National Cancer Prevention Policy - Tobacco Control Supersite

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The challenge Stigmatisation of cervical cancer as a sexually transmitted disease HPV is a sexually transmitted infection and most individuals become infected with HPV within two to five years of initiating sexual activity (Wright et al. 2006). Risk factors for HPV transmission include age at first sexual intercourse, age of the woman and her partner, the number of sexual partners and other surrogate indicators for the likelihood that a sexual partner is infected with HPV (Schlecht et al. 2003). Prophylactic vaccines must be administered to individuals prior to virus exposure. This ideally prevents the establishment of the HPV infection by eliminating the virus at the time of, or shortly after, exposure to HPV. This is achieved by stimulating the immune system to produce neutralising antibodies that bind to certain areas of the virus, preventing it from attaching to the host cell (Devaraj, Gillison & Wu 2003). Parents may be reluctant to involve their young daughters in a vaccination program that is linked to sexual activity. However, cervical cancer should be considered as a rare complication of oncogenic HPV infection rather than as a sexually transmitted disease. Overall, the impact of the HPV vaccines on cervical cancer will be influenced by uptake of the vaccine by the population. In turn, the uptake of the vaccines will be influenced by perceived benefits and risks. Therefore communication strategies with health professionals, parents, women and adolescents which are sensitive to culture, religion and age are required to support uptake of the HPV vaccine. Encouraging high levels of uptake in the indigenous community Immunisation should positively impact on under-screened groups and populations with a higher incidence of cervical cancer. In Australia, Aboriginal women are more than four times more likely to die of cervical cancer than other Australian women (AIHW 2006). This difference is in part due to lower participation of this group in the National Cervical Screening Program. Vaccinating Aboriginal girls and women should reduce the incidence and mortality from cervical cancer but this will require better understanding of their barriers to participation. Targeted efforts are required for this at-risk population. Confusion about the importance of continuing to screen Confusion about HPV vaccination and cervical screening may lessen compliance with cervical screening in the vaccinated population. The currently available vaccines target only two or four of the 40 HPV types infecting the anogenital tract, therefore effective communication strategies will be required to ensure women still participate in the National Cervical Screening Program. The duration and scope of protection provided by the vaccine is unknown Current level 1 evidence supports the delivery of the vaccine to young women who have not yet commenced sexual activity and have therefore not yet been infected with the virus. The level of protection provided to older, sexually active women or boys is under evaluation in clinical trials (Kahn & Burk 2007). As this information becomes available, changes may need to be made to the delivery of the vaccine and the communication strategy. National Cancer Prevention Policy 2007 – 09 1 H u m a n p a p i l l o m a v i r u s
Effective interventions National Cervical Screening Program Between 1991 and 2002 the incidence of cervical cancer almost halved among women aged 20 to 69 (AIHW 2006) and the mortality from cervical cancer in Australia is among the lowest in the world. The decline in incidence and mortality, in part, is attributable to the success of the National Cervical Screening Program (see pages 138 to 144). Prophylactic vaccine Prophylactic vaccination against HPV 16/18 has the potential to prevent up to 70% of cervical cancers. While the National Cervical Screening Program has been effective at reducing cervical cancer incidence and mortality, the vaccine offers the potential to further decrease the incidence of and mortality from this disease. Internationally the greatest impact of the vaccine will be in countries without an organised screening program, in conditions of nutrient deficiency and where HIV is endemic (Gravitt & Shah 2005). Two HPV L1 VLP vaccines have been developed commercially. Cervarix is a bivalent HPV 16/18 vaccine developed by GlaxoSmithKline. The vaccine is given as an intra-muscular injection in a three-step protocol at zero, one and six month intervals (Stanley, Lowy & Frazer 2006). Gardasil, developed by Merck and Co. Inc., is a quadrivalent HPV 16/18/6/11 L1 VLP vaccine delivered by an intra-muscular injection at zero, two and six month intervals (Stanley, Lowy & Frazer 2006). Early studies have shown the HPV vaccines to be safe and well tolerated (Giles & Garland 2006). Results demonstrate that both vaccines are effective at protecting against persistent cervical HPV 16/18 infection and associated disease (Stanley, Lowy & Frazer 2006). Trials have shown almost universal seroconversion in vaccinated subjects (Giles & Garland 2006) and 100% efficacy for preventing persistent infection. The quadrivalent vaccine was shown to confer additional protection in women against HPV 6/11-induced mucosal and cutaneous genital disease (Stanley, Lowy & Frazer 2006). The vaccines have been shown to be safe and effective in preventing infection with HPV 16 and 18. The duration of protection conferred by the vaccine beyond five years is under evaluation in clinical trials (Kahn & Burk 2007). In the short term the impact of the HPV vaccines will be a reduction in cervical dysplasia. The long-term impact is a reduction in the incidence and mortality from cervical cancer. Taken together this translates to a reduction in treatment costs as well as psychological and medical morbidity (Lowy & Schiller 2006). The impact of the vaccine on other anogenital cancers and aero-digestive cancers is not presently known. The prophylactic vaccine and the development of therapeutic vaccines together with emerging new technologies in screening present the opportunity to progressively reduce HPV-associated malignancy and in doing so significantly decrease the burden of cervical cancer on the community (Roden & Wu 2003). Therapeutic vaccine Worldwide it is estimated that there are 100 million women infected with high-risk HPV types, and five million women have persistent infections which may result in anogenital cancers (Giles & Garland 2006). 1 0 Section Three: Immunisation
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National Cancer Prevention Policy 2
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The Cancer Council Australia Member
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Overweight and obesity 86 Introduct
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A b b r e v i a t i o n s AACR Aust
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T h e N a t i o n a l C a n c e r P
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increase their understanding of man
