3- ca cx ppt final

1. KNOWLEDGE OF SAUDI FEMAL UNIVERSITY
STUDENTS REGARDING
CERVICAL CANCER AND ACCEPTANCE OF
THE HPV VACCINE
Ghadeer K. Al-Shaikh
MD, FRCSC
Associate professor , King Saud University
Dean College of Medicine
Princes Nourah bint Abdulrahman University
Riyadh
Kingdom Of Saudi Arabia

2. Background
• Cervical cancer is an important global public health
problem, and a leading cause of mortality all over the world.
• There are approx. 500,000 new cases of Ca Cx. worldwide
and 250,000 Ca Cx related deaths each year
• Higher incidence rates have been reported from sub-
Saharan Africa, Central and South America, Southeast Asia
and Brazil. In contrast the incidence rates were the lowest in
Middle East, particularly among Muslims and Jews
• In KSA, Ca Cx. accounts for 2.6% of female cancers and is
ranked 9th among all carcinomas affecting Saudi females

3. Background –cont.
• Among all known risk factors, persistent infection with
high-risk human papillomavirus (HPV) plays a considerable
role in the pathogenesis of Ca Cx.
• The worldwide HPV prevalence in
cervical cancer was estimated to be
between 85-99%.
• HPV are a diverse group of DNA viruses, which cause
infection without triggering a strong immune response and
natural infection provides only limited protection against
reinfection

4. Background-cont.
• To date more than 200 genotypes
of HPV have been identified; but
there are 13 to 17 types that can
cause Ca Cx.
• HPV 16 is the most frequent type
detected in positive samples,
followed by 18 in more than 70%
positive samples
• The HPVs are grouped according to
their genomic sequence into
oncogenic high, probable high, and
non-oncogenic low-risk.

5. Background-cont.
• The strong association of oncogenic HPV infection with the
development of Ca Cx. provides an opportunity for primary
prevention through prophylactic vaccination.
• Two highly effective and safe HPV vaccines are currently
available; a bivalent vaccine targeting HPV 16 & 18 and a
quadrivalent vaccine additionally targeting HPV 6 and 11.
• Cytological screening based on Pap smear plays a major
role in reducing both incidence and mortality of invasive
cervical cancer; but lack of awareness and access to the test
leads to increased incidence in developing countries

6. Rationale
• Appropriate level of knowledge, attitude and beliefs are
key elements for adopting healthy life style, influencing
human behaviors and accepting newly-introduced
preventive measures.
• The gap of knowledge about clinical presentation, risk
factors, primary and secondary prevention of Ca Cx. has
been documented in several studies both in developed
and developing countries.
• However, fewer studies have been reported from Saudi
Arabia.

7. Objectives of the Study
1. To assess the level of knowledge of healthcare students
about Clinical Presentation & Primary and Secondary
Prevention of Cervical Cancer
2. To determine the extent of Acceptance of HPV vaccine

8. Subjects and Methods
Study design Cross-sectional with convenient sampling
Sample size 1258 students
Study setting Health Colleges at Princess Nourah bint
Abdulrahman University, Riyadh, KSA
Duration December 2013 to February 2014
Study tool Self-administrated questionnaires consisting of
48 questions in 4 sections
Reliability of Questionnaire as tested by Cronbach’s alpha was 0.82.

9. Data Collection
Included
1. Socio-demographic data
2. Knowledge about cervical cancer risk factors
3. Clinical presentation
4. Pap smear and
5. HPV vaccine acceptance
Response rate was 89.9%

10. Statistical Analysis
• Data was analyzed using SPSS version 20.
• The knowledge score represents the sum of the correct
answers of the 27 questions. The value ‘1’ was given for the
correct & ‘0’ for wrong answers & “don’t know” responses.
• The cutoff for a poor knowledge score was set at values
below 60% of the total score.
• Mann-Whitney and Kruskal-Wallis tests were used to
compare knowledge scores among different subgroups.
• P-value of less than 0.05 was considered as statistically
significant.
• Multivariate linear regression analysis was adopted to adjust
the effect of independent variables on the knowledge score.

