Correctedcopyvandawalkerhuman Papillomavirus 2

Human Papillomavirus 1 RUNNING HEAD: HUMAN PAPILLOMAVIRUS AND CERVICAL CANCER Running head:

Health Promotion and Disease Prevention as it relates to the Human Papillomavirus Patricia Vandawalker State University of New York at Morrisville Division of Nursing

Abstract

Human Papillomavirus 2 The human papillomavirus is a sexually transmitted disease affecting the majority of the population. There is the potential for cervical cancer when inflicted with this virus. Through education, behavioral change, and preventive measures we can turn a potentially fatal situation into a healthful one. This research document examines: Health promotion and disease prevention as it relates to the human papillomavirus and cervical cancer, reporting and comparing statistics for cervical cancer at the local, state, and national level, etiology, prevention and health promotion, and health promotion/disease prevention initiatives at the local, state, and national levels, as well as health promotion strategies for teaching purposes. With the documented statistics regarding this topic – education is very important. Through education – individuals can make a more informed decision regarding their health. We can also educate others, and offer informative references for individual research of related topics. An abstract is limited to 120 words.

Health promotion and Disease Prevention as it relates to the Human Papillomavirus

Human Papillomavirus 2 When individuals take risks involving their health, do they always truly understand the implications of their actions? Unfortunately, when we engage in unprotected sexual activity there are potential hazards that sometimes are not known until many years later - as we have seen with other sexually transmitted diseases, and human immunodeficiency virus infections. This paper examines the significance of education as it relates to the human papillomavirus (HPV). With improved understanding regarding this virus, and the vaccine currently being offered for protection against the virus, individuals can make an improved educated decision regarding their actions and their health. Why is education on this topic so important? “Research has shown that 99.7% of cervical cancers are caused by HPV infection” (NYSDOH #1, 2006). Also according to the centers for disease control and prevention “by age 50, at least 4 out of 5 women will have been infected with HPV at one point in their lives” (CDC #1, 2009). This virus is more prevalent than I realized. Reporting and comparing: For reporting and comparing purposes I will be focusing on cervical cancer rates due to the fact that I was not able to obtain information relating to incidence and prevalence of HPV. Locally in Oneida county in 2006 according to the cancer registry data- There were “9 cases of uterine cervical cancer per 100,000 female residents…rates are age adjusted to the 2000 United States population” (NYSDOH #2, 2009). In that same year the “morbidity rate of uterine cervical cancer deaths revealed 7 per 100,000 female residents… rates are adjusted to the 2000 united states population”( NYSDOH #3, 2007). At the state level in 2006 there were “897 cases of uterine cervical cancer per 100,000 Females… rates are age adjusted according to the 2000 United States population” (NYS DOH #2, 2009), and “275 deaths per 100,000 female residents… rates are adjusted to the 2000 United States population” (NYS DOH #3, 2007).

Human Papillomavirus 2 At the national level the centers for disease control and prevention notes that “in 2005, 11,999 Women in the United States were told they had cervical cancer, and 3,924 died from the disease” (CDC #2, 2009). The healthy people 2010 database had information regarding incidence of cervical cancer rates broken down by race: In 2006 there were 1.9 American Indian or Alaskan native, 2.2 asian or pacific islander, 4.3 black or African American, 2.2 white or caucasian, and 3.1 hispanic or latino cervical deaths per 100,000 standard population… any display age-adjusted data are adjusted to the 2000 standard population (CDC #3, 2009). Etiology: The Department of Obstetrics and Gynecology revealed that “the first genital HPV types were identified in 1978” (Motoyama, Ladines-Llave, Villanueva, and Takeshi, 2004). Within the article there is evidence that supports the relatedness between the HPV and cervical cancer. In November 1991, a workshop convened by the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) officially concluded that, based on epidemiological and laboratory data, the association between human papillomavirus infection and cervical cancer is beyond reasonable doubt, and infection with human papilloma virus should be considered as cause to the development of cervical cancer (Motoyama et al., 2004). Why do some women develop cervical cancer from the human papillomavirus while others do not? According to an Indian Journal of Dermatology report “The oncogenes E6 and E7 are responsible for malignant transformation of infected cells…these two genes cause inactivation of two important tumor suppressor proteins” (Rapose, 2008). It is important to understand that “HPV cannot be cured…and previous infection with warts does not make a person immune from repeat infection” (NYSDOH #4, 2004). The warts if

