PUBLIC HEALTH ADMINSITRATION ISSUE.

CERVICAL CANCER

Cervical Cancer

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER Cervical cancer

Cervix is the lower part of the uterus. In the upper part of the uterus (the body) fetus is created and the developed. The cervix connects the uterus and vagina (birth canal). Cervical cancer develops from the epithelium that lines the cervix. Normal cervical cells are subjected to change and become precancerous, and then turn into cancer. There are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Diagnosis of cervical cancer and precancerous states is determined by microscopic examination. 80-90% of cases of cervical cancer are the cases of squamous cell carcinoma. The remaining 10-20% are adenocarcinomas. Adenocarcinoma is more common in women who were born in the last 20-30 years. Sometimes cervical cancer has features of both squamous cell carcinoma and adenocarcinoma (mixed carcinoma). Some women who have precancerous changes tend to develop cancer. The process of its development usually takes several years, but sometimes a single year is enough. In most women, precancerous cells disappear without any treatment. However, if these precancerous states are treated, almost all the other forms of cervical cancer can be prevented (What is Cervical Cancer?). Causes of cervical cancer In recent years researchers identified some factors that increase the risk of cervical cancer. Human papilloma virus is among them. Human papilloma virus is an infection caused by the human papilloma virus which is transmitted from person to person through sexual contact. It represents the greatest risk factor which promotes development of cervical cancer. Normal cells produce substances (gene substances that inhibit the growth of tumors), which prevent very rapid growth of cells and turn them into the tumor. Two proteins (E6 and E7), which are produced by some types of Human papilloma virus can change the function of

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER

the gene substances which inhibit the growth of tumors. However, Human papilloma virus infection does not fully explain the cause of cervical cancer, because not all women with this infection develop the cancer. Currently there is no way to treat an infection caused by Human papilloma virus, but it is treated with outcomes that prevent development of cancers. In most women the infection disappears without any treatment due to their immune mechanisms. The following cases increase possibility of development of Human papilloma virus: - Starting having sex at a young age - Having many sexual partners - Sex with men who were not exposed circumcision surgery - Smoking, since it develops carcinogens that damage the DNA of cells of the cervix, which may contribute to cancer development? - Deficiency of the immune system. The immune system protects people from cancer. The AIDS virus makes the immune system of women is less able to resist the human papilloma virus and cervical cancer early. - A poor diet with low fruit and vegetable consumption also increases the risk of developing cervical poppies (HPV/Genital Warts Health Center). Treatment of cervical cancer The stage (prevalence) of the process is the most important issue when it comes to choosing the method of treatment of cancer of the cervix. However, when choosing a method of therapy it is also necessary to consider location of the tumor on the cervix, the type of tumor (squamous cell carcinoma or adenocarcinoma), age, condition and the desire to have children. At the earliest stage cervical cancer is treated by cryosurgery, laser surgery, excision of electric loop and cone biopsy (removal of a wedge-shaped portion of the cervix). In case of

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER

recurrence (return) of the tumor or unwillingness to have children in the future a simple hysterectomy (removal of the uterus) can be applied. The patients who have more developed stages of cervical cancer are usually treated by extensive hysterectomy (removal of the uterus along with the lymph nodes) in combination with a type of radiation therapy and sometimes chemotherapy. Survival of patients with 0, I and II stages of the disease ranges from 65 to 95%, and the lower the stage of the cancer is, the more chances to survive are possessed by the patients. Women with III-IV stages of cervical cancer use internal and external irradiation and chemotherapy. In this case, survival of the patients ranges from 20 to 50%. In case of recurrence of cervical cancer, its treatment depends on the type of recurrence. Local recurrence advanced operations can be effective in 40-50% of women. As for women who have distant metastases (liver or bone), chemotherapy may lead to a temporary improvement in 15-25% of cases.