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T o b a c c o Introduction 12 Secti
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Figure 1.1 Number of Australians wh
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(16.3%) continues the trends observ
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in the longer-term future, when hea
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Tobacco products are among the top
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In 2007, given estimated costs of $
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improved regulation, by collectivel
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Tobacco control strategy for Aborig
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Australian National Tobacco Strateg
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Regulation of products Possible reg
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• • parents/carers and children
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Australia in partnership with a num
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What needs to be achieved How The C
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——— 2005. 2004 National Drug
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Schofield PE, Borland R, Hill DJ, P
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In adult life, recreational (interm
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ehaviours as a result of public edu
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Screening for melanoma There is ins
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Autier P 2004. Issues about solaria
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N u t r i t i o n Introduction 52 S
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Table 1.4 Conclusions of the major
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It may be possible that different t
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Table 1.5 Current trends in consump
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key stakeholders (Sorensen et al. 1
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A large scale randomised controlled
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• The International Union Against
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References Nutrition Agency for Hea
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Kushi L & Giovannucci E 2002. Dieta
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Strategic Inter-Governmental Nutrit
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How physical activity is measured U
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There is consistent epidemiological
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• • Moderate-intensity physical
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to help them achieve greater and mo
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Populations Aboriginal and Torres S
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An increased capacity to monitor be
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McTiernan A, Kooperberg C, White E,
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O v e r w e i g h t a n d o b e s i
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Table 1.9 Proportion of cancer attr
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were $107.3 million in 2005, with 7
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Obese children have a 25% to 50% ch
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Table 1.10 Summary of the strengths
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more than moderately effective. The
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a screening approach particularly f
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References Overweight and obesity A
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Gebel K, King L, Bauman A, Vita P,
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——— 2004. SNAP: A population
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(the highest level of evidence in t
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How the amount of disease caused by
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The challenge Adults Alcohol is a s
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and healthy drinking cultures in Au
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ook’) (RACGP 2006) assists in dev
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English DR, Holman CDJ, Milne E, Hu
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Section Two: Screening to detect ca
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early detection improves health out
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false positive faecal occult blood
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1987, compared to 51.3 deaths per 1
Page 130 and 131: Breast self-examination Breast self
Page 132 and 133: a significant proportion of women a
Page 134 and 135: An Australian review of the benefit
Page 136 and 137: References Breast cancer Australian
Page 138 and 139: Semiglazov VF, Manikhas AG, Moiseen
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Page 144 and 145: Recruitment Women in the target age
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Page 148 and 149: could focus on: how to use this tim
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Page 152 and 153: participate in the initial phase; t
Page 154 and 155: likely to do so if reinvited, espec
Page 156 and 157: What we want to achieve How The Can
Page 158 and 159: P, Sivak MV & Butler H 2004. Comput
Page 160 and 161: Scholefield JH, Moss S, Sufi F, Man
Page 162 and 163: M e l a n o m a Melanoma in Austral
Page 164 and 165: Would screening be of benefit at th
Page 166 and 167: P r o s t a t e c a n c e r Cancer
Page 168 and 169: have lower levels of free PSA than
Page 170 and 171: • • a monitoring mechanism be p
Page 172 and 173: ecause surgical patients are usuall
Page 174 and 175: Klein EA 2004. Selenium and vitamin
Page 176 and 177: Section Three: Immunisation www.can
Page 178 and 179: epithelial carcinomas of the bladde
Page 182 and 183: The goals of a therapeutic vaccine
Page 184 and 185: Brinkman JA, Caffrey AS, Muderspach
Page 186 and 187: Victorian Cervical Cytology Registr
Page 188 and 189: Chronic hepatitis B infection occur
Page 190 and 191: Global Globally, an estimated two t
Page 192 and 193: The rise in HCC is thought to be as
Page 194 and 195: • • • • • • • • •
Page 196 and 197: The policy context The bleak outcom
Page 198 and 199: Aims What needs to be achieved How
Page 200 and 201: Chen DS 2005. Long-term protection
Page 202 and 203: Williams A 2002. Reduction in the h
Page 204 and 205: Authors Dr Cleola Anderiesz BSc (Ho
Page 206 and 207: Associate Professor John Kelly MDBS
Page 208 and 209: A alcohol 107 - 119 aims of The Can
Page 210 and 211: east cancer (post-menopause) 87, 88
Page 213: The National Cancer Prevention Poli
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