Risk factors for cervical cancer development: what do women think?

Impact of Physical Inactivity on Risk of Developing Cancer of the Uterine Cervix: A Case-Control Study

OBJECTIVE

In this study, we investigated whether physical inactivity was associated with risk of cervical cancer in women treated at an American cancer hospital.

METHODS

This case-control study included 128 patients with cervical cancer and 512 controls matched on age. Controls were women suspected of having but not ultimately diagnosed with a neoplasm. Physical inactivity was defined in accordance with the 2008 Physical Activity Guidelines for Americans. Thus, participants reporting, on average, no moderate or vigorous recreational physical activity were classified as inactive. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Compared with noncancer controls, those with cervical cancer had significantly increased odds of reporting abstinence from recreational physical activity (OR, 2.43; 95% CI, 1.56-3.80). No association was noted between occupational-related physical inactivity and cervical cancer (OR, 0.88; 95% CI, 0.58-1.36).

CONCLUSIONS

Our findings suggest that abstinence from regular recreational physical activity is associated with increased odds of cervical cancer. To our knowledge, this is the first US-based study examining these associations. Given the 2008 Physical Activity Guidelines for Americans, this study has identified yet another potential public health benefit to regular physical activity. Further investigation is needed using a larger sample and prospectively collected data to characterize dose of activity to mitigate risk and the optimal window of susceptibility.

Assessment of knowledge about cervical cancer and its prevention among female students aged 17-26 years

OBJECTIVE

To assess knowledge about cervical cancer and its primary and secondary prevention, and identify the sources of information about the disease among female high school and university students in Krakow, Poland.

STUDY DESIGN

This study was based on a questionnaire consisting of 64 questions, divided into six parts: personal data, general knowledge about cervical cancer, estimation of risk factors, knowledge about primary prevention, knowledge about secondary prevention, and information sources. Data were collected from students aged 17-26 years over a 3-month period in 2011 and 2012.

RESULTS

Four hundred women living in Krakow or its vicinity were included in the study. Nearly all respondents (98.5%) had heard of cervical cancer, 89.4% were aware of the risk of death associated with cervical cancer, and 44.8% believed that the disease could affect them in the future. The interviewees considered genetics and family history to be the most important risk factors, followed by infection with human papillomavirus (HPV) and having multiple sex partners. Most (91.5%) respondents had not been vaccinated against HPV, 47.9% did not know where to go to get vaccinated, and 30.1% were unaware of vaccination as a prevention method. Most (91.5%) respondents were aware of cytological screening, and 86.5% thought that they should have it done in the future. Women who had not heard of cytological screening were more likely to be unaware of cervical cancer than women who had heard about cytological screening (odds ratio 0.24, 95% confidence interval 0.11-0.49, p=0.0001). The Internet, television and newspapers were reported to be the main sources of information about the disease.

CONCLUSIONS

General awareness of cervical cancer among young women in Poland is insufficient. HPV infection is not considered to be the major aetiological factor. A relatively high percentage of women in this study had never heard of the HPV vaccine as a way of preventing cervical cancer. Knowledge about cytological screening, however, appears to be much better.

Information sources for Serbian women on cervical carcinoma risk factors

BACKGROUND

The epidemiological situation regarding cervical carcinoma in Serbia is rather unfavorable and one of contributing factors is the insufficient interest of women concerning the risk factors responsible for occurrence of this disease. The aim of this study was to determine the sources of relevant information for women

METHODS

An anonymous questionnaire was used for questioning of patients, students and women undergoing systematic examinations. There were 600 women in total in 2006, 2009 and 2010, and the data were statistically processed by the χ 2 test with Yates correction and the Fisher test.

RESULTS

When observed for certain groups of tested women, and summed up for all three periods, there was a statistically significant difference for the answer "without any knowledge" (p=0.0001). When observed for certain years and summed up for all three tested groups, there was a statistically significant difference in answers regarding the source of information, the "doctor" (p=0.0011), "media" (p=0.0349) and "encyclopedia-internet" (p=0.0136).

CONCLUSION

The media are a dominant source of information for women on risk factors for cervical cancer. The significance of the Internet increased during the three observed periods, while the students considered themselves least informed of all concerning risk factors.

Attitudes and beliefs of women about the factors responsible for the development of cervical carcinoma

Background: To determine the level of knowledge among women about factors responsible for the development of cervix carcinoma and the necessity of education and health promotion. Methods: Three groups of women were interviewed according to measuring instruments by the specially created questionnaire for this research. The statistically significant difference in answers was determined by the ANOVA test. Results: In most of the investigated factors (7 of 11) statistically significant differences in answers were observed among the groups. Only six participants in all groups indicated human papillomavirus as the factor responsible for the development of cervix carcinoma. Conclusion: In all three groups of the interviewed women, bacterial and viral causes of the disease were highly ranked in comparison to other risk factors. Only a small number of participants indicated human papillomavirus as an etiological factor. There is need to improve the knowledge about risk factors through health promotion and health education in order to change the epidemiological situation concerning cervical carcinoma.

Everything you always wanted to know about HPV (but could not ask your doctor)

OBJECTIVE

To investigate specific information needs of people who search for information about the human papillomavirus (HPV) on the Internet.

METHODS

We performed a qualitative analysis of the e-mail questions asked by the visitors of a website with evidence-based information about HPV. The website, hosted by Antwerp University, provided basic information on epidemiology and natural history of HPV in women and men, diagnostic and treatment options, screening, and vaccination. If visitors did not find an answer to their questions, they could mail their question to an e-mail address associated with the website.

RESULTS

We received 713 questions posed by 527 e-mail correspondents. The following themes emerged as most important: transmission of HPV, the HPV vaccine, the natural history of the virus, the vicious circle (re-infection between partners), HPV detection in men and women, treatment of men and women, incubation time, pregnancy/fertility, genital warts (in)fidelity, and symptoms of HPV infection.

CONCLUSION

Both men and women are seeking health information on HPV on the Internet, often after being counseled by a health care provider.

PRACTICE IMPLICATIONS

Practitioners should be prepared for questions on the themes that concern people most. Practitioners may play a role in guidance towards reliable sources of information.

Awareness of human papillomavirus infection, testing and vaccination in midwives and midwifery students in Greece

Midwives play an important role in the implementation of cervical cancer screening. We assessed the knowledge of human papillomavirus (HPV) infection and of its relationship with cervical cancer in 107 midwives and 29 graduating midwifery students. The majority of midwives (78.5%) were aware that a viral infection causes cervical cancer, whereas only 48.3% of the students knew this (p = 0.003). Only one midwife (0.9%) was not aware of HPV infection compared with 10.3% of the students (p = 0.029). Midwives were also more knowledgeable of the relationship between HPV infection and cervical cancer and of the availability of a vaccine against HPV infection (p = 0.005 and p < 0.0001, respectively). In conclusion, Greek midwives have a satisfactory level of knowledge about cervical cancer and HPV infection, in contrast to midwifery students. It is important to better educate midwifery students in order to facilitate the incorporation of HPV testing and vaccination in clinical practice.

Men and women: beliefs about cancer and about screening

Background

Cancer screening programmes in England are publicly-funded. Professionals' beliefs in the public health benefits of screening can conflict with individuals' entitlements to exercise informed judgement over whether or not to participate. The recognition of the importance of individual autonomy in decision making requires greater understanding of the knowledge, attitudes and beliefs upon which people's screening choices are founded. Until recently, the technology available required that cancer screening be confined to women. This study aimed to discover whether male and female perceptions of cancer and of screening differed.

Methods

Data on the public's cancer beliefs were collected by means of a postal survey (anonymous questionnaire). Two general practices based in Nottingham and in Mansfield, in east-central England, sent questionnaires to registered patients aged 30 to 70 years. 1,808 completed questionnaires were returned for analysis, 56.5 per cent from women.

Results

Women were less likely to underestimate overall cancer incidence, although each sex was more likely to cite a sex-specific cancer as being amongst the most common cancer site. In terms of risk factors, men were most uncertain about the role of stress and sexually-transmitted diseases, whereas women were more likely to rate excessive alcohol and family history as major risk factors. The majority of respondents believed the public health care system should provide cancer screening, but significantly more women than men reported having benefiting from the nationally-provided screening services. Those who were older, in better health or had longer periods of formal education were less worried about cancer than those who had illness experiences, lower incomes, or who were smokers. Actual or potential participation in bowel screening was higher amongst those who believed bowel cancer to be common and amongst men, despite women having more substantial worries about cancer than men.

Conclusion

Our results suggest that men's and women's differential knowledge of cancer correlates with women's closer involvement with screening. Even so, men were neither less positive about screening nor less likely to express a willingness to participate in relevant screening in the future. It is important to understand gender-related differences in knowledge and perceptions of cancer, if health promotion resources are to be allocated efficiently.

Knowledge about infection with human papillomavirus: a systematic review

OBJECTIVE

Human papillomavirus (HPV) is a necessary cause of cervical cancer and genital warts. The aim of this systematic literature review was to provide an overview of knowledge about HPV infection among the public, students, patients and health professionals.

METHOD

PubMed searches were performed and the results of studies were reported by age, gender, study population, country, recruitment score and year of study conduct. The recruitment score covered the mode of recruitment, study size and response rate.

RESULTS

We included 39 studies published between 1992 and 2006 covering a total of 19,986 participants. The proportion of participants who had heard of HPV varied from 13% to 93%. Understanding that HPV is a risk factor for cervical cancer depended on whether the question was closed (8-68%) or open (0.6-11%). Between 5% and 83% knew about the association of HPV and (genital) warts. HPV was often mistaken with other sexually transmitted viruses. Health professionals and women had better knowledge about HPV than other participants.