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER The problem

Despite the fact that modern science has great achievements, cervical cancer remains the most pressing problem in gynecology. Every day dozens of women de because of the disease. European Association for genital infections and neoplasia stated that more than 99% of cervical cancer was caused by human papilloma virus. Now, according to data of different researchers, the prevalence of HPV infection is 5 to 20 percent among the population aged 15-49 years, while the figure is 10 to 40 percent among sexually active women between 16 and 25 years. Along with this tendency the researchers marked increase in the development of cervical cancer. During intercourse probability of human papilloma virus infection reaches 60-67 percent (Cervical cancer). Young women are in higher risk to have the infection, and this risk is especially high among teenagers, because at this age the epithelium of the cervix is more susceptible to the action of the transforming infection due to its immaturity, and, according to some researchers, absence of specific immunity. Introduction of viruses promotes development of micro damages. Therefore, the most vulnerable the erosion (ectopy) of the cervix becomes very vulnerable to human papilloma virus. To reduce the incidence of cancer or precancerous lesions of the cervix, there are a number of preventive measures to be taken, including screening methods research. First of all, cytology should be conducted. It is also obligatory to identify all opportunistic infections, and sexually transmitted diseases present (herpes simplex virus, mycoplasma, ureaplasma, chlamydia, etc.). Women should have direct microscopic study of the discharge of the cervical canal, urethra, vagina (smear on the degree of purity). After careful examination of women, it is

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER

necessary to decide on further treatment that is required if the destructive methods of treatment of the cervix (radio wave surgery, cryosurgery, etc.). It is also possible to use conservative, that is, observation tactic because now cervical ectopy is expelled from the International Classification of Diseases, so surgical treatments are not always appropriate. Unfortunately, in our time, many gynecologists tend to apply aggressive methods of treatment, which in the future can lead to complications (Cervical Cancer Health Center). Thus, approaches to the treatment of any woman who is infected with the human papilloma virus, must be developed individually. Although the infection is difficult to be eliminated, only a complete and detailed examination and correct observation, close contact of the patient and doctor will bring results and reduce the risk of cancer and precancerous processes. It is necessary to mention that the human papilloma virus is a serious and "complex" infection, but if health care staff has modern approaches of diagnosis and treatment, the virus will be treated without any complications. Introduction of new vaccines against human papilloma virus, which causes cervical cancer, may have a significant impact on health of women in developing countries. In 2005, cervical cancer killed more than 250,000 women, most of whom lived in the countries of the third world. Cervical cancer is the second most common type of cancer among women, whose deaths over the next 10 years, according to the World Health Organization (WHO) are going to rise by almost 25%. In 2005 there were more than 500,000 new cases of cervical cancer, 90% of which were in developing countries. Left untreated, invasive cervical cancer is almost always fatal.

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER

Programs of proper screening and treatment of the disease at an early stage are very effective in terms of prevention of the most common type of cervical cancer, but they are costly and difficult to implement in resource-poor countries. In 2006, a vaccine that protected against infection and disease associated with human papilloma virus was licensed. The recently licensed vaccine is effective in preventing infection with the human papilloma virus types (16 and 18) that cause approximately 70% of all cases of cervical cancer, as well as in terms of prevention of infections with those types (6 and 11) that cause approximately 90% of genital warts. This and another human papilloma virus vaccine are under regulatory review in many countries around the world and they can provide a new opportunity to eliminate cervical cancer - cancer in women, which is the second leading cause of death. "New vaccines against human papilloma virus, if delivered effectively, can save hundreds of thousands of lives in the developing world - said Dr Howard Zucker, Assistant Director-General for Health Technology and Pharmaceuticals. - The introduction of effective vaccines is important for several reasons: they help fight a deadly cancer and are a potent technology to add to existing cancer control programs based on prevention, screening and treatment. " Vaccines are initially targeted at girls, but in the future they may be used for boys before they become sexually active, or about that time. The unique opportunity allows addressing the segment of the population that is traditionally difficult to reach: young adolescents. Thus, a multifaceted strategy should use the opportunity to promote sexual and reproductive health by strengthening health programs among teenagers. "We do not know the final cost of the vaccine in developing countries - said Arletty Pinel, Chief, and Branch of UNFPA reproductive health. - But we can be sure that the main challenge is to introduce quickly them where they are needed most - in the poorest countries.

