Burnout Among Physicians

Introduction:

Cancer is a multifaceted and pervasive group of diseases characterized by uncontrolled cell growth and
the potential invasion of malignant cells into surrounding tissues and distant organs. It poses a
significant global public health concern, evidenced by its impact on worldwide morbidity and mortality.
According to the World Health Organization (WHO), cancer was accountable for approximately 10
million deaths in 2020, ranking among the primary causes of mortality (1). Among the spectrum of
cancers, cervical cancer notably affects women.

Cervical cancer initiates from abnormal cell growth in the cervix, the lower part of the uterus. Primarily
caused by persistent infection with high-risk types of the Human Papillomavirus (HPV), a sexually
transmitted virus (2), it stands as the fourth most common cancer in women globally, accounting for
around 604,000 new cases and 342,000 deaths in 2020 (3).

Globally, cervical cancer ranks fourth in frequency among women after breast cancer (2.1 million cases),
colorectal cancer (0.8 million), and lung cancer (0.7 million) in both incidence and mortality. For the age
group of 15-44, it stands as the third most common malignancy [4], [5]. In 2018, the age-standardized
incidence of cervical cancer was 13.1 per 100,000 women globally. Incidence rates, however, varied
widely among countries, with the least burden in Western Asia (Age-Specific Incidence Rate-ASIR <6 per
100,000), modest rates in various regions and higher rates in certain parts of Africa, Melanesia,
Micronesia, Southeastern Asia, Eastern Europe, the Caribbean, and South America (ASIR ≥11–15 per
100,000) [4]. Cervical cancer constitutes the primary cause of death in women in about 42 lower-
resource countries, accounting for approximately 84% of all cases and 88% of all deaths [ 4,5,6]. In the
Kingdom of Saudi Arabia (KSA), cervical cancer incidence is notably low, ranking 20th among other
cancers with only 316 new cases and 158 deaths reported in 2018 [7]. It stands as the sixth leading
cause of cancer-related death in women aged 15–44 years [6].

The incidence of cervical cancer significantly varies across regions, with higher rates observed in low-
and middle-income countries compared to high-income nations [8]. Despite Saudi Arabia's rapid
socioeconomic development, it continues to grapple with health challenges, including cancer. Cervical
cancer's incidence in Saudi Arabia is notably lower than the global average but remains a considerable
public health concern. According to the Saudi Cancer Registry, cervical cancer accounted for 1.9% of all
cancer cases in Saudi Arabia in 2018 [9].

The etiology of cervical cancer is a multifaceted phenomenon influenced by various factors. A primary
risk factor in the development of cervical cancer is the infection with specific types of the Human
Papillomavirus (HPV), a prevalent sexually transmitted infection (STI). Genetic predisposition and
inherited risk factors, such as a family history of cervical cancer, contribute to the susceptibility of an
individual. Additionally, lifestyle choices like smoking, alcohol consumption, and dietary habits play a
role in the development of this disease[10]

HPV, a group of more than 200 related viruses, is primarily transmitted through sexual contact, and the
majority of sexually active individuals will contract the virus at some point in their lives. Some strains of
HPV are considered high-risk due to their association with cervical cancer [11].

The association between HPV infection and cervical cancer is well-established. Persistent infection with
high-risk HPV types, such as HPV 16 and 18, poses a significant risk for the development of cervical
cancer. This virus can lead to cellular changes in the cervix, resulting in the formation of precancerous
lesions and, if left untreated, the progression to cervical cancer. Notably, not all women infected with
HPV will develop cervical cancer, as the immune system often clears the infection within a few years.
However, certain factors, such as a weakened immune system and the presence of other sexually
transmitted infections, can increase the risk of progression to cervical cancer[12].

The importance of HPV vaccination for the prevention of cervical cancer cannot be overstated. HPV
vaccines are specifically designed to protect against the most common high-risk HPV types associated
with cervical cancer. Vaccination is most effective when administered before exposure to the virus,
typically through routine immunization programs targeted at preadolescent or adolescent girls.
Research has demonstrated that HPV vaccination significantly reduces the incidence of HPV infection
and related cervical abnormalities[13].

This study aims to comprehensively assess the knowledge and awareness levels of cervical cancer, HPV,
and the acceptance of the HPV vaccine among female students at King Abdulaziz University, Rabigh
branch in Saudi Arabia. Understanding these factors is crucial for developing effective prevention and
awareness programs to mitigate the burden of cervical cancer in the region. In this extended analysis,
we will delve deeper into the context of cervical cancer in Saudi Arabia, explore the potential impact of
HPV vaccination, and emphasize the significance of knowledge and awareness in preventing this disease

References:
1. World Health Organization. Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer.
Accessed on November 1, 2023.

2. Schiffman M, Castle PE, Jeronimo J, et al. Human papillomavirus and cervical cancer. Lancet.
2007;370(9590):890-907.

3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018:
GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J
Clin. 2018;68(6):394-424.

4 .Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and
mortality of cervical cancer in 2018: A worldwide analysis. Lancet Glob Health 2020;8:e191-203.

5.Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018:
GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J
Clin 2018;68:394-424.

6.Almazrou S, Saddik B, Jradi H. Knowledge, attitudes, and practices of Saudi physicians regarding
cervical cancer and the human papilloma virus vaccine. J Infect Public Health 2020;13:584-90.

7.Global Cancer Observatory (GCO). Cancer in Saudi Arabia. GLOBOCAN; 2018. Available from:
https://gco.iarc.fr/today/data/factsheets/populations/682-saudi-arabia-fact-sheets.pdf. [Last accessed
on 2020 Apr 08].

4. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018:
a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-e203.

5. Saudi Cancer Registry. Cancer Incidence Report in Saudi Arabia. 2018. https://www.scr.org.sa.
Accessed on November 1, 2023.

6. Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer.
Lancet. 2013;382(9895):889-899.

7. La Vecchia C, Boccia S. Oral contraceptives, human papillomavirus and cervical cancer. Eur J Cancer
Prev. 2012;21(1):6-12.