New Research Shows Knowledge Of HPV And Vaccination Could Improve Cervical Screening Attendance

Main Category: Cervical Cancer / HPV Vaccine
Also Included In: Immune System / Vaccines
Article Date: 17 Nov 2008 - 2:00 PDT

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Information about vaccination against the virus that causes cervical cancer could encourage rather than discourage women to attend for cervical screening, a new survey has found.1

A number of commentators have said that vaccinating women against the human papillomavirus (HPV), which causes cervical cancer, could make them complacent about attending for cervical screening (smear test), although to date there has been no evidence to support this.

However, the new research amongst nearly 400 British women has found that the opposite is true - knowledge about the disease and the vaccine makes women more likely to attend cervical screening.1

The findings follow the recent publication of the annual statistics for the cervical screening programme in England 2007-08 which showed a continuing decline in attendance by women aged 25-29, with a 13.5% drop since 1995.2

The new survey looked at views on cervical screening attendance amongst two groups of women, a group of 24-year-old women yet to be screened - and reasons for non-attendance at cervical screening amongst a group of women aged 26 or 27 who had missed their first appointment.1

After being given information about cervical cancer, HPV and vaccination, those saying they would go to their next appointment almost trebled amongst the 26/27 year olds - up from 22% to 60%.1

The vast majority of both groups of women (aged 24 and 26/27) also said they would continue to go for cervical screening after being vaccinated - with 89% of the younger group and 81% of the older group confirming this.1

Dr Jo Waller, from University College London, who has carried out extensive research into women's knowledge of HPV, said: "Research shows that most women still don't understand the connection between HPV and cervical cancer. This link needs to be made clear so that the role of cervical screening and vaccination in the prevention of cervical cancer is better understood."

The survey found a high degree of confusion amongst the women over the cause of cervical cancer. Just 12% of the 24-year-olds correctly named HPV as the cause - and amongst the older group only 9% did so.1

Amongst both groups more than 60% thought women with a family history of cervical cancer were at higher risk - which is untrue as the cancer is not hereditary.1

Despite the fact that an estimated eight out of ten women will be infected with HPV at some point in their lives,3 few women saw themselves at risk of cervical cancer, with less than one in ten of the 26/27 year olds agreeing strongly with the statement: "I am at risk of cervical cancer."1

Robert Music, Director of Jo's Trust, the cervical cancer charity, said: "We know that a lot of women don't understand the risks of cervical cancer and HPV infection. This is evident by the numbers of women who are not attending their cervical screening appointments. Any way of disseminating and communicating further information and helping women understand the nature of this cancer is crucial to saving lives."

The survey was carried out by the market research firm Millward Brown Healthcare. The interviews were carried out between July 10 and August 4 this year.

The survey was commissioned by GlaxoSmithKline, who manufacture an HPV vaccine, but the company had no input into the collection or analysis of the data.

About the research

Nearly 200 women (198) aged 24 were interviewed who had not yet had their first screen. In addition 129 women aged 26 and a further 66 aged 27 were interviewed who had missed their first screen and had no appointment booked.1

The 26/27 year old women who had declined screening gave a variety of reasons for their refusal to accept their invitations. Chief amongst these were "I feel self-conscious/embarrassed" - 54% - and "I'm put off by the procedure" - 53%.1

The complete list of reasons for non-attendance amongst 26/27 year olds is below:1

I feel self-conscious about it/embarrassed 54%
I'm put off by the procedure 53%
I'm worried that it might hurt 31%
Haven't had many sexual partners 19%
I'm not comfortable with my doctor/nurse 17%
Difficult to get an appointment that fits my lifestyle 13%
I'm nervous about the potential results 13%
I haven't had time 12%
I don't have a female doctor/nurse to go to 5%
I don't understand the need for me to attend 4%
I had to cancel the original appointment 3%
I was invited but moved house too far away 3%
I wouldn't attend on religious grounds 1%
I think I'm still too young to need it 1%
Base = 195 women.

About the screening programme

The recently published data from England's cervical screening programme for 2007-08 showed attendance in the 25-29 age group had dropped to 66.2%, down by 13.5% compared with the 79.7% attendance figure in 1995.2

Amongst those aged 30-34 attendance was 76.8%, down from 84.3% in 1995.2

The total cohort aged 25-29 that is invited stands at 739,982. Therefore in real terms the missing women of that age - 33.8% - total more than a quarter of a million - 250,113.2

The report pointed out that the 25-29 age group had the highest level amongst all age groups of serious cell changes in the cervix, known as severe dyskaryosis or worse, with a rate of 1.4%.2

About the UK vaccination programme

Since September 2008, the UK Government has started offering vaccination for girls aged 12-13 (school year 8 or S2 in Scotland or school year 9 in Northern Ireland) against HPV as part of the new national immunisation programme.

In addition, all girls in their final school year (17/18) will also be offered the vaccination. Initially, there will be a catch-up campaign where girls aged 14 to under 18 years will be offered the vaccine.

From September 2009, girls in England, Wales and Northern Ireland aged 16 to 18 (school years 12 and 13 or school years 13 and 14 in Northern Ireland) will be offered the vaccine. From September 2010, girls aged 15 to 17 (school years 11 and 12 or school years 12 and 13 in Northern Ireland) will be offered the vaccine.

In Scotland, the catch up programme will begin from September 2008 with girls aged 16 to 17 (school years S5 and S6). Scottish girls aged 14 to 16 (school years S4 and S5) will be vaccinated from September 2009, and girls who have incomplete or no immunisation will be offered vaccination from September 2010.

GSK's HPV vaccine was selected as the vaccine of choice for the UK immunisation programme in June 2008.

About cervical cancer

Any woman who has a sexual relationship is at risk of acquiring the HPV virus and potentially cervical cancer, whatever their age.4 In the UK every day 3 women die and 9 are diagnosed with cervical cancer.5 In women under the age of 35, cervical cancer is the 2nd most common cancer in the UK.5

Approximately 100 types of human papillomavirus have been identified to date and, of these, approximately 15 virus types are known to cause cervical cancer. Virus types 16 and 18 are responsible for approximately 70 percent of cervical cancers.6

Persistent infection with cancer-causing virus types can lead to the formation of abnormal cells in the cervix, which, over time, may become precancerous or cancerous. Throughout their sexually active lifetime, women may be exposed to cancer-causing virus types. The majority of women will clear an infection spontaneously. However, if the infection persists it can lead to precancerous lesions or cervical cancer.7

References

1. Screening attendance research 2008. GSK data on file

2. Cervical Screening Programme, England 2007-2008. NHS The Information Centre, 28 October 2008.

3. Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med 1997; 102 (5A); 3-8.

4. McIntosh N. Human papillomavirus and cervical cancer JHPIEGO strategy paper No. 8; 2000.

5. Adapted from Cancer Research UK. http://info.cancerresearchuk.org/cancerstats/types/cervix/ (Accessed Oct 2008).

6. Munoz N, et al. Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer 2004; 111: 278-85.

7. Schiffman M, et al. Chapter 2: Natural history of anogenital human papillomavirus infection and neoplasia. Journal of the National Cancer Institute.Monographs. 2003(31):14-9.

GlaxoSmithKline