In this unit, there will be a variety of conditions pertaining to genitourinary, gynecologic, and adolescent health conditions. Select one of the topics below (please choose one that has not already been posted by another student). You are expected to present your initial topic that includes the following items: In addition, you are required to follow the Discussion Board grading rubric and respond to at least three of your classmates.
Topic: Cervical Cancer Prevention and Screening
Cervical cancer is a significant public health issue that affects women worldwide, particularly in low- and middle-income countries. It is the fourth most common cancer in women globally, with an estimated 570,000 new cases and 311,000 deaths in 2018 (Bray et al., 2018). Cervical cancer is primarily caused by persistent human papillomavirus (HPV) infection, with the high-risk HPV types 16 and 18 being responsible for approximately 70% of cases (Bosch et al., 2002). However, cervical cancer is highly preventable through effective screening and vaccination programs.
The primary prevention strategy for cervical cancer is vaccination against HPV. Vaccines targeting HPV types 16 and 18 have been developed and shown to be highly effective in preventing infection with these high-risk types. The quadrivalent (HPV4) and bivalent (HPV2) vaccines are currently available and have demonstrated high efficacy in reducing the incidence of HPV infection, precancerous lesions, and cervical cancer in clinical trials (Lehtinen et al., 2012; Ault et al., 2007). It is recommended for girls and boys to receive the vaccine before their sexual debut to maximize its protective effects.
In addition to vaccination, cervical cancer can be prevented through regular cervical screening programs. The most widely used screening method is the Pap smear (or Pap test), which involves collecting cells from the cervix and examining them for any abnormalities. The Pap smear has been successful in reducing the incidence and mortality of cervical cancer in many countries with organized screening programs (Ronco et al., 2014). However, it requires adequate laboratory infrastructure and trained personnel to interpret the results, which may not be available in resource-limited settings.
To overcome the limitations of the Pap smear, HPV testing has been introduced as an alternative or complementary screening method. HPV testing involves detecting the presence of HPV DNA in cervical cell samples and has been shown to be more sensitive than the Pap smear in detecting high-grade cervical lesions (Arbyn et al., 2018). In some countries, HPV testing has replaced or been added to the Pap smear as the primary screening modality. However, the implementation of HPV testing may face challenges related to cost, infrastructure, and acceptability.
Ensuring high coverage and participation in cervical cancer screening programs is crucial for their effectiveness. Strategies such as organized population-based screening, invitation systems, and reminders have been found to increase screening uptake (Subramanian et al., 2017). Engaging healthcare providers, community leaders, and women themselves in education and awareness campaigns is also important to improve knowledge about the importance of screening and address barriers to participation.
In conclusion, cervical cancer can be effectively prevented through vaccination against high-risk HPV types and regular cervical screening programs. Vaccination should be prioritized to reach girls and boys before their sexual debut. Screening programs should consider the use of HPV testing in addition to or in place of the Pap smear. Implementing organized population-based screening and addressing barriers to participation are necessary to achieve high coverage and reduce the burden of cervical cancer. It is crucial for healthcare providers and public health authorities to actively promote these preventive measures and ensure their accessibility and affordability for all women. Continued investment in research, program implementation, and monitoring is needed to further improve the prevention and control of cervical cancer globally.
References:
Ault KA, et al. (2007). Quatergicent Gardasil Phase III Investigators. Effect of prophylactic human papillomavirus L1 viruslike-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials. Lancet, 369(9576): 1861-1868.
Arbyn M, et al. (2018). Chapter 9: Cervical cancer screening. In: World Health Organization. Comprehensive cervical cancer control: a guide to essential practice, 3rd edn. Geneva. World Health Organization.
Bray F, et al. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6): 394-424.
Bosch FX, et al. (2002). Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. Journal of the National Cancer Institute, 87(11): 796-802.
Lehtinen M, et al. (2012). Overall efficacy of HPV-16/18 AS04-adjuvanted vaccine against grade 3 or greater cervical intraepithelial neoplasia: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. The Lancet Oncology, 13(1): 89-99.
Ronco G, et al. (2014). Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. The Lancet, 383(9916): 524-532.
Subramanian S, et al. (2017). Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India. The Lancet Oncology, 18(11): e698-e708.