Etiology of Cervical Cancer

Discuss about the Cervical Cancer Strategic Plan Roles.

Cervical cancer is the fourth most frequent cancer in women,, with almost 530,000 new cases and in 2012 and represents 7.9 % percentages of all the female cancers. Approximately 90 % of the 270,000 deaths from the cervical cancer have occurred in the low and the middle income countries. High mortality of the patients in the low and the middle income countries can be reduced by proper screening and treatment programs (“Cervical cancer epidemiology and etiology of cervical carcinoma | Eurocytology”).

This essay aims to focus on the Etiology and the epidemiology of the cervical cancer across and globe, Singapore and especially in the Bukit Panjang community of Singapore.  The essay also focuses on the probable risk factors behind the prevalence of the condition in this community. The writing has been supported by the statistical data of WHO or Singapore government (Quek et al.,2013). The paper further discusses the role of the community health nurses in the education and promotion of the appropriate health care approaches to manage cervical cancer such as adoption of proper screening techniques, cessation of smoking and adhering to the treatment regimen.

Cervical cancer is a sexually transmitted disease caused by the Human Papilloma Virus (HPV), especially the HPV-16 and HPV- 18 (Haverkos, 2015). Many investigators acknowledge the fact that alone HPV is not sufficient to induce the cervical cancer. Other factors such as herpes simplex virus type 2 infections, vaginal douching, cigarette smoking, nutrition, use of the oral contraceptives are the contributing factors. Cervical tar exposures include tar based vaginal douches, long years of smoke inhalation of wood and coal burning stoves in the poorly ventilated houses (Haverkos, 2015).

The cervical cancer risk factors are pregnancy such as full term pregnancy before the age of 17. Family history plays an important role in detecting the cervical cancer. According to Quek et al.,(2013) certain types of sexual behaviors are considered to be the risk factors of cervical cancer, such as sex before the age of 18, multiple sex partners. Jin et al.,(2013) have shown a link between the cervical cancer and the Chlamydia infection. Other risk factors includes weakened immune system, people taking medications like Diethylstilbestrol (DES) have the risk of developing the cervical cancer.

According to the GLOBOSCAN figures for 2012 published by the International Agency for Research into Cancer (IARC) for the World Health Organization (WHO 2012), cervical cancer was the third commonest form of cancer recorded in women worldwide and is fourth in terms of death  by cancer (Human Papillomavirus and Related Diseases Report”, 2018). Current estimates indicate that every year almost 300 women are screened with cervical cancer and about 106 die each year (Akinyemiju et al. 2013). Data is not yet available regarding the HPV burden in Singapore but 3.0% of the women are estimated to contain HPV-16/18 infection in a given time.

Epidemiology of Cervical Cancer

Smoking has been considered as one of the risk factors for cervical cancer. According to the 2010 National health survey data, the prevalence of smoking has increased from about 12 % in 2004 to 14.3 % in 2010 (Human Papillomavirus and Related Diseases Report”, 2018). This can be explained by the increasing prevalence of smoking among the young adults and the youths. As per the study conducted by the health promotion board the 58 % of the youth smokers have at least one parents who smokes compared to the 27 5 of the youths who doesn’t smoke.

As per the data published by the ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre) 2017, about 5.2 % of the women smoke and has the chance of developing the cervical cancer (“Cervical cancer epidemiology and aetiology of cervical carcinoma | Eurocytology”). A new study has found that one in 10 healthy women are infected with Human Papilloma Virus (HPV). A study conducted by the Singapore general hospital involving 900 women found that the infection was common in women aged between 20 and 24 years. () has argued that those with HPV infections should not worry as the body naturally gets rid over 90 % of the HPV infections on their own.

As per the Singapore board of statistics the about 115 of the population are heavy smokers. The proportion is higher in males than that of the females. The adults aged between 40 to 64 years were more likely to be smokers than those above 40 to 64 years. This data can be linked to the cervical cancer in the community of the Bukit Panjang. A cohort study proposed by Roura et al. (2012), have found positive associations between smoking and the cervical cancer risks. Significant associations have been found between the intensity and duration of smoking. It has also been found that quitting the habit long enough can actually reduce the risk of cervical cancer and pre-cancer. Hence as per the study, woman who have quit smoking for long period of time have shown reduced risks of cervical cancer. Trimble et al.(2015) has found the increased risk of cervical neoplasia among the passive smokers.

