Introduction
The human papillomavirus (HPV) is from the papillomavirus family which infects the cells in the skin or the mucous membrane. HPV is a non-enveloped double stranded virus which carries its genetic code from early (E1-E7) and late (L1-L2) proteins. The early proteins promote viral replication while late proteins are responsible for structural support or capsids of proteins. Two viral oncogenes together with the non-structural early proteins (E6-E7) were associated to the transformation of the tumor from benign to malignant stage. The aforementioned proteins influence carcinogenesis by promoting both the retinoblastoma (Rb) and p53 proteins. These proteins regulate cell growth and inhibit tumor growth and promote apoptosis as a response to cell damage respectively (Panwar et al., 2014).
The lifetime risk of acquiring HPV infection for people who have an active sexual life is 80%. Most cases of infections were found asymptomatic and are spontaneously resolved in the absence of clinical consequences in six to thirty months. Such infection was attributed to smoking, early age at first intercourse, past and present sexually transmitted infections. Indirect attribution such as attitude or behavior involves promiscuity of partners (D’Hauwers et al., 2013).
Some types of HPV causes benign papilloma while other types can lead to cancer which targets the some parts of both the male and female reproductive system such as the penis, vagina, cervix and even the anus and oropharynx. Some studies linked the human papilloma virus to head and neck squamous cell carcinoma (HNSCC). This weakening disease affects the mucosa of the tongue, tonsils, palate and pharynx which is collectively known as the oropharyngeal region. Thus, the HNSCC is collectively known also as the oropharyngeal squamous cell carcinoma. About 11,700 cases of HPV facilitated oropharyngeal squamous cell carcinoma has been diagnosed in the United States annually and most of those that has been infected were males (Panwar et al., 2014). There were several risk factors identified for the HNSCC. These factors include smoking, betel nut chewing and alcohol consumption. To date, at least 20-30% of all patients may not have acquired oropharyngeal squamous cell carcinoma through the said factors but by the presence of HPV virus. Indeed the role of HPV in the development of such disease has been well-recognized (Panwar et al., 2014). Given this setting, several therapeutic methods have been recommended to manage the disease such as chemotherapy and radiation therapy. Prior to the onset or the detection of the tumor, vaccines were even developed to prevent such disease.
Background of the Problem
Infants and young children received the highest priority of immunization because they are the most vulnerable. Only tetanus-diptheria vaccine was recommended before the end of year 2000 because recent studies have indicated that some vaccines are exclusively risky to young children and this may also cause epidemiological and clinical problems (Principi and Esponito, 2013). During adolescence however, fundamental changes in immunization scheme should be administered according to experts (Principi and Esponito, 2013). This has been implemented in most countries throughout the world. The human papillomavirus vaccination programs in adolescents have been implemented in the United States and Australia and some countries in Europe. About 74.3% of Year 7 students in Western Australian have returned their vaccination consent forms of HPV (Mak et al., 2012). The huge statistics has been attributed to the fact that the virus in itself has a debilitating effect on human physiology in nature.
Every year, there are 700 women being diagnosed with the human papillomavirus in The Netherlands. Of the total number of women diagnosed annually, 160 cases are from the age group 30-39 years old. Several studies suggested that screen test for the human papillomavirus is preferable at the age 35 years old and above (de Kok et al., 2013). But vaccination programs on adolescents have been widely implemented in some countries throughout the world. That HPV vaccine has been included in the recommended list of vaccines for adolescents is due to the fact that: (1) infection of HPV comes from sexual contact in humans; (2) the link between HPV and the development of genital, oropharyngeal warts and other anogenital andoropharyngeal cancers which is the main cause of cervical cancer; and (3) the fact that the first sexual intercourse happens usually among adolescents.
There are two specific types of HPV vaccine that were developed to address HPV-related disease. HPV2 which consists of types 16 and 18 is for the prevention of cancer and HPV4 which contains types 6 and 11 is for genital warts. Both types of vaccines are safe and efficient against cervical infections occurring in 6 months and also in pre-cancer lesions caused by types 16 and 18 HPV. The efficiency of the vaccine among adolescent females has been reported to be 93.2%.
