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Running head: CERVICAL CANCER PREVENTION PROGRAM
Cervical Cancer Prevention Program
Sue Vansteel RN, BSHA, MSM
Ferris State University
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CERVICAL CANCER PREVENTION PROGRAM
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Abstract
This paper will examine the prevalence of cervical cancer and indentify the steps to eradicate this
disease. The cause of cervical cancer is undetected continuous infection from the human
papilloma virus (HPV) which is spread through sexual contact. The incidence of HPV is
relatively common among sexually active people. Cervical cancer is detectable by regular
Papanicolaou (Pap) tests and pelvic examines. In March, 2012, the Center for Disease Control
and Prevention released new recommendations for cervical cancer screening. Two vaccines
have been identified for women to protect them against the most common HPV that cause
cervical cancer. For men only one vaccine is available to protect them from the most common
HPV.
CERVICAL CANCER PREVENTION PROGRAM
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Cervical Cancer Prevention Program
Cervical cancer is a public health problem that can affect any woman regardless of age,
lifestyle, demographic, ethnicity or culture. Most cervical cancer develops over a relatively long
period of time and can take a profound toll one’s life. Complications from cervical cancer are
preventable by a combination of safe sex practices, routine Papanicolaou (Pap) tests, appropriate
follow-up of abnormal screening results and vaccination for human papilloma virus (HPV)
(MDCH, 2012).
Information
National Incidence and Mortality
According to the American Cancer Society, most cases of cervical cancer are found in
women younger than 50 years of age, and rarely in women younger than 20 years of age
(American Cancer Society, 2011). National statistics show there has been a decline in the
incidence and mortality rate among women because of improvements in treatment and screening.
Despite the decline the American Cancer Society indicates that in 2012 there will be roughly
12,170 women with newly diagnosed cases of invasive cervical cancer. It is estimated that 4,220
women will die as a result of this disease. Most women who die of cervical cancer have never
been screened (American Cancer Society, 2010). From 1998 to 2007 the national incidence rate
for cervical cancer has also declined from 9.1 cases per 100,000 to 6.4 in 100,000 (SEER, 2011).
These statistics coincide with a decline in the national mortality rate for cervical cancer from 3.0
deaths per 100,000 women in 1998 to 2.4 deaths per 100,000 women in 2007 (SEER, 2011).
Michigan Incidence and Mortality
According to the Michigan Department of Community Health (MDCH), the incidence of
invasive cervical cancer in Michigan has been declining since 1990. Today Michigan ranks
CERVICAL CANCER PREVENTION PROGRAM
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thirty-fourth in the nation for deaths from invasive cervical cancer (MDCH, 2011). Screening
has resulted in early detection and treatment of cervical cancer and has decreased the number of
deaths related to this disease (Simon, 2012). As demonstrated nationally, the Michigan Cancer
Burden Report shows a decline in mortality and incidences for cervical cancer. The mortality
rate decreased from 3.0 deaths per 100,000 in 1998 to 2.0 in 2008. The incidence of cervical
cancer showed a declined from 9.8 cases per 100,000 of invasive cervical cancer in 1998 to 8.0
cases. In 2007, 412 women were diagnosed with invasive cervical cancer and there were 116
deaths in 2008 (MDCH, 2010).
Risk Factors
The identified risk factors for cervical cancer include sexual behavior, human papilloma
virus (HPV), multiple pregnancies, smoking, immunosuppression, long term use of oral
contraceptive, family history of cervical cancer, and low socioeconomic status (CDC, 2011).
According to the National Cancer Institute (NCI), persistent HPV infections are now recognized
as the cause of essentially all cervical cancers. Persistent infections of HPV can lead to abnormal
cell growth after 10 to 20 years. If HPV is not detected, it can develop into cervical cancer (NCI
2009). HPV is spread through skin-to-skin contact during sexual activities (NCI, 2009).
According to the Center for Disease Control and Prevention (CDC),
HPV is the most common sexually transmitted infection in the United States with about
20 million people currently infected. Another 6 million people become newly infected
each year. HPV is so common that at least 50% of sexually active men and women get it
at some point in their lives (CDC, 2012, Genital HPV Infection).
CERVICAL CANCER PREVENTION PROGRAM
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Point of View
Prevention and Screening
Prevention and early detection is the key to surviving cervical cancer. Screening includes
regular Pap tests, visual inspection of the cervix and testing for the high-risk strains of HPV
(Maine, Hurlburt, & Greeson, 2011). In developed countries the Pap test is the most common
method used for screening. In addition to early detection through screening, the development of
the HPV vaccines is the most recent option for prevention of some cervical cancers. HPV types
16 and 18, account for approximately 70% of cervical cancer in the United States, and these high
risk strains can be prevented through the utilization of vaccines (NCI, 2009).
In March 2012, the American Cancer Society released new screening guidelines for
cervical cancer detection. These new recommendation decrease the number of Pap tests over a
women’s lifespan (Simon, 2012). Studies have shown that cervical lesions identified on the Pap
test disappeared on their own without treatment and ultimately had no residual effects (Simon,
2012). Prior to the implementation of these new guidelines, the recommendation for Pap testing
included women age 21-29 and those sexually active women under the age of 21 to have a Pap
test annually and included HPV testing. For women age 30- 65 Pap tests were recommended
every three years (MDCH, 2011).
The new evidence shows women who were treated for cervical lesion have had side
effects of cervical incompetence and miscarriage. These side effects could have been avoided if
the lesions were left to disappear on their own (Simon, 2012). Under the new guideline women
should begin cervical cancer screening at 21 year of age regardless of their prior sexual activity
(Simon, 2012). A Pap test is recommended every 3 years for women who are between 21 and 29
years of age. A follow up HPV test is done only if the results of a Pap test are abnormal. For
CERVICAL CANCER PREVENTION PROGRAM
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women between the ages of 30 to 65, a Pap test and HPV test are recommended every 5 years
(Simon, 2012). For this age group and at the discretion of the provider they may determine a Pap
test alone may be adequate every 3 years (Simon 2012).
The new screening guidelines have not changed CDC recommendations for HPV
vaccination (CDC, 2011). “There are 40 types of HPV that can affect the genital areas for men
and women” (CDC, 2011, para 1). Today there are two vaccines that are recommended to be
administered from 11 through 26 years of age for females. These vaccines can protect females
from the most common cause for cervical cancer (CDC, 2011). There also is a HPV vaccine for
males that protects against genital warts and anal cancer. The CDC recommends this vaccine to
be administered for males ages 9 through 26 years of age (CDC, 2011).
Assumption
According to the State of Michigan’s Governor’s task force on cervical cancer
report, (2006)“ Seventy percent of the women who die of cervical cancer either never had a Pap
test or did not have one in the past five years” ( State of Michigan, 2010, para 1). In Michigan, to
bring attention to the seriousness of cervical cancer, Governor Jennifer Granholm commissioned
a statewide Cervical Cancer Task Force in 2006. This task force was responsible for the
development of a statewide cervical cancer prevention and screening awareness campaign. Since
the advent of this campaign the Michigan Department of Community Health has selected
January as the Cervical Cancer Awareness Month. Public education messages were directed to
all women about the importance of cervical cancer screening and the HPV vaccine.
Concepts
A low income and lack of access to health care are key elements that prohibit women
from obtaining treatment and impact the survival rate of women with cervical cancer. For more
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than 20 years, women with low income and little to no health insurance have free or low-cost
mammograms and Pap tests made available through CDC, National Breast and Cervical Early
Detection Program (NBCCEDP). These services are made available across the 50 States and US
territories (NBCCEDP, 2011).
The Michigan Breast and Cervical Cancer Control Program (BCCCP) founded in 1991
has had a substantial influence in providing screening services and follow-up care, inclusive of
cancer treatment for women who meet certain income and insurance requirements (CDC, 2011).
