Health Policy and Cancer Prevention – The Case of Cervical Cancer. A Pilot Study on the Premises and Prospects of the Implementation of the HBV Vaccination in the Prevention of Cervical Cancer

Funded by: Sanofi Pasteur MSD

Project status/period: 2007-2009, completed

Research Question: Why do (don’t) women take advantage of preventive measures against cervical cancer (screening, HPV vaccination)? Which health policy measures are suited for a more efficient integration of women into preventive measures against cervical cancer?

Research Area / Methods: Health policy; representative survey, expert survey, expert interviews

Short description:
This pilot study seeks to evaluate attendance at preventive measures against cervical cancer (screening and HPV vaccination) in order to identify health policy measures for a better implementation of prevention measures against cancer. The potential of the newly introduced vaccination against the Humane Papillomavirus (HPV) is hereby of special interest. The study has a three-fold methodological approach. First, the prevention behavior (participation in screening and HPV vaccination), prevention-related attitudes, knowledge on cervical cancer and related preventive measures as well as socio-structural characteristics were captured by means of a representative survey. 760 randomly selected women between the ages of 14 and 65 living in the German federal state of Mecklenburg-Western Pomerania were interviewed via telephone based on a structured questionnaire. Second, a postal expert survey was carried out among physicians who are directly involved in providing preventive measures against cervical cancer or HPV vaccination (gynecologists, pediatricians, general practitioners and public health officers). Thereby we could include insights and experiences of medical professionals in the evaluation of the prospects of cervical cancer prevention measures. Third, diverse experts were interviewed in different phases of the project in order to integrate specific knowledge for the construction of the survey questionnaires and to gain insights from differing perspectives.

The results show that attendance at both screening and HPV vaccination can be best predicted by attitudinal factors. Positive connotations of cancer prevention measures and utility expectations, fear of cancer and high subjective risk perception were conducive to attendance at screening and HPV vaccination. Screening attendance is somewhat less regular among women of lower socioeconomic status. In contrast, HPV vaccination participation was higher for young women with lower educational attainment and lower social class. Knowledge did not have a significant impact on prevention. Also there is no trade-off between screening and vaccination attendance; the vast majority of respondents was aware of the necessity of regular screening attendance even when vaccinated against HPV.

Participation rates for existing primary and secondary prevention measures against cervical cancer can be enhanced by fostering perceptions of utility and positive connotations of regular screening and vaccination against HPV. In particular elderly women should be encouraged to attend screening by means of a recall system. Given the low overall level of knowledge about cervical cancer and its risk factors there is a need for education about the necessity and utility of prevention in order to reach women of all social classes.

The project is located within the framework of the interdisciplinary working group “Cancer Politics” at the University of Greifswald which involves scholars from medical science, political science, psychology and economics.

Project team:
Principal investigator: Prof. Dr. Detlef Jahn
Research fellows: Kati Kuitto, Dr. Susanne Pickel
Student assistant: Henning Neumann
Enrollees: Prof. Dr. Detlef Jahn, Prof. Dr. Hubertus Buchstein, Prof. Dr. med.dent. Dr.med. Hans-Robert Metelmann, Kati Kuitto, Dr. Susanne Pickel

Publications and Working Papers:
Kuitto, Kati/Pickel, Susanne/Jahn, Detlef 2010. Ansichten und Erfahrungswerte über die Praxis der Früherkennungs- und Präventionsmaßnahmen von Gebärmutterhalskrebs. Ergebnisse einer Expertenbefragung unter Ärzten in Mecklenburg-Vorpommern, in: Prävention und Gesundheitsförderung, Nr. 5 (Supp. 1): 38-45. DOI: 10.1007/s11553-010-0235-4.

Kuitto, Kati/Pickel, Susanne/Neumann, Henning/Jahn, Detlef/Metelmann, Hans-Robert 2010. Attitudinal and socio-structural determinants of cervical cancer screening and HPV vaccination uptake: a quantitative multivariate analysis, in: Journal of Public Health, Vol. 18, Nr. 2 (April 2010): 179-188. DOI: 10.1007/s10389-009-0308-z

Metelmann Hans-Robert/Kuitto Kati 2009. Attitudinal and socio-structural determinants of attendance at cervical cancer screening and HPV vaccination, in: Onkologische Pharmazie 2009 (2):20.

Kuitto, Kati/ Pickel, Susanne/Neumann, Henning 2009. Ärztliche Ansichten zur Prävention von Gebärmutterhalskrebs und zum Einsatz der HPV-Impfung. Ergebnisse einer Expertenbefragung unter niedergelassenen Frauen-, Kinder- und Jugend-, Allgemeinärzten sowie Amtsärzten im Öffentlichen Gesundheitsdienst im Rahmen des Forschungsprojektes „Gesundheitspolitik und Krebsprävention – Modellfall Cervixkarzinom. Eine Pilotstudie zu den Voraussetzungen und Erfolgsaussichten der Einführung der HPV-Impfung zur Prävention des Gebärmutterhalskrebses in Mecklenburg-Vorpommern“

Kuitto, Kati/ Susanne Pickel, unter Mitarbeit von Henning Neumann 2008. Frauen und Gebärmutterhalskrebsvorsorge in Mecklenburg-Vorpommern – Verhalten, Wissen und Einstellungen. Ergebnisse einer repräsentativen Bevölkerungsumfrage im Rahmen des Pilotprojektes „Gesundheitspolitik und Krebsprävention – Modellfall Cervixkarzinom. Eine Pilotstudie zu den Voraussetzungen und Erfolgsaussichten der Einführung der HPV-Impfung zur Prävention des Gebärmutterhalskrebses in Mecklenburg-Vorpommern“

Conference presentations:
Kuitto, Kati/Pickel, Susanne/Neumann, Henning/Jahn, Detlef 2009. Determinants of Attendance at Cervical Cancer Screening and HPV Vaccine. Poster presentation at the 25th International Papillomavirus Conference, Malmö, May 8-14, 2009.

Kuitto, Kati/Pickel, Susanne/Neumann, Henning/Jahn, Detlef/Metelmann, Hans-Robert 2009. Determinants of attendance at cervical cancer screening and HPV vaccine: Results of a representative survey. Poster presentation at the AACR 100th Annual Meeting, Denver, USA, April 18-22, 2009.