Assessment of Knowledge, Awareness about

Cervical Cancer, Human Papillomavirus, and

Vaccine Acceptance of Human Papillomavirus
(HPV) among Students at King
Female Abdulaziz
University, Rabigh Branch inSaudi Arabia.

BY
:
SUPERVISOR: DR. HANADI TALAL
AHMEDAH QUSAY ALYOUBI
DR:HAMZA
HABEEBALLAH
DR:AHMED M. TOLAH
DR:ISRAA ALSAADY

2023

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1.1. 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

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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

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 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].
8. 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.
9. Saudi Cancer Registry. Cancer Incidence Report in Saudi Arabia. 2018.
https://www.scr.org.sa. Accessed on November 1, 2023.
10. Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus
and cervical cancer. Lancet. 2013;382(9895):889-899.
11. La Vecchia C, Boccia S. Oral contraceptives, human papillomavirus and
cervical cancer. Eur J Cancer Prev. 2012;21(1):6-12.
12. Zur Hausen, H. (2009). Papillomaviruses in the causation of human cancers - a brief
historical account. Virology, 384(2), 260-265.
13. Munoz, N., Bosch, F. X., de Sanjose, S., Herrero, R., Castellsague, X., Shah, K. V.,
... & International Agency for Research on Cancer Multicenter Cervical Cancer Study
Group. (2003). Epidemiologic classification of human papillomavirus types
associated with cervical cancer. New England Journal of Medicine, 348(6), 518-527.

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