In July 2006 Michigan was granted a waiver to provide family planning services including Pap
testing for 200,000 women between the ages 19-44 years of age (State of Michigan, 2006). This
has enabled many more women to receive Pap testing through the Medicaid Waiver for the
Family Planning, Plan First program (State of Michigan, 2006).
In many developing countries the burden of cervical cancer is a health problem that has
not been effectively addressed. Most developing countries lack lab equipment and healthcare
resources to manage screening programs (Maine, Hurlburt, & Greeson, 2011). While many are
struggling to meet their basic needs of clean water and food, there is little concern for cervical
cancer health screening and prevention.
Implication
Through public awareness programs cervical cancer screening and HPV vaccination will
continue to make inroads in the saving of lives. According to MDCH, there has been a decline
from 84.1% in 1996 to 77.7% in 2010 for women having a Pap test within the past three years in
Michigan (MDCH, 2011). While the percentage of the women screened for cervical cancer
remains at an unsatisfactory level, continued efforts to raise public awareness is necessary. The
nursing community can aid the cervical cancer prevention awareness through direct interaction
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with the public and clients. Nurses can provide information and resources for women in the
community through direct patient education, pamphlets, participating in health fairs, and
providing education in high schools and universities. Nurses can assist with conducting research
and gathering of data in various demographics areas to gain an appreciation regarding attitudes
and perception about cervical cancer screening and HPV vaccinations. Another study might
consist of obtaining data from men regarding their knowledge of HPV, how it is spread and what
protection is available for them as well as females.
Interpretation
Regular screening as recommended by the American Cancer Society is the most effective
way to ensure cervical cancer is caught at an early, treatable stage (Simon, 2012). According to
MDCH, there is a 90% survival rate for women that have been diagnosed with localized invasive
cervical cancer (MDCH, 2011). By following the American Cancer Guidelines and obtaining the
HPV vaccine women will decrease their chances of developing cervical cancer.
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Reference
American Cancer Society. (2011). Cancer fact and figures 2012. (p.1-64). Retrieved from
http://www.cancer.org/acs/groups/content/@epidemiologysurveillance/documents/docum
ent/acspc-031941.pdf
Center for Disease Control and Prevention. (2012). Genital HPV infection – fact sheet. Retrieved
from http://www.cdc.gov/std/HPV/STDFact-HPV.htm
Center for Disease Control and Prevention. (2011). National breast and early detection program.
Retrieved from http://www.cdc.gov//cancer/nbccedp/
Maine, D., Hurlburt, S., & Greeson, D., (2011). Cervical cancer prevention in the 21st century:
cost is not the only issue. American Journal of Public Health, Sept; 10(9) 1549-1555.
Retrieved from http://www.ncbi.nlih.gov/pubmed/21778496
Michigan Department of Community Health. (2011). Facts about Cervical Cancer. Retrieved
from http://www.michigan.gov/documents/mdch/Cervical_Fact_Sheet_February2012
_378339_7.pdf
Michigan Department of Community Health. (2010). The cancer burden in Michigan 19932011. Retrieved from http://www.michigan.gov/document/mdch/Ca-burden_MIselect_stats_1993-2011_371092_7.pdf
National Cancer Institute. (2009). Human papillomavirus (HPV) vaccines. Retrieved from
http://www.cancer.gov/cancertopics/factsheet/risk/HPV-vaccine.
State of Michigan. (2006). Governor’s task force on cervical cancer report. Retrieved from
http://www.michigan.gov/documents/mdch/FINAL_102306_GovTaskForceOnCervCanc
eredit2007_183728_7.pdf
CERVICAL CANCER PREVENTION PROGRAM
Simon, S. (2012). New screening guidelines for cervical cancer. Retrieved from
http://www.cancer.org/Cancer/news/new-screening-guidelines-for-cervical-cancer
Surveillance Epidemiology and End Results (SEER) (2011). Cancer statistics 1975-2008.
Retrieved from http://seer.cancer.gov/factstats/selections.php?
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