Global elimination of cervical cancer as a public health problem
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Cervical screening
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Knowledge of the risk factors for cervical cancer (CC) and the benefits of cervical cancer prevention motivates women to participate in preventive screening. However, several studies indicate that thereis a significant lack of knowledge about the human papillomavirus (HPV) around the world. This study examines the level of knowledge about the prevention of HPV and cervical cancer in the contextof socio-demographic and behavioral characteristics of women in Uzbekistan.Key words: questioning, cervical cancer, Human Papillomavirus, prevention
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Direct international comparisons which aim to understand how factors associated with human papillomavirus (HPV) vaccine initiation and attitudes towards the HPV vaccination in parents differ are scarce. Parents (n = 179) of daughters aged 9–17 years in the US, UK and Australia completed an online survey in 2011 with questions measuring daughters' HPV vaccination status, HPV knowledge, HPV vaccination knowledge, and statements assessing attitude towards the HPV vaccine. The strongest factor associated with vaccination status across all countries was parental HPV knowledge (p < 0.001). Parents with both very low and very high knowledge scores were less likely to have vaccinated their daughters. Parents with higher HPV vaccination knowledge scores intended to vaccinate their daughters (if not already vaccinated) for protective reasons (p < 0.001), while those whose daughters were already vaccinated understood that vaccination protection was not 100% and that their daughters may still be at risk of getting HPV (p < 0.05). Compared to the UK and Australia, a higher proportion of parents with unvaccinated daughters from the US were worried about the side-effects of the HPV vaccination (US: 60.5%, UK: 36.4%, AUS: 15.4%; p < 0.05), believed that getting the vaccination might be a hassle (US: 21.1%, UK: 0%, AUS: 7.7%; p < 0.05), and that the vaccine was too new (US: 44.7%, UK: 22.7%, AUS: 7.7%; p < 0.05). This study adds to the understanding of how parents may influence vaccination uptake by demonstrating the effect of knowledge and the parental attitudes towards HPV vaccination across three countries.
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In May, 2018, the Director-General of WHO issued a global call to eliminate cervical cancer as a public health problem, which will involve ambitious screening and vaccination coverage targets. We aimed to assess the potential for, and timing of, cervical cancer elimination in the USA and whether this could be expedited by adopting ambitious coverage targets, using two cervical cancer simulation models.In this modelling study, we used two independently-developed cervical cancer microsimulation models-Harvard and Policy1-Cervix-to estimate changes in the incidence of human papillomavirus (HPV)-induced cervical cancer over time in the USA, including herd effects from vaccination. We compared nine alternative scenarios for prophylactic HPV vaccination and cervical screening scale-up with a status quo scenario that involved no additional interventions in the context of a threshold for cervical cancer elimination of four or fewer cases per 100 000 women-years. We also estimated the number of cervical cancer cases that could be averted between 2019 and 2100 associated with the adoption of ambitious goals for cervical cancer screening and vaccination coverage, and other potential strategies.Under status quo assumptions, the Havard and Policy1-Cervix models projected that cervical cancer incidence would decrease to less than four or fewer new cases per 100 000 women-years by the 2038 and 2046, respectively. Scaling up screening coverage to 90% in 2020, was the most effective intervention to expedite time to elimination (10-13-year reduction), averting a mean of 1400-2088 additional cases annually between 2019 and 2100. Increasing HPV vaccination coverage to 90% or vaccinating adults aged 26-45 years had relatively little effect on cervical cancer incidence. Sensitivity analysis using different population structures resulted in differences in time to elimination (range -10 years to +27 years) compared with status quo predictions.The USA is on track to eliminate cervical cancer as a public health problem in the next two to three decades. Time to elimination could be expedited by 10-13 years by achieving higher screening coverage. Targeting of underscreened and under-vaccinated women remains key to achieving cervical cancer elimination for all women.US National Cancer Institute.
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Human papillomavirus is recognised as the main cause of cervical cancer. Vaccines to protect against specific HPV types have been developed and a national HPV vaccination programme is due to begin in the UK in September 2008. Girls aged 12 to 13 years of age will be offered one of the vaccines, Cervarix, and it is hoped that it will offer them protection against over 70% of cervical cancer.
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Cervical screening has had a significant impact on the incidence and mortality of cervical cancer in developed regions of the world, particularly where organised screening programs have been implemented. In Australia, the National Cervical Screening Program was established in 1991. The two-year participation rate for Australian women in 2004- 2005 was estimated to be 61% and has been relatively constant over the last decade. Australia currently has the lowest mortality rate (1.9 women per 100,000) and second lowest incidence rate (9.1 women per 100,000) from cervical cancer in the world. However, this largely represents a reduction in incidence of squamous cell carcinomas, which are more readily preventable by screening than adenocarcinomas. The incidence of cervical cancer plateaus after the age of 35 years and increases again for older women (11.6 women per 100,000 age 75 years and over). The mortality from cervical cancer for Aboriginal and Torres Strait Islander women is more than four times that of non-Indigenous women. The National Cervical Screening Program has been highly successful in reducing both incidence and mortality from cervical cancer in Australia, however inequities in the burden of disease exist, particularly for Indigenous women. (author abstract)
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This article aims to update nurses who are experienced in obtaining cervical samples and stimulate interest in health professionals who wish to undertake the procedure in the future. It also provides information on the NHS cervical screening programme and its relevance in the reduction of cervical cancer. It should help the reader to understand the nature, importance and prevention of cervical cancer, and the techniques for detection and treatment of pre-cancer.
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Infection with human papillomavirus (HPV) is the first necessary cause for cervical cancer development. Although cervical cancer can be prevented and treated if detected early enough, it is the second biggest cause of female cancer mortality worldwide. Early detection of precursor cervical lesions by screening methods based on cytological and/or HPV testing should be encouraged because it offers protection against invasive cervical cancer. This review discusses the essential issues concerning cervical cancer and provides future prospectives.
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Cervical cancer is the 11th most common cancer in women. Cervical screening aims to reduce the number of women who develop invasive cervical cancer and, consequently, the number of deaths caused by cervical cancer, by regularly screening women so that cervical abnormalities that might otherwise develop into invasive cancer can be identified and treated. GPs play an important role in raising awareness of cervical cancer and ensuring that women are provided with the necessary information and advice to assist them in making an informed choice about attending cervical screening appointments.
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