As per the global cervical cancer statistics the major risk factor for the development of cervical cancer is the HPV infection. In an HPV screening test taken up in Bukit Panjang, about 11 % of the women were found to be diagnosed with HPV infection that can be associated with cervical cancer in the community (“Singapore Cancer Registry Annual Registry Report 2015”, 2018).

Cervical Cancer in Bukit Panjang Community of Singapore

As per the study ethnicity in Singapore also plays a role in the prevalence of the cervical cancer. There were three major ethnic groups in Singapore, the Chinese, the Malay and the Indian. The percentage of the cervical cancer has been found to be highest among the Chinese with the least among the Indians. From the year 2011 to 2017, the age specific incidence rate in Burkit Pajang was found to increase with the age from 23- 27. As per the data there had been an overall decrease in the survival of the cervical cancer patients. Again the survival rates of the stage 3 and 4 cancer patients improved remarkably over the two time periods (“Singapore Cancer Registry Annual Registry Report 2015”, 2018).

Socio-economic disparities in the screening of the cervical cancer have been found in the lower income countries. Akinyemiju et al., (2016) have stated that non compliance with the screening protocol can be due to low financial resources among the people. Other reasons for the non compliance include the poor implementation of the cancer screening plan, poor infrastructure and lower levels of health literacy. Prior studies have indicated towards the fact that socio economic condition over the entire life course strongly influences the health outcomes (Urasa & Darj, 2011). Prior to the urban development in Bukit Panjang mainly consisted of rural settlements. Initially the land was mainly used for the agricultural purposes. Hence the socio economic status of the residents residing in the rural areas might have low socioeconomic condition to afford the costly screening and the treatment of cervical cancer.

The community nurses play a crucial role in the primary health care team and they are the qualified nurses that provide care and support to the patients outside the hospital, in home or by taking up community services. The community nurses can improve the patient health condition by proper recommendations and encouraging the clients also participative in the preventive strategies and programs. 

Whilst many people are surviving from cervical cancer there are long term consequences for many of the survivors who are dealing with several physical as well as psychological side effects (Ndikom & Ofi, 2012).

The primary health care strategies involve patient education and promotion of screening tests for cervical cancer. According to Murphy & Girot, (2013) there are certain barriers and facilitators for the screening of the cervical cancer. It has already been mentioned that cervical cancer is mainly common in the low income groups. Women might not get   to do the screening tests like Pap smear test may be due to the lack of proper economic conditions (Canadian Task Force on Preventive Health Care, 2013). Furthermore in many racial groups, there is a social stigma surrounding the cervical cancer as infection by the HPV virus is linked to multiple sexual partners (Urasa & Darj, 2011). Hence women might face the stigma while going for the screening test. It the duty of a community nurse to encourage the patients to opt for proper screening and monitoring. This can be done by proper patient education and spreading of awareness regarding the proper screening techniques like the pap smear tests. According to Ndikom & Ofi, (2012), most of the women’s reasons for not being screened were due to lack of signs and symptoms, carelessness, fear of the vaginal detection an lack of interests. 

Role of Community Health Nurses in Cervical Cancer Care

Primary health care, the Bukit Panjang polyclinic has been set up providing a larger health care facility that includes a nursing home, senior care centre and also contains facilities for cancer screening (Jin et al., 2013). It provides a suite of services including medical treatments for acute care conditions, chronic disease management and women health services. Awareness among the women about cervical cancer and promotion of the Pap smear test can be done by health awareness campaigns (Urasa & Darj, 2011). The patients should be made aware of the Pap smear screening interval and the possible symptoms for cervical cancer.

As stated by Jin et al., (2013) awareness campaigns in schools and colleges for promoting education regarding the practice of hygiene and safe sex can be effective in reducing the HPV infection in the youths.