11. TABLE.1: DISTRIBUTION OF STUDENTS ACCORDING TO SOCIO-DEMOGRAPHIC
CHARACTERISTICS
College N (%)
Medicine 122 (9.7)
Dental 67 (5.3) lowest
Pharmacy 416 (33.1)
Nursing 215 (17.1)
Health and rehabilitation 438 (34.8) highest
Father’s occupation
Health Professional 89 (7.1)
Mother’s occupation
Health Professional 37 (2.9)
Monthly Income
More than 15,000 SR/month 612 (48.6)

12. 24.1
34.6
48.9
33.7
22.6
26.5
59.6
48.8
25.9
0
10
20
30
40
50
60
70
80
90
100
%ofcorrectanswers
FIG.1: KNOWLEDGE ABOUT RISK FACTORS

13. Fig.2:KNOWLEDGE ABOUT THE CLINICAL PRESENTATION OF Ca Cx
79.5
51.1
54.8
31.9
21.8
39.3
22.3
6.3
Breast cancer
is the most
common
female cancer
Cervical cancer
is preventable
Irregular
vaginal
bleeding
Vaginal
discharges
Post coital
bleeding
Pelvic pains Weight loss Asymptomatic
%ofcorrectanswers

14. 46.7
30.8
15.7
38
28.7
17.8 18
0
10
20
30
40
50
60
70
80
90
100
Heared about
Pap smear
Pap smear a
sensitive way
to early
diagnose
cancer
cervix?
Pap smear
painful
One pap
smear
enough
Pap smear
have serious
complications
Appropriate
time to have
pap smear
Frequency of
pap smear
%Ofcorrectanswers
FIG.3: KNOWLEDGE ABOUT PAP SMEAR

15. 10.9
6.1
8.1
0
5
10
15
20
25
30
Vaccine against cervical
cancer contains Human
Papilloma Virus
The vaccine is protective
against genital warts
Appropriate age to get the
vaccine is 12-25 years
%ofcorrectanswers
FIG.4: KNOWLEDGE ABOUT HPV VACCINE

16. TABLE.2: ACCEPTANCE AND BARRIERS FOR HPV VACCINE
Questions N (%)
Acceptable vaccine cost*
Less than 100 SR 481 (38.2)
100-300 SR 511 (40.6)
Up to 500 SR 114 (11. 4%)
More than 500 SR 57 (4.5)
Reasons for refusal to be vaccinated
Being afraid of the vaccine injection 333 (26.5)
Being worried about side effects 652 (51.9)
The cervical cancer is rare, is not worth
vaccination
116 (9.2)
The vaccine might be unaffordable 168 (13.3)
She might have no time 257 (20.4)
Family refusal 106 (8.4)
She does not believe in the effect of vaccination 82 (6.5)

17. Good
4%
Poor
96%
FIG.5: DISTRIBUTION OF STUDENTS
ACCORDING TO THE LEVEL OF TOTAL SCORE
OF KNOWLEDGE
However senior and Medical students had a significantly higher knowledge score

18. Limitations of the Study
• The dissimilar proportions of the numbers of
respondents in different colleges
• Males and students from non-health colleges are not
represented.

19. Conclusion
This study indicates:
1. Poor level of knowledge about cervical cancer and
2. Misinformation about primary and secondary
preventive measures.
▫ The data provides a benchmark about the level of
knowledge which can be used to formulate effective
awareness program in future.

20. References
• GLOBOCAN, 2013. cervical cancer incidence, mortality & prevalence
world wide in 2011. International agency or research on cancer. WHO.
• Saudi Cancer Registry. Cancer Incidence and Survival Report: Saudi
Arabia 2007. In Special Edition. Riyadh (KSA): Ministry of Health: 2011
• World Health Organization. Cervical cancer, human papillomavirus (HPV)
and HPV vaccines. Geneva:WHO:2008
• Navarro-Illana P, etal 2014. Ethical considerations of universal
vaccination against human papilloma virus. BMC Med Ethics;15: 29
• Zaridah S, 2014. A Review of cervical Cancer Research in Malaysia. Med J
Malaysia; 69(sup A): 33-41
• Pelucchi C, etal, 2010. Knowledge of human papillomavirus infection and
its prevention among adolescents and parents in the greater Milan area,
Northern Italy. BMC Public health; 10:378
• Carozzi etal, 2014. Age and geographic variability of HPV high-risk
genotype distribution in a large unvaccinated population and of
vaccination impact on HPV prevalence. J. of Clinical virology;60: 257-63