The etiology of cervical cancer: Do you really know the ways it develops? Jill Cufley, R. N. California State University, San Marcos NURS 316
Objectives • To answer the question; what is the epidemiology of cervical cancer in relation to the human papilloma virus (HPV)? • To answer the question; which populations are more likely to be diagnosed with cervical cancer? • To answer the question; what can be done to decrease the incidence of HPVrelated cervical cancer cases?
Introduction & Background • Cervical cancer is one of the top three cancers affecting women worldwide (Centers for Disease Control, 2014). • Infection due to the Human Papilloma Virus (HPV) is the main contributor to the changes in the cervix leading to malignancy (Centers for Disease Control, 2014). • Because of mass screenings of women during routine pelvic exams and the Pap Smear, the number of new cases of cervical cancer in the United States has been greatly reduced (Centers for Disease Control, 2014).
Introduction & Background (cont.) • The American Cancer Society (ACS) estimated that in the United States, 12,170 new cases of cervical cancer would be diagnosed in 2012.
Pathophysiology of cervical cancer • The cervix is the lower portion of the uterus located at the posterior portion of the vagina. It consists of two types of cells in two different locations: • The endocervix (glandular cells) • The exocervix (squamous cells) • The location where the cells come together is called the “transformation zone”
• Source and diagram: American Cancer Society, 2014.
Pathophysiology of cervical cancer (cont.) • Most cervical cancers begin developing in the transformation zone. • Cellular changes in the cervix occur over time and go from pre-cancerous cells to malignant cells. Sometimes these changes take place over the course of a year or less and other times it can take many years to develop (American Cancer Society, 2014).
The role of the Human Papilloma Virus (HPV) in the development of cervical cancer • According to the Centers for Disease Control (CDC), HPV is the most common sexually transmitted infection (STI) (2015). • HPV is spread through direct skin-to-skin contact via vaginal, anal, or oral sex • Currently about 79 million people in the United States are infected with HPV and most do not know they are infected. Routine pelvic exams for women 30 and older may find HPV but often times it is not detected until malignancies are diagnosed (CDC, 2015).
The role of the Human Papilloma Virus in the development of cervical cancer (cont.) • Although 79 million people have the HPV infection, only about 11, 000 women will have HPV turn into cervical cancer this year (CDC, 2015). • There are over 200 different types of HPV strains. Two strains (16 & 18) are responsible for most cancers (American Cancer Society, 2015). • The cervix is made up of layers of epithelial cells, HPV infections invade the epithelium where proteins (called E6 & E7) invade the nucleus. It is here that the changes in cell communication occur. As we know, cells send the message to stop growing when they reach their predesignated size. The HPV infection interferes with the communication allowing malignancies to advance (CDC, 2015). See next slide for diagram.
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Source: http://www.nature.com/nrc/journal/v12/n12/images/nrc3400-f2.jpg
Cervical cancer by ethnicity and race This is a chart from the CDC for the years 2004-2008 showing the incidence of cervical cancer broken down by race and ethnicity. Source: http://www.cdc.gov/cancer/hpv/statistics/ cervical.htm
Cervical cancer: race and ethnicity • After examining multiple journals, articles, and books regarding why black and Hispanic women are more likely than their white, Asian, or pacific islander counterparts there was no clear-cut answer. The biggest theory is that black and Hispanic women did not have the means to be able to get an early diagnosis, maintain the treatment regimen, and/or have the necessary community resources to get information (American Cancer Society, 2014).
What can be done? Education! •
In doing research for this project I felt that education was a large piece that was missing for communities. Providing necessary education plus backup resources for young people would be a step in the right direction.
What’s next? (cont.) • In targeting the young, teenage population, we would be able to better educate them on the risks of unprotected sex and the risks associated with this risky behavior.
What can be done? (cont.)
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The vaccine, Gardasil, was introduced as a routine vaccine for children ages 11-12 several years ago. It was first marketed to young girls but then the guidelines were changed to include boys and girls.
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Gardasil protects against strains 6, 11, 16, & 18.
Image source: National Vaccine Information Center, nd).
What can be done? (cont.) • Gardasil is recommended by the American Cancer Society, the American College of Obstetricians and Gynecologists, the Centers for Disease Control, and other national organizations (Merck, 2014). • This vaccine is a recommendation and is not mandatory like some other childhood vaccines. This vaccine is given to young children hopefully before they have had sexual encounters that would expose them to HPV.
References Cervical cancer. (2014). American Cancer Society. Retrieved from http://www.cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection /cervical-cancer-prevention-and-early-detection-what-is-cervical-cancer Cervical cancer. (2014). Centers for Disease Control. Retrieved from http://www.cdc.gov/cancer/cervical/index.htm Cervical cancer statistics. (2012). Centers for Disease Control. Retrieved from http://www.cdc.gov/cancer/hpv/statistics/cervical.htm Gardasil. (2014). Merck. Retrieved from https://www.merckvaccines.com/Products/Gardasil/Pages/home
References (cont.) Gardasil image. (nd.). National Vaccine Information Center. Retrieved from http://www.nvic.org/Vaccines-and-Diseases/HPV.aspx HPV cells. (nd.). International Weekly Journal of Science. 12 (12). Retrieved from http://www.nature.com/nrc/journal/v12/n12/images/nrc3400-f2.jpg