Contexts of Practice: Health Alteration

Answer 1: Human papillomaviruses (HPVs) are very small viruses that holddeoxyribonucleotide acid (DNA). Their objective is to target squamous epithelium which ultimately affects the skin and cause infection of the mucosa. Infection of HPV can cause cancer of the cervix. Exocervix and endocervix which is lined by epithelia are joined at a junction known as squamocolumnar. This junction is very vulnerable to the infection caused by HPV. This virus also initiates cervical dysplasia and moreover intraepithelial neoplasia (CIN) that grows into cancer of the cervical (Wang, Huang & Zhang, 2018).

The risk factors identified are: having new male companions, having multiple numbers of sexual partners during their lifetime and having male partners which are non- monogamous (Chelimo et al., 2013). Studies also suggest that the long use of birth control pills can also cause cervical cancer (Mwaka et al., 2016).Therefore, in Whitney's case, we can say that having multiple sexual partners over the years and taking pills might have cause cervical cancer.

Answer 2: In December 2017, a new screening test known as Cervical Screening Test was introduced in Australia which has eliminated the Pap test that was done before. The new test is expected to prevent and protect more women by the percentage of 30%. This test detects the HPV in women whereas Pap test could only tell about changes in the cell of the cervix. Hence, the new test that has come into play is safe to use every five years instead of two (Australian Government, Department of Health, 2017).

The renewed guidelines mentioned that women in the ages between 25- 74 years should attend the screening in every 5 years with partial HIV18 and 16 genotyping plus liquid-based cytology (LCB)triage for those females in which cancer-causing HPV is detected. Those women who were detected with HPV16/18 or those with triage LCB will be stated as atypical squamous cells, probably high-grade lesion. If they have oncogenic HPV then follow-ups have to be done in every 12 months which will be referred to as HPV tests. This is done because in the studies it was found out that women having HVP 16/18 has high risk of CIN2+ development as compared to those who have HPV but not 16/18 type. The addition of HPV 16/18 into vaccines leads to a lower number of these types in females who are young. Thus, it will open a practical strategy beginning from 25 years of age which will comprise partial genotyping with an instant recommendation to colposcopy (Hall et al., 2018;Sultana et al., 2020).

References for Projected Future Impact of HPV Vaccination

Australian Government, Department of Health.(2017). National cervical screening program.http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/cervical-screening-1

Chelimo, C., Wouldes, T. A., Cameron, L. D., & Elwood, J. M. (2013).Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. The Journal of Infection, 66(3), 207–217. https://doi.org/10.1016/j.jinf.2012.10.024

Hall, M. T., Simms, K. T., Lew, J. B., Smith, M. A., Saville, M., &Canfell, K. (2018). Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017-2035: Example from Australia. PloS One, 13(2), e0185332. https://doi.org/10.1371/journal.pone.0185332

Mwaka, A. D., Orach, C. G., Were, E. M., Lyratzopoulos, G., Wabinga, H., & Roland, M. (2016). Awareness of cervical cancer risk factors and symptoms: Cross-sectional community survey in post-conflict northern Uganda. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, 19(4), 854–867. https://doi.org/10.1111/hex.12382

Sultana, F., Roeske, L., Malloy, M. J., McDermott, T. L., Saville, M., &Brotherton, J. (2020). Implementation of Australia's renewed cervical screening program: Preparedness of general practitioners and nurses. PloS One, 15(1), e0228042. https://doi.org/10.1371/journal.pone.0228042

Wang, X., Huang, X., & Zhang, Y. (2018).Involvement of human papillomaviruses in cervical cancer. Frontiers in Microbiology, 9, 2896.https://doi.org/10.3389/fmicb.2018.02896

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