CONCLUSION

Overall, the knowledge of the general public about HPV infection is poor. Efforts should be increased to give sufficient and unbiased information on HPV infection to the general public.

Human papillomavirus vaccine: knowledge and attitudes in two Appalachian Kentucky counties

OBJECTIVE

A vaccine against common high-risk types of human papillomavirus (HPV) associated with cervical cancer risk was recently approved. We assessed women's acceptance of HPV vaccination for themselves and for adolescent girls, in an Appalachian population with cervical cancer incidence and mortality rates among the highest in the United States.

METHODS

We conducted a population-based, random-digit telephone survey of over 600 adult women residing in two Appalachian Kentucky counties. The analysis focused on questions of HPV vaccine acceptance, and their relationship to several factors.

RESULTS

The majority of women indicated an interest in HPV vaccination for themselves (85.2%), but they were less accepting of a vaccine being administrated to girls of ages 10-15 (67.6%). Women who were younger, lower-income and smokers were more likely to support vaccination.

CONCLUSIONS

Although a relatively high percentage of women found the HPV vaccination acceptable for their own use, there was less enthusiasm for supporting vaccination to girls. This finding is of concern since the vaccine is being recommended for adolescent girls and young women, prior to sexual initiation. Educational campaigns will be needed for a successful vaccine implementation.

Why do women participate in the English cervical cancer screening programme?

The vast majority of women in England attend for cervical cancer screening. Conventional economic theorising fails to explain why and its predictions are inconsistent with the evidence. Using questionnaire data, we analyse directly motivations for screening attendance. We conclude that regular attendance at screening is driven primarily by a search for reassurance, a sense of duty and herd signalling. It is evident that recognisable sub-groups of attenders exist, in which the configurations of motivational factors differ. Being motivated to attend by physicians is less significant that is widely supposed and is more frequently associated with irregular attendance.

The male factor in cervical carcinogenesis: a questionnaire study of men's awareness in primary care

BACKGROUND

The incorporation of testing for human papillomavirus into protocols for cervical cancer screening has far-reaching consequences for counseling patients. The sexual transmission of HPV implies the recognition of sexual behavior of both men and women as a risk factor for cervical cancer. The aim of this study was to investigate which knowledge men have of the relation of HPV and cervical cancer.

METHODS

A patient questionnaire was developed in which 20 possible risk factors for cervical cancer development were suggested. In a family practice setting in Flanders, Belgium in 2004, male patients were asked to rate the importance of these factors on a five-point scale.

RESULTS

Participants (n=121) rated genetic factors highest (mean score 4.03) regardless of age or educational level. Not having cervical smears regularly (3.76), smoking (3.75) and infections were also perceived as important risk factors (3.69 for bacterial and 3.34 for viral infections). Sexual behavior of the male partner was scored much lower (2.63).

CONCLUSIONS

This study shows that awareness of HPV and its sexually transmitted nature is low among male general practice attendees. Promoting safe sex to reduce HPV transmission for primary prevention of cervical cancer should target at both male and female patients.

General practitioners' perception of risk factors for cervical cancer development: consequences for patient education

OBJECTIVE

The introduction of human papillomavirus (HPV) detection in cervical screening will make it necessary to provide appropriate information to the general public. Only 3% of Flemish women could name HPV as the viral agent involved in cervical cancer development. The aim of this study was to investigate whether general practitioners (GPs) have appropriate knowledge of the relationship between HPV and cervical cancer to be able to inform women.

METHODS

A questionnaire was developed to measure perception of 20 risk factors for cervical cancer development, on a scale of 1 (unimportant) to 5 (very important). Respondents were also asked to give an estimate of the chances of survival for women, diagnosed with cervical cancer detected by screening.

RESULTS

Sixty GPs and 28 trainees filled in the questionnaire. The five most important risk factors in the perception of the respondents were, in order of decreasing importance, viral infection, number of sex partners, sexual behaviour of the partner, unsafe sex, and early start of sexual activity. Fifty-six percent of the GPs expected the chance of survival to be between 80 and 100%, compared to only 31% of the trainees.

CONCLUSION

Most GPs are well aware of sexual habits as risk factors for cervical cancer development, including the role of HPV as the viral agent in the etiology. However, they seem to underestimate the role of smoking and are unable to identify the correct chance of survival for women in whom cervical cancer is detected within the frame of the cervical smear program.

PRACTICE IMPLICATIONS

Attention should be given to education of medical students and practitioners, in order to allow them to supply patients with sufficient background information to make an informed choice on participating in cervical cancer screening.

HPV information needs

This chapter discusses the importance of providing women with information about human papillomavirus and its role as the causative agent in the development of cervical cancer. Studies assessing current levels of knowledge among the general public are reviewed. What women need to know will be covered, followed by possible strategies for implementation. There are no randomised controlled trials to review regarding information for women about human papillomavirus but a number of well-conducted qualitative studies explore the issues that are faced both by the women undergoing cervical screening and their healthcare providers.