Adolescent: Cervical Cancer and Human Papillomavirus

The staggering rate of cervical cancer caused by the Human Papillomavirus (HPV) is chilling. Researchers are learning more about this disease and discovering successful prevention measures to fight it. Having the tools for disease prevention, health care providers are often challenged by real world obstacles. Tove Finch

Lack of public awareness regarding HPV transmission and at risk populations is limited, vaccine controversies surrounding adolescent girls becoming sexually active, and lack of routine screening increases the risk for cervical cancer each year. Targeting the at-risk population, educating HPV prevention, and advocating for cervical cancer screening are essential nursing strategies to reduce the burden of illness caused by HPV.
According to Cox and the CDC (2006), HPV is the most prevailing sexually transmitted infection responsible for cervical cancer. In the United States, 20 million people are currently infected with HPV, an additional six million people become newly diagnosed and nearly four thousand women die from cervical cancer each year (Cox, 2006). Many young women do not know that being sexually active puts them at risk for cervical cancer because HPV can develop undetected and become transmitted unknowingly (Cox, 2006). Fawcett (2007) supports this by stating, “young girls are particularly at risk because some start having sexual intercourse earlier, have higher number of partners, smoke and fail to use barrier methods of contraception” (p.2). Vaccinations to eradicate HPV are underway, but controversial issues continue over personal and religious beliefs. According to Ritchie (2006), there are varied levels of sex education because of religious and cultural beliefs. Therefore, greater preventative steps need to be taken to reduce the incidence of HPV in the younger population.
One nursing strategy on illness prevention is to target the adolescent at risk population. Providing a holistic approach to adolescent health care by including pediatric reproduction health services will benefit public health as a whole and assure access to the at risk population. Roye, Nelson, and Stanis (2003), support this by stating, “nurses should advocate for the provision of comprehensive reproduction health services in all clinical sites that provide primary care to adolescents” (p.4). This type of standardized quality health care will enable goals to eliminate health disparities among adolescents and permit early primary prevention. The national health promotion and disease prevention goals, Healthy People 2010, will also be promoted by strengthening community prevention and protecting the future health of the adolescent population from cervical cancer caused by the Human Papillomavirus, (Potter, 2005).
While targeting the adolescent at risk population, another key strategy must address educating HPV prevention and transmission. Fawcett (2007) states, “educating adolescents about protection against HPV is a vital part of adolescent health care” (p.5). Cox (2006) adds, “At present, HPV is widespread such that most sexually active individuals will be infected in their lifetime” (p.3). Society needs to change their attitude and eliminate political barriers by including an objective nursing focus on educating parents and adolescents about the prevention and transmission of HPV, thus empowering adolescents to participate in disease control. This education may include topics such as risky behaviors, the HPV vaccine, Pap screenings, condom use, and abstinence. Educating on adolescent behavior and giving informed sexual advice permits comprehensive decisions. According to Bartlett, Davis and Belyea, (2007), in any health-related interactions with an adolescent, failure to inquire about an adolescent's involvement in problem behaviors may result in lost opportunities to educate the adolescent, who may have nowhere else to gain such information. Fawcett (2007) supports this by stating, “sexual health education should be aimed at reducing the risk” (p.4). This strategy also supports Healthy People 2010 goals by promoting healthy behaviors and protecting adolescent sexual health, thereby increasing the quality and years to their life.
In addition to education and immunization, screening by Papanicolaou, (Pap) smear, is an essential strategy that contributes to early detection of cervical cancer (Fawcett, 2007). Nurses need to collect comprehensive patient history and advocate screening services in clinical sites that provide primary adolescent care. Cervical screenings have led to a notable decrease in cervical cancer deaths in the middle age population and adolescents alike (Roye, Nelson, and Stanis, 2003). If sexually active adolescents are not regularly screened for HPV they may develop cancer undetected. Fawcett supports this strategy by stating, “We believe that Pap smear screening of sexually active adolescents remains an important preventive health procedure that is clinically justifiable” (p.5).
Evidence exists showing the link between cervical cancer caused by the Human Papillomavirus and the prevalence of this disease on the adolescent population. HPV is like butter, it spreads, making HPV prevention imperative. Many parents are uncomfortable with the idea that the majority of young people are or have had sex by the time they reach early adulthood. Therefore, advocating for adolescent reproductive health services and promoting protective sexual behaviors like HPV prevention and awareness, is an essential step to lessen the burden of disease. It has only recently become a preventable infection. Every effort must be made to further eradicate cervical cancer and provide greater continuity of adolescent health care.