According to Yildirim & Arabaci,  (2014), the recent introduction of the HPV vaccines have reduced the transmission of the HPV virus. Hence such a vaccine would not only lessen the morbidity and will also reduce the financial burden brought about by the screening and the medications. It is the duty of the community nurses to disseminate the information among the people regarding the importance of the vaccination.  Adherence to the medications and radiotherapy is another important aspect of treating cervical cancer.

The community nurses can also take up secondary strategies such as the awareness campaign regarding the cessation of smoking or exposure to passive smoke or other pollutants (Mossialos et al., 2015). As the tertiary prevention component the community nurses can take initiatives to provide screening and other medical care free of cost.

In conclusion it can be said that the increasing rate of cervical cancer in Singapore is quite alarming and account for an increased burden of health care costs. A multidisciplinary care approach guided by the physicians and the community nurses can improve the health condition of the Bukit Panjang.

References

Akinyemiju, T., Ogunsina, K., Sakhuja, S., Ogbhodo, V., & Braithwaite, D. (2016). Life-course socioeconomic status and breast and cervical cancer screening: analysis of the WHO’s Study on Global Ageing and Adult Health (SAGE). BMJ Open, 6(11), e012753. https://doi.org/10.1136/bmjopen-2016-012753

Canadian Task Force on Preventive Health Care. (2013). Recommendations on screening for cervical cancer. Canadian Medical Association Journal, 185(1), 35-45.

Cervical cancer epidemiology and aetiology of cervical carcinoma | Eurocytology. (2018). Eurocytology.eu. Retrieved 28 April 2018, from https://www.eurocytology.eu/en/course/953

Haverkos, H. W. (2015). Multifactorial Etiology of Cervical Cancer: A Hypothesis. Medscape General Medicine, 7(4), 57.

Human Papillomavirus and Related Diseases Report. (2018). Retrieved 28 April 2018, from https://www.hpvcentre.net/statistics/reports/SGP.pdf

Jin, A. Z., Louange, E. C., Chow, K. Y., & Fock, C. W. (2013). Evaluation of the national cervical cancer screening programme in Singapore. Singapore Med J, 54(2), 96-101.

Mossialos, E., Courtin, E., Naci, H., Benrimoj, S., Bouvy, M., Farris, K., … & Sketris, I. (2015). From “retailers” to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy, 119(5), 628-639.

Murphy, J. L., & Girot, E. A. (2013). The importance of nutrition, diet and lifestyle advice for cancer survivors–the role of nursing staff and interprofessional workers. Journal of clinical nursing, 22(11-12), 1539-1549.

Ndikom, C. M., & Ofi, B. A. (2012). Awareness, perception and factors affecting utilization of cervical cancer screening services among women in Ibadan, Nigeria: a qualitative study. Reproductive health, 9(1), 11.

Quek, S. C., Lim, B. K., Domingo, E., Soon, R., Park, J. S., Vu, T. N., … & Cao, N. T. (2013). Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical intraepithelial neoplasia across 5 countries in Asia. International Journal of Gynecological Cancer, 23(1), 148-156.

Roura, E., Castellsagué, X., Pawlita, M., Travier, N., Waterboer, T., Margall, N., … & Tjønneland, A. (2014). Smoking as a major risk factor for cervical cancer and pre?cancer: Results from the EPIC cohort. International journal of cancer, 135(2), 453-466.

Singapore Cancer Registry Annual Registry Report 2015. (2018). Retrieved 28 April 2018, from https://www.hpvcentre.net/statistics/reports/SGP.pdf

Trimble, C. L., Genkinger, J. M., Burke, A. E., Hoffman, S. C., Helzlsouer, K. J., Diener-West, M., … & Alberg, A. J. (2015). Active and passive cigarette smoking and the risk of cervical neoplasia. Obstetrics and gynecology, 105(1), 174.

Urasa, M., & Darj, E. (2011). Knowledge of cervical cancer and screening practices of nurses at a regional hospital in Tanzania. African Health Sciences, 11(1), 48–57.

Yildirim, J. G., & Arabaci, Z. (2014). Innovations in HPV vaccination and roles of nurses in cervical cancer prevention. Asian Pac J Cancer Prev, 15(23), 10053-10056.