Running head: ASSIGNMENT2



Cervical Cancer

Dania Morejon

Florida National University

Advanced Primary Care of Family 

Professor:  Jorge Brito

November 17, 2022

Globally, cervical cancer is considered the fourth most common cancer among women. Approximately 604,000 new incidences were reported in 2020, while deaths due to this condition are said to be 342 000. It is estimated that about 90 percent of deaths happen in developing countries (low and middle-income). Women diagnosed with HIV are at six times higher risk of developing cervical cancer than those without HIV. About 5 percent of all incidences are linked to HIV. There has been a drop in the contribution of HIV disease on diagnosis with cervical cancer amongst younger women. Some programs in developed nations allow girls to vaccinate against HPV regularly with adequate treatment. The screening process is essential as it will enable early identification of the pre-cancerous lesions, thus making it easier for successful treatment.

On the other hand, individuals from nations from low- and middle-income regions experienced reduced levels of accessing preventive measures. The disease is not identified until it reaches the advanced stage and shows the symptoms. There is also limited access to treatment hence causing high rates of death from this condition in these nations. Therefore, the discussion looks into the effects of the HPV vaccine in reducing cervical cancer incidences compared to no interventions amongst women aged 15-26 years.


In young women between the ages of 15-26 years (P), what is the effect of the HPV vaccine (Gardasil-9,9vHPV) (I) compared to no vaccine (C) on the incidence of cervical cancer (O) in five years? (T)


In this case, the targeted population is young women aged 15-26. Over the last few decades, cervical cancer disease incidences and mortality rates have declined. The reduction is associated with population-based cervical cancer screening programs and the anti-human papillomavirus (HPV) vaccines. Nonetheless, epidemiological research works still show that the increase in rates of the disease among younger women (Kong et al., 2019). There wass an annual increase in the incidences of this condition amongst women aged 20-29 between 2000 and 2009.


The proposed intervention, in this case, is the HPV vaccine (Gardasil-9,9vHPV) which is targeted at reducing the risk of diagnosis and death from cervical disease amongst the selected population.


The proposed intervention is compared to no vaccination to determine its effectiveness.


The expected outcomes of implementing the proposed intervention are a reduction in the reported incidence of cervical cancer.


The proposed timeline for implementing the proposed intervention is five years.

The Vulnerable Population

Individuals considered to be a vulnerable population have high-risk factors for cervical cancer. One of the risk factors is HPV infections. Most HPV infections occur after individuals become sexually active; some clear the virus without any issues. At the age of 15 to 26, most younger girls are sexually active, leading to the risk of exposure to HPV infection (Cancer.Net, 2022). Starting to have sex early or engaging in multiple sexual partners exposes individuals to a high risk of getting infected with high-risk HV types.

The other risk factor is age and individuals vulnerable to cervical cancer disease based on the age increases from teens and mid-30s. Individuals past this age remain exposed to the risk of the disease (Cancer.Net, 2022). They require regular cervical cancer screenings involving a Pap test or HPV test process. Exposure to the condition is also linked to young women engaging in smoking behaviors. Individuals smoking are two times highly exposed to risk of diagnosis with cervical cancer than the non-smokers.

The vulnerability is also linked to socioeconomic factors. In this case, the condition is widespread among individuals with less access to cervical cancer screening. The vulnerability due to the socioeconomic aspects affects people from Hispanic people, American Indian individuals, and individuals from low-income families.

Another factor is linked to oral contraceptives. The use of oral contraceptives is common among individuals of ages above 18 years old. The use of oral contraceptives increases the risk of exposure to cervical cancer disease (Cancer.Net, 2022). The behavior is also linked to high-risk sexual behavior, resulting in a rise in the incidences of diagnosis with cervical cancer disease.

The risk for this condition is also linked to exposure to diethylstilbestrol (DES). In this case, young women whose mothers were provided with drugs during pregnancy to help in the prevention of miscarriage are highly exposed to the risk of diagnosis with a rare type of vaginal and cervical cancer disease (Cancer.Net, 2022). Without the annual pelvic examination for the cervical pap test and the four quadrant Pap test, the chances of diagnosis with the condition increase.

Literature Review

The alternative dosing schedules for the licensed HPV vaccine, especially single doses and the extended intervals between the doses, are under consideration to help address the shortages and improve operational flexibility. Secor et al. (2020) performed a systemic review study using databases such as PubMed and Medline. The non-inferiority analyses were performed to compare the alternative and the standard schedules utilizing the mixed impacts meta-recognition to control the baseline HPV status and the disaggregated by the vaccine. The most extended interval analyses were assessed against the standard schedules, revealing that the provision of the doses apart will deliberate on the non-inferior immune responses. Based on the criteria for non-inferiority, a single dose failed to meet such criteria. For the two schedules, sparse data reduced the number of potential comparisons.

HPV infections lead to a substantial burden of illness globally. Some of these diseases include cervical cancer. Patel et al. (2018) conducted a non-systemic review to determine the new epidemiological research that investigated the problems caused by HPV-linked illness and infection in Australia. The authors adopted a database search for relevant articles published between 2007 and 2016. Based on the outcome of this study, the clinical experiments show that the 9vHPV vaccine effectively prevents precancerous lesions and the tenacious infection of the cervix, vulva, and vagina (Patel et al., 2018). The 9vHPV vaccine prevents high-grade cervical lesions caused by the other five types of HPV viruses. The effectiveness of HPV vaccination is influenced by the attainment and maintenance of high vaccine uptake amongst girls and boys.

