screen positive get the right treatment, do people found to have invasive cancer get the right treatment, the right symptom management, and how many women die from cervical cancer. So, to get there, we need to have strong vital registration, including birth registries, unique personal identifier number, whether that's a national identifier number or biometric data. For example, they've given biometric data using fingerprints and iris scans to almost 80% of the population. And we need strong death registries, which capture both approximate causes and contributing causes of death. In terms of vaccination, we need to have pediatric vaccine registries, so we know which children and infants have been vaccinated, and we need to think about adolescent vaccine registries, so we know which girls in the target age group have been vaccinated. We've seen that school-based campaigns seem to be the most effective, and there's been some very nice work in Vietnam looking at school-based approaches, but you also have to worry about what are you going to do about the girl who's not in school the day that the vaccine takes place or has left school. Now, the WHO advisory committee last month, or in April, actually, recommended that one or two doses for adolescents of HPV vaccines are okay. And obviously, one dose is a lot easier to deliver than two doses. It's a lot cheaper and a lot less complicated. So, I think that gives us a greater ability to vaccinate girls around the world. In terms of screening, as I said, we need to track who's been screened for cervical cancer, and we need to think about whether we want to build that into screening programs that are looking at other noncommunicable diseases, such as diabetes, hypertension, breast masses, screening at the time of other health visits, whether it's for reproductive health care, family planning, HIV care, well-women care. So, wherever a woman comes, we want to get her screened and capture information on that screen. It's very important that we have good follow-up. We want to make sure that if she screens positive, needs that triage, and or needs ablative or excisional therapy, that we make that referral. There's got to be good exchange of information between the primary health setting and the district hospital. We've learned that we can have pretty good telephone communication with women or with somebody in their family or their circle of friends, but we also need to think about whether that person needs help with what we call patient navigation or help with transportation as well to get the person to the site for triage or the ablative therapy. Similarly, after diagnosis of suspected ovarian cancer, we want to minimize the loss of follow-up. We need good exchange of information between the clinic, the district hospital, the regional hospital, or the cancer center. Again, we want to use mobile phone technology as much as possible, and certainly for women found to have invasive disease, they desperately need patient navigation and help with transportation. I know on these tumor boards, we've discussed the treatment cascade, but we definitely want to make sure that we think about things like lodging if the patient needs to go to the big city, what are the out-of-pocket expenses. We've certainly heard earlier in the session today about the importance of accurate diagnosis from pathology, and we've seen beautiful imaging studies. We need to combine those with presentation data at tumor board, and then schedule the patient for high-quality surgery, anesthesia, post-operative care if the patient is surgical eligible. If they're appropriate to be treated with high-quality radiation therapy, how do we make sure that there's external beam, there's brachytherapy, there's platinum-based chemotherapy? One question that we're seeing, or one advance we're seeing, is you can now import data from imaging studies directly into the radiation therapy treatment planning, and certainly both GE and Siemens are doing this in partnership with Varian and Electa. There have been some beautiful papers coming out of the World Health Organization on the unmet needs for symptom management and palliative care for women with cervical cancer, and so we think it's really important that that be part of the management algorithm for women found to have invasive disease. As we've seen in the discussions today, multidisciplinary care for women with cervical cancer is particularly important, and so this includes the primary care team, gynecology, anatomic pathology, imaging, GYN oncology, radiation oncology and radiation physics, medical oncology, palliative medicine, oncology nursing, social work, and spiritual support are all critical for the care of women found to have invasive disease. In terms of data, cancer registries should feed into the hospital, or cancer cases need to feed into the hospital cancer registry, the regional cancer registry, national cancer registry. We need to capture the details of the treatment. If the patient does have surgery, we need to get the final pathologic diagnosis. It's critical to make sure that the plans for survivorship care, symptom management, and follow-up is communicated back to the primary health clinic in the district hospital, because if we're delivering, to deliver effective symptom management and effective palliative care, that has to be done in the community. And again, we can use mobile telephones to check on, see how women are doing, and for women to ask questions. We are now working to develop a kind of a pared-down list of questions so that we can capture issues related to imaging, preservation of sexual bladder and rectal function, fatigue, pain, so that we can address those appropriately. And again, I will make sure that Susan sends you all the WHO publications I mentioned. We want to work with those patients who have had potentially curative therapy to help them return to normal family life and work, to put in place palliative care and end-of-life care as needed for individuals. In terms of survivorship data needs, again, we need to share information across the, between the primary health care clinic, the district hospital, regional hospital, cancer centers. We want to know if the patients are having any persistent symptoms, if they've responded to treatment, what is their disease status, do they have persistent or recurrent cancer, and finally, their vital status. So, they're alive or dead. If they died, was the cancer the primary cause of death? Where and when did the person die? So, as I said, the goals for 2030, vaccination of 90% of girls, screening of 70% of women, treatment both for pre-cancer and invasive cancer, 90% timely and effective therapy, and a 30% reduction in cervical cancer deaths. I'd be happy to answer any questions, and as I said, I will share the papers I mentioned through, with you all, as well as my slides with Susan's help.

Cervical Cancer Initiative

health data

screening

treatment

palliative care