Girls’ and Parents’ Decision-Making About HPV Vaccination Uptake

__Abstract__ In Europe 60,000 women are diagnosed with cervical cancer every year. In the Netherlands, about 700 women are diagnosed with cervical cancer annually and about 200 to 250 women die from the disease [www.rivm.nl]. Cervical cancer can only develop in the presence of infection with a high-risk type of human papillomavirus (HPV). There are two types of HPVs: high-risk (oncogenic) and low-risk. HPV 16 and 18, both high-risk strains, cause approximately 70% of cervical cancers. HPV 16 and 18 can also cause cancer of the vulva, vagina, penis, or anus; and oropharyngeal cancer (cancer in the back of throat). The low-risk strains HPV 6 and 11 cause approximately 90% of genital warts. HPV infections are sexually transmitted, most often during vaginal or anal sex. Condoms may lower the risk of HPV infection, but do not provide complete protection. The estimated lifetime risk of HPV infection is 75% to 80% in Europe and in the US, so it is very common. Most HPV infections are cleared rapidly by the immune system and do not progress into cervical cancer. When the infection persists there is a risk of developing precancerous lesions of the cervix. The precancerous lesions are called cervical intraepithelial neoplasia (CIN) and are graded into three categories: mild (CIN1), moderate (CIN2), and severe dysplasia (CIN3. Precancerous lesions can progress to invasive cervical cancer. One percent of CIN1 cases, 5% of CIN2 cases and 12% of CIN3 cases will progress to invasive cervical cancer. Progression to cervical cancer typically takes about 12-15 years. Routine screenings to detect precancerous tissue changes in the cervix help lower the risk of cervical cancer. In the Netherlands, such screenings are available to women aged 30-60 years (once every 5 years). Diagnosing and treating precancerous conditions often makes it possible to prevent cervical cancer. In 2016 the screening program will be changed. Instead of cytological screening to look for neoplastic abnormalities, screening for the presence of high-risk HPV will take place first. If high-risk HPV is detected, the smear will also be screened for cytological abnormalities. If both high-risk HPV and cytological abnormalities are present, a woman will be referred to a gynecologist for follow-up examination. If no cytological abnormalities are found, a cytological follow-up test will be performed six months later. The advantage of screening for high-risk HPV is that cervical cancer can be prevented in an earlier stage. Such screening would prevent 75 extra cases of cervical cancer and 18 deaths each year.

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