1. Target the At-Risk Population:
A. Failure to Address Adolescent Reproductive Health Issues:
Even though the number of sexual health clinics has increased, it remains difficult to persuade young women to use them. Many young women are sexually active, but very few visit a clinic for advice or treatment. This may be due to feelings of embarrassment or the lack of awareness of the services available. According to Fawcett, nearly half of American teenagers had engaged in sexual intercourse before graduation which suggests that many young people appear oblivious to health promotion messages (2007). Health care providers, such as pediatricians, are often uncomfortable addressing reproductive health issues with adolescent patients and many will fail to do so (Roye, Nelson, & Stanis 2003). Therefore, important adolescent reproductive health information is being overlooked and not getting through from family members or health professionals alike.

B. Lower Socioeconomic Barriers:
Cervical cancer disproportionately affects women of lower socioeconomic status, poor access to health care, and for those who are uninsured (CDC, 2006). Cultural and socioeconomic barriers to cervical cancer screenings have contributed to a distinct health disparity among African American women nation wide. African American women represent a medically underserved population, therefore more likely to be diagnosed with cancer at a later stage when the chance of survival is limited. Additionally, increased rates of cervical cancer have also been found in women in lower socioeconomic groups who may have limited access to basic health care needs. Moore and Seybold (2007) state, “The overall cervical cancer death rate among African American women is six times that among white women” (p.1). The HPV vaccine is new to the market and is not currently covered by most health care plans. While some insurance companies may cover the vaccine costs, others may not. Due to the lag-time after a vaccine is recommended and before it is covered by health plans many young females will miss the opportunity for prevention. The problem of establishing a safety net care for low-income uninsured and underinsured people is national in scope as the number of uninsured has risen past 43 million (Shapiro, Thompson, & Calhoun, 2006).

2. Educating HPV Prevention and Transmission
A. Personal and Cultural Beliefs:
As with any new immunization, controversy exists regarding the ethical use of the HPV vaccine. While it could be argued that routine vaccinations would decrease the numbers of cervical cancer deaths, many may believe that mandatory vaccine programs, currently being proposed in some states, infringe on parental rights to make wise health care decisions for their children. Additionally, some parents believe the HPV vaccine or seeking adolescent reproductive health services promotes sexual promiscuity. Parents are concerned that by consenting to the vaccine they are giving their child unspoken permission to become sexually active. Likewise, groups that promote abstinence until marriage worry that this vaccination will send a message to young women that sexual activity is safe and will undermine the abstinence message (Moore & Seybold, 2007).

B. Lack of Efficacy Data:
According to the CDC, the duration of protection from the HPV vaccine is unclear, however it is believed the vaccine is effective for at least five years (2006). Dawar, Deeks, & Dobson state that, “There are knowledge gaps, especially about the long-term efficacy, this is not unusual at the outset of any new vaccine” (p.7). In 2006 the HPV vaccine became available to the public and so far no adverse effects have been reported and a detailed post-licensure safety monitoring plan is currently in place. Nearly 100% of the study participants developed antibodies after given the HPV vaccination, but at this time there is no data available as to how long the effects of the drug will last or any long term adverse effects directly related to this drug might be.







References:

Bartlett, R., Holditch-Davis, D., & Belyea, M. (2007). Problem behaviors in adolescents. Pediatric Nursing 33(1), 13. Retrieved October 22, 2007 from Proquest database.
Cox, J. (2006). Epidemiology and natural history of HPV. Journal of Family Practice 15(11), 7. Retrieved April 14, 2007 from Expanded Academic ASAP database.
Dawar, M., Deeks, S., & Dobson, S. (2007). Human papillomavirus vaccines launch a new era in cervical cancer prevention. Canadian Medical Association Journal. 177(5), 456. Retrieved February 4, 2007 from Proquest database.
Fawcett, E. (2007). Cervical screening for under 25’s – evaluating the evidence. Journal of Community Nursing, 21(2), 4. Retrieved October 10, 2007 from Proquest database.
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Potter, P., Perry, A., (2005). Fundamentals of nursing, 6th edition. (pp.90-91). St. Louis, Missouri: Mosby.
Ritchie, G. (2006). Strategies to promote sexual health. Nursing Standard. 20(48), 35-40. Retrieved October 23, 2007 from PubMed Central database.
Roye, C., Nelson, J., & Stanis, P. (2003). Evidence of the need for cervical cancer screening in adolescents. Pediatric Nursing, 29(3), 224. Retrieved October 10, 2007 from Proquest database.
Shapiro, L., Thompson, D., & Calhoun, E., (2006). Sustaining a safety net breast and cervical cancer detection program. Journal of Health Care for the Poor and Underserved. 17(2), 20. Retrieved October 22, 2007 from Proquest database.