Prophylactic HPV immunization is representing a golden chance of reducing the problem caused by HPV-linked illnesses. The bivalent HPV 16/18 and the quadrivalent HPV 6/11/16/18 vaccines have been brought into the market for the last decades since they can prevent about 70 percent of the cervical cancer incidences linked to the HPV-16/18 globally and in Asia. Garland et al. (2018) described the efficacy, immunogenicity, and safety among Asian participants in 2 global studies. The study was randomized and double-blinded using the qHPV vaccine-controlled effectiveness study amongst younger women aged 16-26. The results from this study confirm the efficacy, immunogenic, and perfectly tolerated 9vHPV amongst the Asian population or participants. The data from the research supports the 9vHPV vaccination programs within the country.

The 9-valent HPV vaccine was designed for the purposes of expanding the past-designed quadrivalent vaccine coverage. Ruiz-Sternberg, in his study, focused on the efficacy, immunogenicity, and safety of the 9-valent HPV vaccine. This was a randomized, double-blinded, and controlled study using the qHPV vaccine to determine its immunogenicity, efficacy, and safety when used in women of age 16-26 years. Based on the study’s outcomes, the 9vHPV vaccine assisted in preventing HPV 31, 33, 45, 52, and 58 associated high-grade cervical, vulvar, and vaginal dysplasia (Ruiz-Sternberg et al., 2018). The outcome revealed 92.3 percent efficiency. The authors concluded that the 9vHPV vaccine is effective, immunogenic, and excellently tolerated by younger women, girls, and the boys from the Latin American ethnic groups.

Cervical cancer is higher in developing nations like Kenya and is linked rate of access to cancer prevention measures or services. HPV has increased, especially for individuals with HIV. Nevertheless, the possible effect of HPV immunization is not yet known. Liu et al. (2022) modeled health effects of the HPV vaccination from the perspective of HIV epidemiology. The authors adopted a validated compartmental transmission model of HIV and HPV to assess five situations of the nonavalent HPV immunization, single-age immunization of 10 years old girls at 90 percent coverage (Liu et al., 2022). The study's outcome shows that the model-age-cohort vaccination assists in reducing cancer rates by 75 percent.

Vaccines against HPV are essential in the control of this disease amongst nations from the low- or middle-income regions where the disease is more common. Nevertheless, there have been few data from these organizations concerning the effect of the program on HPV incidences Machalek et al. (2022). For the low and middle-income nations, the presently proposed two-dose schedule is challenging to provide at scale. Therefore, there is increased interest in a single-dose program.


Based on the evidence presented in the literature review, it is clear that the HPV vaccination program is effective in preventing cervical cancer disease, hence reducing the rates of infections among individuals. The HPV vaccine (Gardasil-9,9vHPV) helps in protecting individuals of ages 9 to 45 years against the illnesses caused by nine categories of HPV. This implies that the selected population in this proposed capstone project is highly likely to benefit from this evidence-based intervention.

The HPV vaccination program involving the use of the HPV vaccine (Gardasil-9,9vHPV) helps in protecting against the nine types of HPV associated with vaginal, cervical, and vulvar cancers amongst females. Therefore, to ensure the safety of the selected population, it is necessary to undertake a project involving the use of participants placed on the HPV vaccine (Gardasil-9,9vHPV) and those with no treatment intervention to determine the effects of the proposed solution to the problem of cervical cancer. The timeline for the implementation procedure is anticipated to take about five years, and the outcome is expected to show a drop in the incidences of cervical cancer disease amongst younger women of ages 15 to 26 years.


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Kong, Y., Zong, L., Yang, J., Wu, M., & Xiang, Y. (2019). Cervical cancer in women aged 25 years or younger: a retrospective study.  Cancer Management and Research11, 2051.

Liu, G., Mugo, N. R., Bayer, C., Rao, D. W., Onono, M., Mgodi, N. M., … & Barnabas, R. V. (2022). Impact of catch-up human papillomavirus vaccination on cervical cancer incidence in Kenya: A mathematical modeling evaluation of HPV vaccination strategies in the context of moderate HIV prevalence.  EClinicalMedicine45, 101306. DOI:https://doi.org/10.1016/j.eclinm.2022.101306

Machalek, D., Rees, H., Chikandiwa, A., Munthali, R., Travill, D., Mbulawa, Z., … & Kaldor, J. (2022). Impact of one and two human papillomavirus (HPV) vaccine doses on community-level HPV prevalence in South African adolescent girls: study protocol and rationale for a pragmatic before–after design.  BMJ open12(2), e059968.

Patel, C., Brotherton, J. M., Pillsbury, A., Jayasinghe, S., Donovan, B., Macartney, K., & Marshall, H. (2018). The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent?.  Eurosurveillance23(41), 1700737. Doi: 

Ruiz-Sternberg, Á. M., Moreira Jr, E. D., Restrepo, J. A., Lazcano-Ponce, E., Cabello, R., Silva, A., … & Luxembourg, A. (2018). Efficacy, immunogenicity, and safety of a 9-valent human papillomavirus vaccine in Latin American girls, boys, and young women.  Papillomavirus Research5, 63-74.

Secor, A. M., Driver, M., Kharono, B., Hergott, D., Liu, G., Barnabas, R. V., … & Drain, P. K. (2020). Immunogenicity of alternative dosing schedules for HPV vaccines among adolescent girls and young women: a systematic review and meta-analysis.  Vaccines8(4), 618. doi: