Public Health

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INTRODUCTION
Cervical cancer is a major public health problem, as it is the second most common cancer in women world-wide after breast cancer. Cervical cancer is a common type of malignancy accounting for about 6% of all cancers found in women. It is a disease in which cancerous cells develop in the uterine cervix (this is the connecting passage between the uterus and vagina). The human papillomaviruses are the principal cause of most cervical cancers. The peak incidence of cervical cancer occurs between the ages of 40 to 55. It is rare before the age of 35; however the incidence of cervical cancer in younger women rose dramatically during the two decades after 1960. Regular Pap smear tests may detect abnormal changes in the cervical tissues, before cancer develops. Symptoms of cervical cancer may include vaginal bleeding after intercourse or bleeding between periods. However, in the early stages of the disease there are often no obvious signs or symptoms, so regular smear tests are important.

CERVICAL CANCER- A PUBLIC HEALTH APPROACH
Cervical cancer is the sixth most common cancer in women in the UK. (Department of Health, 1999). Around 3200 women are diagnosed with cervical cancer in the UK each year, with 95% of cases being in women over 35. However, deaths from cervical cancer have fallen by more than 40% over the last 20 years, and the incidence of cervical cancer is much lower than it is for breast cancer, for example (nearly 41,000 new cases a year). This reduction is mainly because of the NHS screening programme, for all women between the ages of 20 and 64 in the UK. Cervical cancer is a major health problem in the world today. In some developing countries it is the commonest female cancer. It is estimated that around 370, 00 cases of cervical cancer are diagnosed in the world each year. (www.cervicalcancer.uk.com/index.html (6/05/06) date accessed) PUBLIC HEALTH

Public health carries out its mission through organized, interdisciplinary efforts that address the physical, mental and environmental health concerns of communities and populations at risk for disease and injury (Roberts & Reich (2002). Public Health is everything to do with diagnosing, analyzing, reporting, monitoring, treating, educating, researching, managing and enforcing the overall health of the general public. A sub-category of Public Health is Environmental Public Health. This specifically addresses the relationship between humans and the environment. It is focused on things like food safety, pest management, air quality etc. Six public health priorities are identified: health inequalities, (Department of health 2000) Smoking, Obesity, Sexual health, mental health, well being, and Sensible drinking. CAUSES OF CERVICAL CANCER

The exact cause of cervical cancer is not known, but certain things appear to increase the risk. Around 95% of all cases of cervical cancer are linked with the specific types of the Human Papilloma Virus. This is a common viral infection that is passed on during sexual intercourse. Most women who have had sex will get Human Papilloma Virus at some point in their life, but the immune system often gets rid of the virus without you realising you had it. The women having a lot of sexual partners can increase the risk of getting Human Papilloma Virus. Other factors that can increase the risk include smoking heavily, getting pregnant at an early age, or having three or more pregnancies. (Department of Health Statistical Bulletin, Cervical Screening Programme, England: 2001-2002.) There is an excess risk of cervical cancer associated with long-term use (12 years or more) of oral contraceptives. The association is somewhat stronger for adenocarcinomas than for squamous cell carcinomas (Schiffman, (1996). Women who smoke are more likely to be affected than non-smokers, and, as with most cancers, its thought that diet can affect the risk. Tobacco smoking has been a well-known risk factor for cervical cancer (Winkelstein, (1990)....
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