Elsevier

Vaccine

Volume 26, Issue 43, 9 October 2008, Pages 5435-5440
Vaccine

Conference report
The need for public education on HPV and cervical cancer prevention in Asia: Opinions of experts at the AOGIN Conference

https://doi.org/10.1016/j.vaccine.2008.07.077Get rights and content

Abstract

Asia accounts for more than half of all cases of cervical cancer registered globally and improving prevention is urgently needed. A range of tools and strategies is now available to effectively prevent this disease, including two new prophylactic HPV vaccines approved and recommended for adolescents and young women. However, without communication these tools may have little impact on disease burden. The conferences of the Asia Oceania Research Organisation in Genital Infection and Neoplasia (AOGIN) bring together clinicians and scientists whose work is related to genital infections, particularly HPV, cervical dysplasia and neoplasia, as well as other anogenital cancers, with the aim of improving communication on prevention through human papillomavirus (HPV) vaccination and screening in Asian countries. The scope of this year's AOGIN conference was to extend education to include health workers, family doctors, paediatricians, governmental health agencies, and the general public through patients’ testimonials that can reach out to women raising awareness of this silent disease. Community based initiatives and awareness campaigns were also reported, and can empower the people to engage in a dialog with local governments towards prioritization of cancer prevention programs, achieving more for the public than isolated actions. Parents and teachers are encouraged to communicate about these issues within families and schools. Evidence was discussed that males can participate in cervical cancer control as well, and prevention programs involving men should not be neglected as they may reduce genital disease burden in women. Opinion leaders proposed prevention measures to be considered for governmental decisions. While each country develops a locally appropriate policy for cervical cancer control there is a need to revise these programs regularly, as knowledge increases in response to public need, as well as to gather evidence about disease burden and the effectiveness of education and interventions. In conclusion, AOGIN is committed to improve communication with patients, health authorities, professional organizations and opinion leaders towards strengthening cervical cancer prevention in Asia, to achieve a timely steep reduction in this cancer.

Introduction

Cervical cancer is caused by genital infections with oncogenic types of human papillomavirus (HPV) and is the second most common cancer among women worldwide [1]. More than half of all cases in the world occur within the Asia-Pacific region (Fig. 1). An array of tools is now available to effectively prevent this disease, and, importantly, communication with the public at large to ensure compliance can enhance and accelerate the impact on disease burden. Hence, the Asia Oceania Research Organisation in Genital Infection and Neoplasia (AOGIN) developed a multi-disciplinary approach to tackle cervical cancer prevention within the region through communication. AOGIN aims to working with health care professionals as well as the lay public, to foster collaboration and research, scientific exchanges, education and training, providing information, surveys and audits.

The vision of AOGIN is to reduce the burden of disease caused by reproductive tract infections, especially human papillomavirus, in the Asia-Pacific regions. Today AOGIN has 16 country members, including Australia, Bangladesh, China, Hong Kong, India, Japan, Indonesia, Korea, Laos, Nepal, New Zealand, Philippines, Singapore, Sri Lanka, Taiwan, and Thailand, and welcomes new members.

The AOGIN conferences bring together clinicians (gynaecologists, pathologists, infectious diseases physicians, sexual health physicians, gynaecological oncologists) and scientists whose work is related to genital infections and neoplasia. Presently the challenge is to reach out to health workers, family doctors, paediatricians, governmental health agencies, and the general public. Therefore, at the 2008 conference in Seoul, Korea, AOGIN initiated an effort to broaden the scope of the conference and provide information and education to professionals involved with the lay public, working at governmental and non-governmental organizations and patient associations.

Section snippets

What is the role of patients in health education?

Mrs. Bautista – a Hong Kong resident from the Philippines – shared her story with the public, through a video testimonial in the hope to reach out to other women and help prevent cervical cancer more effectively. At 33 years of age she was newly married and trying to conceive. In a routine gynaecological control her doctor found a tiny lump in her cervix, and did a biopsy. Two weeks later the results reported an invasive cervical cancer. This was an unexpected outcome for her as she led an

How do health authorities educate the public about HPV and cervical cancer prevention?

A range of strategies to prevent and treat cervical lesions are available in most Asian countries. Health authorities have a role in facilitating introduction of new products, providing guidance as to appropriate target populations, based on clinical data, and ensuring proper product manufacturing. For example, the Korea Food and Drug Administration (KFDA) evaluates the safety of food and drug products that reach the public nationwide. Quadrivalent and bivalent HPV vaccines based on virus like

What is the impact of community mobilization initiatives?

As an example of community mobilization to prevent cervical cancer within the Asia-Pacific region, the Cancer Council Australia and the Cancer Council of Queensland through partnerships across the country, produced information materials designed jointly for educating the public and health care professionals. A second example of community mobilization is that various international non-governmental organizations will ratify a document advocating for the introduction of HPV vaccination programs

Opinions of Asian experts about preventing cervical cancer in Asia

In 2006, the first vaccine against human papillomavirus infection, Gardasil®, a quadrivalent prophylactic vaccine (6, 11, 16 and 18 VLPs) was approved for use in North America and later in over 100 countries worldwide. A second vaccine, Cervarix® a bivalent vaccine (16 and 18 VLPs) was first approved in 2007 in Australia, then Europe, with just over 60 countries approved and currently undergoing regulatory review in many countries. Both vaccines are designed with the goal of preventing three

Conclusion and recommendations

To take up the task of communicating broadly about HPV infections and genital neoplasias to a larger group of professionals implicated in cancer prevention, as well as to the public at large, is a considerable challenge for Asian countries. AOGIN is committed to serve as platform for developing scientifically accurate and culturally appropriate yet simple messages, in creating a regional effort to maximize information flow to reach the women who need it most, and achieve clinical benefits for

Acknowledgements

We are grateful to Mrs. Bautista for her testimonial. We also acknowledge untied educational grants from Merck and Roche, as well as a donation of an educational tool for medical and scientific participants of CCEPI/AOGIN, plus a tool for the education slides from Glaxo Smith Kline and, handed out to participants at the education session AOGIN, Seoul, Korea.

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    A recent study of HPV vaccine acceptability identified knowledge about HPV as one of the predictors of greater vaccine acceptance [16]. At the 2008 Asia Oceania Research Organisation in Genital Infection and Neoplasia (AOGIN) conference, it was concluded that identifying and understanding knowledge levels and attitudes to HPV vaccination can aid the development of communication and educational strategies to encourage HPV vaccine uptake [17]. Although studies of attitudes towards HPV vaccination have been conducted amongst lay women in some Asian Pacific countries, including Australia [18], Hong Kong [13,19] Malaysia [12,15], and Vietnam [20], this is the first multi-country survey to determine attitudes and knowledge levels around cervical cancer and HPV vaccination amongst both physicians and mothers in Asia.

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    This goal is stymied by lack of general education and literacy, lack of ability to travel, lack of knowledgeable health professionals, and by cultural barriers that allow families or husbands to prevent access for adolescents, daughters or wives even when the opportunity for education exists. Some groups are using patient testimonials to reach out to professionals and women themselves to educate and empower a dialogue with local governments to prioritize the prevention and therapy of this disease [11]. Access to available health may be prevented by social structures that prevent women from making their own authentic choices for healthcare treatment or allow other family members, particularly husbands, brothers, or fathers to control access to either financial or mobility resources to access care.

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