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present can be removed. Methods commonly used to treat lesions include cryosurgery (freezing that destroys tissue). LEEP (loop electro-surgical excision procedure – the removal of tissue using a hot wire loop), and conventional surgery. In addition, some drugs may be used to treat external genital warts (NCI, 2008). Prevention and health promotion: When discussing prevention – we need to examine the risk factors involved with acquiring a HPV infection. The article “Role of Human Papilloma Virus Testing in Cervical Cancer Prevention” (M. Fey, M. Beal, 2004) explains the following risk factors: The most significant risk factor for infection with HPV is the number of lifetime sexual partners. Adolescent sexual activity has also proved to be associated with increased risk of HPV infection, yet other factors also influence this risk. The correlation between younger age of first intercourse and subsequent HPV infection is mediated by the number of sexual partners in the last 6 months, a history of sexually transmitted infections, alcohol and drug use related to sexual behaviors, and partner’s number of sexual partners (M. Fey, M. Beal, 2004). The article previously stated also identified certain “cofactors for the development of cervical cancer” (M. Fey, M. Beal, 2004) the cofactors listed are “cigarette smoking, Oral contraception use, Parity, and Immune status” (M. Fey, M. Beal, 2004). Parity is explained in that “A direct association exists between a higher number of full-term pregnancies and the increased risk of squamous cell malignancy” (M. Fey, M. Beal, 2004). The above risk factors can begin to assist us on how to prevent a HPV infection, hence limiting our chances of developing cervical cancer. What else can we do to prevent cervical cancer? “Pelvic exams may help find other types of cancers and reproductive problems, but only

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pap tests will provide information on early cervical cancer or pre-cancers” (American Cancer Society, 2005). How often should a woman have a pap test performed? “Cervical screening should be done every year with regular pap tests…at or after age 30, women who have had three normal test results in a row may get screened every two to three years” (American Cancer Society, 2005). An important point to make regarding cervical cancer is that “Cervical cancer is very curable if found early”(American Cancer Society, 2005), which explains the importance of obtaining routine pap tests. In 2006, the U.S. Food and Drug administration (FDA) approved Gardisil, a vaccine that is highly effective in preventing infection with types 16, and 18, two high risk HPV’s that cause most (70 percent) of cervical cancers, and types 6 and 11, which cause most (90 percent) of genital warts (NCI, 2009). According to a journal of family practice article “most sexually active adolescents and women become infected with HPV within several years of initiating sexual activity” (Wright, T.C. Jr., 2009). It is difficult to consider a vaccine to protect your child against a sexually transmitted disease when they are as young as 11 years of age, however according to an article by the national institute of health “HPV vaccine is routinely recommended for girls 11 – 12 years of age…if a girl is already infected with a type of HPV, the vaccine will not prevent disease from that type” (NIH, 2009). This explains the young age for the vaccine administration. The article went on to say “the vaccine is also recommended for girls and women 13-26 years of age who did not receive it when they were younger” (NIH, 2009). As with any vaccine there are risks involved. Certain people should not get this vaccine “anyone who has ever had a life-threatening allergic reaction to yeast, to any other component of HPV vaccine, or to a previous dose of HPV vaccine… pregnant women,… and anyone who is moderately or severely ill” (NIH, 2009). The centers for disease control and prevention reports:

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39 U.S. deaths have been reported to VAERS (Vaccine Adverse Events Reporting System) as of May 1, 2009. Each of these deaths has been reviewed and there was not a common pattern to the deaths that would suggest they were caused by the vaccine. In cases where there was an autopsy, death certificate, or medical records, the cause of death was explained by factors other than the vaccine. Some reported causes of death received to date include illicit drug use, diabetes, viral illness, and heart failure (CDC #4, 2009). “When HPV is transmitted from one person to another, the virus infects the top layers of the skin and can remain inactive or latent for months or possibly years before warts or other signs of HPV infection appear” (NYSDOH #4, 2004). Dr. S. Krishnan M.D. explains in her book – The HPV controversy “warts can resolve spontaneously, recur, or be resistant to treatment…some specialists believe that removal of warts will nevertheless reduce the viral load at the site” (Krishnan, 2008 p. 52). Health promotion/disease prevention initiatives: Local: “The Oneida County Health department’s diagnostic and treatment center provides health education and preventive services. The services provided include: Immunizations, and Sexually transmitted disease clinics” (Health clinic programs/Oneida County, 2009). The immunization clinics: provide education and information to parents concerning their children’s immunization needs…administer vaccine according to New York State Department of Health guidelines to individuals of all ages for protection against vaccine preventable diseases…and offer walk in clinics in Utica and Rome (Health clinic programs/Oneida County, 2009). Currently the STD clinics “provide screening and treatment for gonorrhea, chlamydia, and

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Syphilis”, but not HPV (Health clinic program/Oneida County, 2009). State: At the state level in regards to sexually transmitted disease “you can call the national STD hotline (1-800-232-4636) to find a clinic near you. Some clinics are free, at others, you may have to pay to get STD testing and treatment” (NYSDOH #5, 2009). The “New York State recommended childhood and adolescent immunization schedule lists Human Papillomavirus (HPV) for 11-12 year olds. The vaccine is given through a series of three shots over a 6 month Period” (NYSDOH #6, 2009). National: Three federal programs with the potential to reduce cervical cancer incidence, morbidity, and mortality are administered by the Centers for Disease Control and Prevention (CDC): the National Breast and Cervical Cancer early detection program (NBCCEDP), the Vaccines for Children program, and the section 317 immunization grant program. These complementary programs provide prevention and screening services at no cost to females belonging to the U.S. populations most vulnerable to developing and dying from cervical cancer (CDC #5, 2009). Health promotion is described as “behavior motivated by the desire to increase well-being and actualize human health potential” (Pender, Murdaugh, and Parsons, 2006). As the registered professional nurse providing care for individuals at risk for HPV infection and cervical cancer I would use the health promotion model as my teaching strategy. The following are strategies in utilizing the health promotion model: “raising consciousness – awareness of benefits of adopting a healthy behavior or discontinuing a risky behavior is enhanced through seeking and processing information, observing others, and interpreting information in light of one’s personal situation” (Pender, Murdaugh, and Parsons, 2006 p.57). “Re-evaluating the self is another strategy – a

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contradiction between personal values and current behavior is most directly resolved by engaging in behavior change” (Pender, Murdaugh, and Parsons, 2006, p.58). Lastly, “controlling the environment –modifying the environment to support behavior change…reconfiguring environmental stimuli augments conditions for desirable behaviors or decrease conditions for undesirable behaviors”(Pender, Murdaugh, and Parsons, 2006 p.61).

References American cancer society. (2002). Early detection of cervical cancer. CA: A cancer journal for clinicians; 52, 375. doi: 10.3322/canjclin.52.6.375 Centers for disease control and prevention #1. (2009, June 22). Basic information about HPV-associated cancers. Retrieved from http://www.cdc.gov/cancer/hpv/basic_info/index.htm Centers for disease control and prevention #2. (2009, July 20) Cervical cancer. Retrieved from http://www.cdc.gov/cancer/cervical/index.htm

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Centers for disease control and prevention #3. (2009, Sept. 22). The health people 2010 database. Retrieved from http://wonder.cdc.gov/scripts/broker.exe Centers for disease control and prevention #4. (2009, June 30). Questions and answers about HPV vaccine safety. Retrieved from http://www.cdc.gov/vaccinesafety/updates/hpv_faqs.htm Centers for disease control and prevention #5. (2009, Sept. 17). Questions and answers about Assessing the burden of HPV – associated cancers in the United States (ABHACUS) Retrieved from http://www.cdc.gov/cancer/hpv/what_cdc_is_doing/qa.htm Fey, M.C. & Beal, M.W. (2004). Role of human papilloma virus testing in cervical cancer prevention. Journal of midwifery & women’s health; 49 (1), 4-13. doi:10.1016/j.jmwh.2003.10.002 Krishnan S.S. (2008). The HPV vaccine controversy: sex, cancer, god, and politics – a guide for parents, women, men, and teenagers. Westport, Conn.: Praeger Motoyama, S., Ladines-Llave, C.A., Villanueva, S.L., & Maruo, T. (2004) Minireview the role of human papilloma virus in the molecular biology of cervical carcinogenesis. Kobe J. Med. Sci; 50(1) 9-19. National cancer institute (2008, Feb. 14). Human papillomaviruses and cancer: questions and answers. Retrieved from http://www.cancer.gov/cancertopics/factsheet/Risk/HPV National Institute of health. (2009, July 1). Drug information: Human papillomavirus (HPV) vaccine. Retrieved from http://www.nlm.nih.gov/medlineplus/print/druginfo/meds/a607016.html New York state department of health #1. (2006, Aug.) Questions and answers about human papillomavirus (HPV) vaccine. Retrieved from http://www.health.state.ny.us/prevention/immunization/human_papillomavirus/index.htm

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New York state department of health #2. (2009, April) Uterine cervical cancer-cases and incidence rates per 100,000 female residents. Retrieved from http://www.health.state.ny.us/statistics/chac/cancer/ci_utc.htm New York state department of health #3 (2007, June) Uterine cervical cancer-deaths and death rates per 100,000 female residents. Retrieved from http://www.health.state.ny.us/statistics/chac/cancer/ca_utc.htm New York state department of health #4. (2006, Nov.) Human papillomavirus (HPV, genital or venereal warts). Retrieved from http://www.health.state.ny.us/diseases/communicable/human_papillomavirus/fact_sheet.htm New York state department of health #5. (2009, Sept.). Sexually transmitted diseases (STDs). Retrieved from http://www.health.state.ny.us/diseases/communicable/std/index.htm New York state department of health #6. (2009, Mar.) New York state recommended childhood and adolescent immunization schedule. Retrieved from http://www.health.state.ny.us/publications/2378.pdf Oneida County health clinic programs (2009) health clinic programs. Retrieved from http://ocgov.net/oneida/health/clinics Pender, N.J., Murdaugh C.L., & Parsons, M.L. (2006) Health promotion in nursing practice (5th. ed.). New Jersey: Prentice Hall. Rapose, A. (2008). Human papillomavirus and genital cancer. Indian journal of dermatology, venereology, & leprology; 75(3), 236-244. doi: 10.410310378-6323.48429 Wright, T.C. Jr., (2009). Natural history of HPV infections. Journal of family practice, 58.9 pS3(5). Retrieved from Health reference center academic – Gale database. Format: some of the spacing issues, abstract length, internal citation, grammar and organization of the material not always APA. Did you use the Perrin guide?

Human Papillomavirus 2 Content: somewhat disorganized and difficult to follow but full of information that shows you did try to research the topic. You could have talked about the nurses roles more completely and extend the discussion on initiatives as there is much information on TV, websites etc. that target high risk populations. In APA rarely do you use 1st person tense which you use throughout. Grade: 72