Introduction: Human Papillomavirus and Cervical Cancer
The primary goal is to assess the knowledge, awareness of human papillomavirus (HPV) and attitudes towards HPV-vaccine among Saudi Women Attending Family Medicine Clinic, as it is vital to determine these aspects. Human papillomavirus can be considered as the initial cause of cervical cancer and the initiator of the anogenital cancers including the vulva, anus, penis, and neck cancers by HPV16 and 18 being in charge for the majority of the cases internationally.1 Lastly, the disease is transmitted sexually. 2
In this instance, Saudi Arabia’s population is 8.82 million women, who are at possible risk in the increased presence of cervical cancer, and the statistics depict that 84 women die from the disease out of 241 being diagnosed.1 It remains evident that Saudi Arabia ranks number 8th due to the presence of these results.1 For instance, low-risk kinds are HPV6 and 11, which cannot be considered as the primary causes of cancer, but their consequences imply having condylomata or anogenital warts. In turn, the types such as HPV16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, and -59 can be considered as the primary cultivators of cervical cancer.3
Another essential attribute of the study is the prevalence of HPV in Saudi Arabia, Gulf Countries, and worldwide. Firstly, Saudi Arabia has a prevalence of 9.8 % of HPV, but cervical cancer prevalence is high.4 Nonetheless, the presence of the low prevalence can be explained by the lack of information and insufficient diagnosis among women. It remains evident that further research on this aspect remains a requirement due to the lack of suitable statistical data on this matter. Additionally, the research has to be conducted across the whole country by using similar measurements to enhance the validity of the data.3 the Nonetheless, it could be assumed that the presence of the lower prevalence in Saudi Arabia than the representatives of the other countries might exist due to the difference in the sexual behavioral patterns and the number of partners.4 Nonetheless, the presence of HPV was present in 40% of the cases while conducting the research with the females with cervical cancer, and the most common HPV genotypes were -16, -18, and -45.5
As for the prevalence in other Gulf countries, in this instance, Bahrain’s women also have a low prevalence of 9,8 %.6 Nonetheless, the high attention still has to be informed about the vaccination due to the ability of the disease to evolve. Furthermore, the prevalence is 6.2% among Qatar women.7 In this instance, the low prevalence can be explained by the diverse patterns of sexual behavior, which cannot characterize the behavior of women from developed countries.
Lastly, the situation in the world has to be described, as it contributed to the understanding of the current condition in Saudi Arabia due to the comparison of the percentage of the prevalence. It is apparent that the situation in the world is worse than in Saudi Arabia and other Gulf countries. For instance, the crude estimate in Africa is 29.6%, in Europe is 15.5%, and in Eastern Europe and Russia is 28.9% respectively.8 Nonetheless, the highest prevalence is in Eastern Asia, China, and Korea (57.7%).8
HPV-Vaccine
Nonetheless, the history of the development and improvement of the HPV vaccine has to be described. It could be said that the first vaccine was introduced in Australia in 2006.9 It is apparent that the modern medicine has a tendency to develop due to the new discoveries and innovation in technology. Nowadays, the three vaccines such as Gardasil 9 (approved by FDA in 2014), which protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, Gardasil (approved by FDA in 2006) protects against HPV types 6, 11, 16, and 18, and Cervarix (approved by FDA in 2009) protects against HPV types 16 and 18.10 It is apparent that the 9vHPV vaccine is a significant definer of the situation, as it is able to prevent cervical cancer by 70-90% due to the influence of HPV31/33/45/52/58.11 In turn, this vaccine can be considered as a changer of the situation regarding the relevancy of HPV due to the increased protection from vulvar, vaginal and anal cancers. All of the vaccines offer high protection and assist in avoidance of the transmittance of the dangerous disease. As for the utilization and the application of the HPV vaccine, it is currently applied international level and the increase the efficiency of the protection from the HPV virus.2
Nonetheless, the concerns tend to be present, and they are related to the safety, doses, and efficacy of the current HPV-vaccine. In this instance, the assessment of the vaccine eliminates the concern of the efficiency as it portrays the 100 percent fortification from the most dangerous HPV types for up to seven years.2 As for the doses, the application of three of them is preferred, but two dosages will be relevant while assuring the protection from HPV.2 Nonetheless, the primary distress of the application of any vaccine is safety. In this instance, no significant side effects of the implementation of the vaccine were emphasized during the experiments and employment for several years of usage.2 Despite the assurance of the absence of the severe side effects since the minor ones tend to be present in the form of nausea, fever, headache, and muscle pain.10 Various check systems Vaccine Safety Datalink and Vaccine Adverse Effect Reporting System such as are used to monitor the quality of the vaccine and eliminate the presence of side effects.10 In this instance, the youngsters and young adults of nine to twenty-six years old are considered as the primary groups for vaccination due to the high possibility of being infected.12 It is apparent that the injection is recommended at the early age of the high prevalence of the disease in the world. In turn, it will contribute to the decrease in the percentage of deaths due to cervical cancer as the individuals will be protected from the causative. In the end, the inoculation at the early age contributes to the healthy development of the children and youngsters, and it has to be applied to females and males.
Knowledge, Awareness, and Attitudes towards HPV Vaccine
Firstly, the situation in the world regarding the information and opinions about the HPV vaccine are discussed. The study compares the knowledge of HPV in the USA, UK, and Australia, as, firstly, the vaccine was introduced in these countries.13 It could be said that the percentage of the awareness about the existence of the vaccine is higher in the United States than in the other countries due to the presence of the highly motivating and encouraging advertising campaigns.13 Nonetheless, despite the active promotion, gaps in the understanding of the necessity of the vaccine tend to be present in the developed countries. Nevertheless, the overall score of knowledge of the existence of the HPV vaccine is 11.0 out of 19 among the women of the age of 19 to 26.14 In addition, the positive tendencies are present, as more and more people in the world become acquainted with the existence of HPV and vaccine.14The presence of this information assists in understanding that the development of the sufficient of the promotion and education about HPV and existence of the vaccine is a requirement. It is apparent that it will modify the spread of the disease in the world.
As for the knowledge and awareness of Saudi Arabia, the women have the general understanding of HPV and cervical cancer.4 Nonetheless, despite the positive outcomes, the consciousness of about the problems, which are highlighted in the research have to be increased due to the essentiality of the minimization of deaths and spread of the disease. Furthermore, women have to be aware of the first symptoms of cervical cancer to avoid its development.15The lack of educational sessions about HPV and appropriate screening programs is the critical reason for the increase in the deaths caused by cancer.16 It is apparent that the establishment of the sufficient delivery of the information will contribute to the ability to decrease the percentage of deaths at national and international levels. Furthermore, the research, which was conducted and determined in April 2010 and December 2011, displays that the number of partners, parity, and smoking has an influence on the educational level.4 In this instance, 101 (approximately 30%) had knowledge of HPV, and the majority of the respondents (approximately 90%) showed the positive attitudes towards vaccination.
Moreover, it is critical to determine the attitude among students of the medical school in Al-Ahsa, Saudi Arabia, as the young adults have a low understanding of the development of the symptoms, risks factors, and deterrence of cancer. In turn, the majority of the students were not aware of the existence the HPV vaccine.15 Furthermore, a similar study was conducted among Saudi female students in health colleges at Princess Nora University, in Saudi Arabia in 2013-2014, and the substantial goal was to determine the level of awareness about the HPV vaccine and cervical cancer.17 The results also depicted that the presence of the low knowledge of the vaccine, and only 46,5% of respondents were familiar with the screening as a prevention tool.17 In turn, the knowledge among senior medical students was higher. On the contrary, the study in Taif University discusses that half of the students have knowledge of the vaccine and disease.18 Nonetheless, the gap in the form of the lack of understanding of the screening will be present. It could be said that these studies revealed that the young females in Saudi Arabia have the low awareness of the screening as a prevention instrument, and this aspect explains the presence of the high cervical cancer prevalence.
Speaking of the awareness in other Gulf countries, only 20% of the population of the United Arab Emirates have the general understanding of HPV.19 In this instance, the cross-sectional study was conducted in UAE and displayed the low level of familiarity with HPV and vaccine.19 Nonetheless, the awareness tends to increase with the development of the education of the spouse and maturity. It could be said that the similar results are present in the other countries. It remains evident that the awareness is not high since no educational sessions are present in this area. It is hard to be compared to the results of the other countries, as the bias tends to be present. Furthermore, the study, which was conducted in the Kingdom of Bahrain shows that approximately 69% of women are not acquainted with HPV, but they show positive attitudes towards vaccination.6
Nonetheless, the coverage and spread of the HPV vaccine are questionable, as it has an increasing popularity in the urban areas while being almost disregarded in the rural areas and low-income regions.2 It remains evident that this situation has a tendency to exist due to the lack of the knowledge of cervical cancer and HPV. Despite the absence of the information about the presence of the potential health risks related to HPV, the civilians show the positive attitudes towards the necessity of the vaccination after receiving the data about the pros and cons of illnesses.
Conclusion
In the end, the conclusions have to be drawn based on the findings, which were revealed with the assistance of the literature review. It is apparent that the early intake of the vaccine can contribute to the development of the positive alteration in the prevalence and eliminate the risks of cancer and HPV among adolescents. Additionally, the potential solutions to the current issue in Saudi Arabia are proposed, as the maintenance and control of the situation remains a requirement to minimize deaths. It could be said that the essentiality of the popularization of the HPV vaccine was highlighted. The primary reason for its importance is the dangerous consequences of HPV virus, which are presented in the form of cervical cancer. In turn, the prevalence remains at the high level due to the lack of the implementation of the vaccine in the rural areas. Additionally, the representatives of the different nations show the positive attitudes towards the utilization of the vaccine after being increasing their knowledge of the risks of HPV.
It could be said that increasing the percentage of the world population, which has a general understanding of HPV, is the critical solution to the existing problem. Firstly, the understanding of the essentiality of the vaccination of Saudi Arabic women has to be increased, as this part of the population is considered as the core component of the study. In this case, it could be said that the application of the advertising campaigns can be the core modifier of the situation due to the positive implementation in the United States of America. The primary goal of this promotion instrument will be cultivating the positive perceptions of the vaccine among Saudi Arabic women while focusing on its beneficial influence and the avoidance of cancer in future. In turn, the strategical development of the awareness programs will increase the vaccination practices at national and international levels to prevent cervical cancer and spread of HPV.
Lastly, it remains evident that the findings can have implications towards defining actions in the healthcare sector of the Saudi Arabia governmental authorities. In turn, the coverage of all the vital aspect of HPV and its awareness emphasizes the importance of HPV in the world and determines the necessity of taking the actions to modify the perceptions of the disease in the society. Nonetheless, the critical limitation of the research is the emphasis on Saudi Arabia. The further research is needed to understand the situation in the other countries.
References
ICO Information Centre on HPV and Cancer. Saudi Arabia: Human Papillomavirus and Related Cancers, Fact Sheet 2016; Barcelona: ICO HPV Information Centre; 2016. Web.
Hopkins T, Wood N. Female human papillomavirus (HPV) vaccination: global uptake and impact of attitudes. Vac. 2013;31:1673-1679.
Alhamlan F, Al-Qahtani A, Al-Ahdai M. Current studies on human papillomavirus in Saudi Arabia. J Infect Dev Ctries. 2015;9(6) 571-576.
AlObaid A, Al-Badawi I, Al-Kadri H, Gopala K, Kandeil W, Quint W, Al-Aker M, DeAntonio R. Human papillomavirus prevalence and type distribution among women attending routine examinations in Saudi Arabia. Inf Dis. 2014;14:1-8.
Turki R, Sait K, Anfinan N, Sohrab S, Abuzenadah A. Prevalence of human papillomavirus in women from Saudi Arabia. Asian Pac J Cancer Prev. 2013; 14(5):3177-81.
Moosa C, Alsayyad A, Quint W, Gopala K, DeAntonio R. An epidemiological study assessing the prevalence of human papillomavirus types in women in the Kingdom of Bahrain. BMC Cancer 2014;14:1-8.
Bansal D, Elmi A, Skariah S, Haddad P, Laith J Abu-Raddad L, Aysha H Al Hamadi A, Nady Mohamed-Nady N, Affifi N, Ghedira R, Hassen E, Al-Thani A, Al-Ansari A, Sultan A. Molecular epidemiology and genotype distribution of Human Papillomavirus (HPV) among Arab women in the state of Qatar. J Transl Med. 2014;12:1-8.
Vinodhini K, Shanmughapriya S, Das B, Natarajaseenivasan K. Prevalence and risk factors of HPV infection among women from various provinces of the world. Arch Gynecol Obstet. 2012;285:771–777.
Hawkes D, Lea C, Berryman M. Answering the papillomavirus vaccine concerns; a matter and science and time. Infect Agents Cancer. 2013;8:1-8.
Centers diseases control and prevention – human papillomavirus (HPV) vaccine safety. [monograph on the internet]. 2015.
Pitisuttithum P, Velicer C, Luxembourg A. 9-Valent HPV vaccine for cancers, pre-cancers and genital warts related to HPV. Expert Rev Vaccines. 2015; 14(11):1405-1419.
Fisher W, Kohut T, Salisbury C, Salvadori M. Understanding human papillomavirus vaccination intentions:comparative utility of the theory of reasoned action and the theory of planned behavior in vaccine target age women and men. J Sex Med. 2013;10:2455–2464.
Marlow L, Zimet G, McCaffery K, Ostini R, Waller J. Knowledge of human papillomavirus (HPV) and HPV vaccination: an international comparison. Vac. 2013; 31:763-769.
Unger Z, Maitra A, Kohn J, Devaskar S, Stern L, Patel A. Knowledge of HPV and HPV vaccine among women ages 19 to 26. J Womens Health Issues Care. 2015;25(5):458-62.
Al-Darwish A, Al-Naim A, Al-Mulhim K, Al-Otaibi N, Morsi M, Aleem A. Knowledge about cervical cancer early warning signs and symptoms, risk factors and vaccination among students at a medical school in Al-Ahsa, Kingdom of Saudi Arabia. Asian Pac J Cancer Prev. 2014;15(6):2529-2532.
Alsbeih G. HPV infection in cervical and other cancers in Saudi Arabia: implication for prevention and vaccination. Front Oncol. 2014;4:1-6.
Al-Shaikh G, Almussaed E, Fayed A, Khan F, Syed S, Al-Tamimi T, Elmorshedy H. Knowledge of Saudi female university students regarding cervical cancer and acceptance of the human papilloma virus vaccine. Saudi Med J. 2014; 35(10):1223–1230.
Al-Bizrah N, Arain F. Knowledge and attitude about cervical screening and HPV vaccine among female medical students of Taif university. Int J Curr Res Acad Rev. 2015; 3(8):106-112.
Ortashi O, Raheel H, Shahal M, Osman N. Awareness and knowledge about human papillomavirus infection and vaccination among women in UAE. Asian Pac J Cancer Prev. 2013;14(10):6077-6080.