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Running head: CERVICAL CANCER PREVENTION PROGRAM Cervical Cancer Prevention Program Sue Vansteel RN, BSHA, MSM Ferris State University 1 CERVICAL CANCER PREVENTION PROGRAM 2 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 3 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 4 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 5 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 6 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 CERVICAL CANCER PREVENTION PROGRAM 7 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 CERVICAL CANCER PREVENTION PROGRAM 8 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. CERVICAL CANCER PREVENTION PROGRAM 9 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? 10