At present, the knowledge about HPV is fast accumulating over time and established facts such as the relationship of HPV to cervical cancer and that the infection is asymptomatic has prompted the vaccination of female teenagers in the United States. However, debates are still ongoing in regards to the safety of the vaccine. Other treatment methods for cancer related HPV infection has been proposed by clinicians to improve the survival rate of cancer patients. For patients HPV infected patients related to oropharyngeal squamous cell carcinoma, the management protocols were based on the stage and the location of the lesion. Having recognized the biological and clinical behavior of HPV, therapeutic interventions on the cellular and genetic level has been considered by some clinicians. There has to be a balance between survival and reduction in treatment toxicity.
Given this current setting, it is only imperative to undertake a research to understand the perception of clinicians regarding the best treatment option to combat the human papillomavirus especially on female adolescent females. It is hypothesized that radiation and chemotherapy are among the best options to treat females who are infected with HPV.
Purpose of the study
This research aims to understand how the perception of clinicians on HPV cancer related treatments affect the condition of adolescent females.
Research Questions
This study aims to address the following questions:
- What is the human papillomavirus?
- What are its effects to adolescent females?
- How sexually active are the female adolescents in the chosen institution[s]?
- What are the implications of an active sexual life among female adolescents to acquiring HPV?
- How informed are adolescent females on the dire consequences of acquiring HPV?
- What treatments would clinicians recommend that is suitable for adolescents who are both infected and not infected with HPV?
- What are the factors considered for the treatment of HPV among adolescent women?
- What are the risks involved in treatments for cancer related HPV such as chemotherapy and radiotherapy?
- How does treatment recommendations of clinicians affect the female adolescent survival rate for those HPV infected?
Significance of the Study
The results of this study will further our understanding on how treatment choices of clinicians for cancer related HPV infection affects the survival rate of adolescent females affected with such disease. Such information will also help other interested parties on their study related to HPV.
Limitations of the Study
This study focuses solely on HPV virus and the effect of clinician treatment recommendations on HPV infected female adolescents. The study will also include the risk factors involving HPV treatment in women adolescents such as race, geographic region, age, sexual relationships, diet and nutrition, therapy undertaken i.e. chemotherapy or radiation therapy. Information of patients infected with HPV, will be requested to the hospital administration. Following the assumptions of normality of distribution of samples, 109 patients from the chosen institution will be considered upon the approval of request. Using random sampling, respondents will be selected via drawlots to avoid bias. Infected patients will be sent an informed consent request form before their participation to the survey. Female adolescent patients infected with HPV will be surveyed through a close-ended question format covering all aspects required to show the relationship of treatment choices to the HPV infected patients. Similarly, an informed consent request form will be given also to doctors administering treatment of HPV related disease assuring that their personal information will be kept confidential and that data will only be shared but not limited to this research only.
Analysis of data will be carried out using bivariate and descriptive statistics via SPSS. HPV virus is the dependent variable, while the independent factors include race, geographic region, age of female adolescents, sexual relationships, chemotherapy, and radiation therapy. Bivariate analysis will allow the researcher to study the relationship between dependent and independent variables. On the other side, descriptive analysis will help identify differences in the prevalence of the disease among participants. The research is likely to find that the prevalence of this disease is high among minority women because of their poor living conditions. The research is also likely to find out a positive relationship between the prevention of this disease and gynecological exam and vaccination. The recommended methods of treatment, expected to be found through this study include radiotherapy and chemotherapy.
Definition of Terms
Human papillomavirus (HPV) is from the Papovavirus family which affects the skin and basal cells of the squamous epithelium of cattle birds and humans. Can be transmitted from person to person via sexual contact and causes a change in the nature of tissue growth.
Viral oncogenes – these are the early and late proteins which promote excessive growth of tissues and the transformation of a tumor to a malignant stage.
Vaccine – is a weakened virus or a weakened foreign microbiological organism which is injected to the human body as an antigen to develop immunity for a particular disease caused by such microorganism.
Chemotherapy – is a treatment method for cancer that uses cytotoxic anti-neoplastic drug which is also known as a chemotherapeutic agent. This treatment method is used to prolong survival rate and reduce the effect of cancer to the body. This treatment is also combined with other treatment methods such as radiotherapy and surgery.
Radiotherapy – also known as radiation therapy uses radiation to kill malignant cells which are the main cause of cancer. Ionized radiation damages the DNA of tumor cells and causes apoptosis. This treatment is used along with other treatment methods for cancer such as chemotherapy and surgery.
