Preventing human papillomavirus-related cancers: we are all in this together

Outcomes of Human Papilloma Virus Vaccination in a Private Women Health Clinic in Lebanon

Objectives

The study aims to report on the feasibility and associated adverse events of HPV-Vaccination (HPVV) in a private clinic setting in Lebanon and, when available, the results of subsequent cervical cancer screening.

Methods

Opportunistic HPV vaccination is offered at the Women's Health Center of the AUBMC. We retrospectively reviewed the patients' demographic data, the incidence of adverse events, and their cytological screening.

Results

A cohort of healthy women (n = 1013) aged 26.2 years (12-54 years) were opportunistically vaccinated with one of two HPV vaccines; 845 (83.4%) received the quadrivalent vaccine (Q4V), and 151 (14.1%) received the bivalent vaccine (B2V). The majority (75.8%) received three doses while 16% received two doses. Out of these women, 26.3% (267) became sexually active postvaccination (NS2), whereas 17% (174) were sexually active prior to vaccination (SA) and the rest 57% (572) reported no sexual activity (NS1). Among the SA group, 26% (46/147) presented with abnormal cytology at time of vaccination. As for the NS2 women, 5% (14/267) had subsequently abnormal screening within 37 (12-103) months following vaccination.

Conclusions

In this observational study, we report the successful introduction of HPVV with negligible adverse events. The incidence of abnormal cervical cytology was low among our patients.

Promoting Strategies to Increase HPV Vaccination in the Pediatric Primary Care Setting

INTRODUCTION

Evaluation of a quality improvement project designed to improve HPV vaccine uptake in a pediatric primary care setting for young adolescents.

METHOD

Three strategies were implemented in one private pediatric practice to promote HPV vaccine uptake for 11- and 12-year-old adolescents. 1) a standardized vaccine policy change was made to include HPV vaccine with other adolescent vaccines, 2) a pre-visit email was sent to parents of teens to provide factual vaccine information in preparation for the visit, and 3) a provider communication initiative was implemented to ensure all providers communicated consistent messages and delivered an effective cancer prevention recommendation for HPV vaccination. A pre/post design was used to compare vaccine rates. Data was obtained via the electronic health records.

RESULTS

The post-intervention group demonstrated HPV vaccine rates increased substantially from 17.8% to 63.6%.

DISCUSSION

Strategically implementing standardized clinical vaccine policies and presumprive provider communication practices has implications for significantly increasing HPV vaccine uptake among teens and may be key to preventing cancer among future generations.

Prevention of gynecological cancers: the affecting factors and knowledge levels of Turkish women

Purpose

Gynecological cancers are preventable and treatable diseases in case of early diagnosis. However, lack of knowledge is one of the factors preventing women from benefiting from early diagnosis. Increasing women's knowledge of gynecological cancers contributes to improving the health of both women and the community. The purpose of this research study was to determine the affecting factors and knowledge level of Turkish women-related gynecological cancer prevention.

Design/methodology/approach

This was a cross-sectional descriptive study and was carried out at a state hospital's outpatient clinic between May and June 2019. The sampling included 496 women who are not diagnosed with gynecological cancer in the individual or in the family. Data were collected using the personal information form and Gynecological Cancer Prevention Information Scale (GCPIS). Data were evaluated using the SPSS 22.0 software program. Frequencies, mean and standard deviation were used for the descriptive variables. For the data that met the parametric conditions, those with two groups were analyzed using independent samplest-tests and those with more than two groups were analyzed usingF-test.

Findings

In this study, the GCPIS total mean score of women was found 16.22 ± 8.21 (min: 0, max: 35). A statistically significant difference was found between the women's level of knowledge according to the age group of the participants, education level, economic status perception, regular pap-smear test, regular vulva examination and getting information about prevention from gynecologic cancers (p < 0.05).

Research limitations/implications

This study was conducted on a group of Turkish women and cannot be generalized to other cultures.

Practical implications

This study can be beneficial for determining the Turkish women's knowledge levels about gynecological cancers of women and for providing data for health education programs planning to be created.

Social implications

The data of this study can be used to improve women's knowledge and examination skills of gynecological cancers. Thus, the quality of life of women can be improved.

Originality/value

Healthcare professionals can play vital roles in presenting needed knowledge about gynecological cancers and raising awareness in women. It is extremely important for women to be informed about gynecological cancers for prevention of gynecological cancers and health improvement.

Pharmacotherapy of Anal Cancer

Anal squamous cell carcinoma (SCCA), among other malignancies, is associated with the human papillomavirus (HPV) and its incidence continues to rise. Anal SCCA will likely remain an existing healthcare concern given compliance issues with the HPV vaccination seen in the US. Localized disease is predominantly treated with standard of care (SOC) definitive chemoradiation that has remained unchanged for decades. Clinical and molecular prognostic factors have emerged to characterize patients unresponsive to SOC, revealing the need for an alternate approach. Metastatic disease is an extremely small subset and understudied population due to its rarity. Recent prospective trials and mutational analysis have opened treatment options for this subset in need. Our review details the pharmacotherapeutic treatment in localized and metastatic anal SCCA chronologically, while also describing future outlooks.

Survey of cervical cancer and precancerous lesion prevention knowledge within community health service centers in Shanghai, China

To study deficiencies in knowledge of the general public health-care professionals in community health service centers regarding the prevention of cervical intraepithelial neoplasia and cervical cancer. In addition, this study examined the key content of training required for primary health-care personnel to prevent cervical precancerous lesion and cervical cancer.A questionnaire was distributed among 172 medical staff personnel (the ratio of general practitioners and nurses was 1:1 in five community health service centers in Shanghai, China. This questionnaire assessed four knowledge areas of cervical cancer prevention using 10 single-choice questions.Out the 172 questionnaires distributed, 105 (61.05%) were completed correctly. No statistically significant difference in the percentage of complete correct answers among the five community health service centers was seen (P = .06). Additionally, there was no significant difference in the percentage of correct answers among the three age groups surveyed: age ≤35 years, 36-45 years, and ≥46 years (P = .12). We did find a statistically significant difference in the percentage of correct answers between general practitioners and nurses (P = .01) and between staff with master's degrees, bachelor's degrees, and associate's degrees (P = .03).General practitioners and nurses in community health service centers in Shanghai require additional education on the secondary prevention of cervical intraepithelial neoplasia and cervical cancer. The health knowledge related to human papillomavirus also needs to improve. Nurses and medical staff with lower degrees have insufficient awareness of the prevention of precancerous lesions of the cervix and cervical cancer; these two groups should be prioritized for additional training.

Missed opportunities for HPV immunization among young adult women

BACKGROUND

Despite the availability of a safe and efficacious vaccine against human papillomavirus, uptake of the vaccine in the United States is low. Missed clinical opportunities to recommend and to administer human papillomavirus vaccine are considered one of the most important reasons for its low uptake in adolescents; however, little is known about the frequency or characteristics of missed opportunities in the young adult (18-26 years of age) population.

OBJECTIVE

The objective of the study was to assess both the rates of and the factors associated with missed opportunities for human papillomavirus immunization among young adult women who attended an urban obstetrics and gynecology clinic.

STUDY DESIGN

In this cross-sectional study, medical records were reviewed for all women 18-26 years of age who were underimmunized (<3 doses) and who sought care from Feb. 1, 2013, to January 31, 2014, at an urban, hospital-based obstetrics and gynecology clinic. A missed opportunity for human papillomavirus immunization was defined as a clinic visit at which the patient was eligible to receive the vaccine and a dose was due but not administered. Multivariable logistic regression was used to test associations between sociodemographic variables and missed opportunities.

RESULTS

There were 1670 vaccine-eligible visits by 1241 underimmunized women, with a mean of 1.3 missed opportunities/person. During the study period, 833 of the vaccine eligible women (67.1%) had at least 1 missed opportunity. Overall, the most common types of visits during which a missed opportunity occurred were postpartum visits (17%) or visits for either sexually transmitted disease screening (21%) or contraception (33%). Of the patients with a missed opportunity, 26.5% had a visit at which an injectable medication or a different vaccine was administered. Women who identified their race as black had higher adjusted odds of having a missed opportunity compared with white women (adjusted odds ratio, 1.61 [95% confidence interval, 1.08-2.41], P < .02). Women who reported a non-English- or non-Spanish-preferred language had lower adjusted odds of having a missed opportunity (adjusted odds ratio, 0.25 [95% confidence interval, 0.07-0.87], P = .03). No other patient characteristics assessed in this study were significantly associated with having a missed opportunity.

CONCLUSION

A majority of young-adult women in this study had missed opportunities for human papillomavirus immunization, and significant racial disparity was observed. The greatest frequency of missed opportunities occurred with visits for either contraception or for sexually transmitted disease screening.