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER

80% of women who die from cervical cancer are generally poor and live in areas with inadequate medical services. They can benefit most from affordable prices and access to this vaccine. " Mobilization of resources for strengthening health systems and purchasing human papilloma virus vaccines, both at the national and international levels, should become a priority. \ Introduction of human papilloma virus vaccines should be performed at an international level. It is also necessary to develop various partnerships to reduce the time lag between formal registration and availability in developed countries, and establishment of a negotiated price and adequate production capacity to supply to developing countries. Along with the fact that human papilloma virus vaccines are a new tool for the prevention of the most common forms of cancer, the introduction has other potential benefits for health systems in general. The introduction of such vaccines could help build synergies among immunization, cancer control and sexual and reproductive health. Furthermore, this experience can be potentially valuable for future introduction of a vaccine against HIV. Vaccination against HPV. Experience and results of the supporters of this type of prevention. There are several medications which are used to vaccinate against human papilloma virus and two of them, the most popular ones, are described below. Creators of the vaccine "Cervarix" (pharmaceutical company GlaxoSmithKline) state that the usage of this drug immediately creates a high level of antibodies to oncogenic human papilloma virus types 16 and 18, which becomes higher later. Clinical studies suggest that more than 98% of women vaccinated "Cervarix" develop antibodies which protect them for more than seven years. Also, this drug provides a so-called

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER

cross-protection - from HPV types 31 and 45 for five and a half years. Nowadays, according to GlaxoSmithKline, the vaccine was taken by more than 1.4 million women. The second vaccine is called "Gardasil". It works against virus 6, 11, 16 and 18. Company Merck Sharp & Dohme are the manufacturers of the drug. The company conducted a study involving 24 thousand women. None of them was detected after vaccination to have HPV infection. About one million women received the vaccine to promote their immunity (Pros and Cons to getting the HPV (Human Papilloma virus) vaccine). Thus, these vaccines are effective only when it comes to four types of viruses. However, the views of experts on the subject differ. And there is a strong opposition which has solid arguments to deny the fact that vaccination might bring any benefits in terms of health. The opponents of vaccination use the following evidence to prevent people from being vaccinated: 1. Human papilloma virus infected many people. A person can be a carrier of HPV, but it is difficult to diagnose the situation, the virus might not cause any symptoms and it might be even not identified by the tests. 2. Ways of transmission of HPV are numerous, and sexual contact is one of them. Therefore, any woman (girl), who had at least one sexual contact, could be infected. In addition, as it has been already noted above, the virus cannot demonstrate itself in any way and as a consequence, not become diagnosed. Vaccination, according to some doctors, does not only has no desired result, and might even have the opposite result, that is increase the risk of cancer of the cervix. 3. There different types of HPV, but the vaccination works only against some of them. 4. as it has been already mentioned above, presence of HPV in the body does not mean that it is going to result into cervical cancer and any vaccination is stress for the body, which might have negative health-related consequences (HPV Vaccine: Pros and Cons).

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER

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Despite these negative arguments, it is important to notice that the cost of vaccination is covered by most health insurance plans. In the case of a person does not have any insurance, they might use special programs which might help and pay for the vaccination (Sexually Transmitted Diseases (STDs)). Conclusion Thus, taking into account all the information mentioned above, it is possible to conclude that cervical cancer is one of the most urgent problems to be addressed when it comes to gynecology. It should be taken care about beforehand and there are various ways to prevent it. Vaccination is believed among the most effective measures to take. However, some researchers oppose this point of view and they have some argumentations to support their point of view. Regardless of the opposition vaccination remains the main method to prevent cervical cancer and promote well being of women, especially of those who come from poor countries. The reason is that these are supposed to be among the first ones to be provided with free vaccination since few citizens can afford it.

PUBLIC HEALTH ADMINSITRATION ISSUE. CERVICAL CANCER References Cervical Cancer Health Center. Retrieved from http://www.webmd.com/cancer/cervicalcancer/default.htm Cervical cancer. Retrieved from http://www.cancervic.org.au/aboutcancer/cancer_types/cervical_cancer HPV Vaccine: Pros and Cons. Retrieved from http://ohioline.osu.edu/hygfact/5000/pdf/5239.pdf HPV/Genital Warts Health Center. Retrieved from http://www.webmd.com/sexualconditions/hpv-genital-warts/cervical-cancer-hpv-what-women-girls-should-know Pros and Cons to getting the HPV (Human Papilloma virus) vaccine. Retrieved from

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http://youthservicesslc.wordpress.com/2011/02/11/pros-and-cons-to-getting-the-hpvhuman-papillomavirus-vaccine/ Sexually Transmitted Diseases (STDs). Retrieved from http://www.cdc.gov/std/hpv/stdfacthpv-vaccine-young-women.htm What is Cervical Cancer? Retrieved from http://www.news-medical.net/health/What-isCervical-Cancer.aspx