Assignment Topic:
Cervical Cancer and the Evidence-Based Public Health Using The
P.E.R.I.E. Process.
Course Tittle: Introduction to Public Health
(POP202)
Section: 01
Semester: Fall 2024
Submitted To:
Mohammad Bellal Hossain, PhD
East West University
Submitted By:
Sadia Binte Hossain
2022-1-10-034
What is evidence-based public health??
Evidence-based public health practice is the development, implementation, and evaluation of
effective programs and policies in public health through applying principles of scientific
reasoning, including systematic uses of data and information systems and appropriate use of
behavioral science theory and program planning models.
Even with all of public health's achievements, evidence-based practices deserve more emphasis.
Based on evidence When making decisions concerning the care of communities and people in
the areas of illness prevention, health maintenance, and health promotion, public health is
described as the diligent, clear, and prudent application of the best available evidence.
What is P.E.R.I.E. Process?
In public health, the P.E.R.I.E. process is a methodical framework for analyzing and successfully
addressing health issues. It leads experts through a methodical process to recognize
,comprehend, and resolve public health issues. This process is actually circular. If the evaluation
suggests that more needs to be done, the cycle can and should be repeated. Thus, it is an ongoing
process.
There are five basic questions that we need to ask that together make up what we will call the
evidence-based public health approach.
1.
2.
3.
4.
5.
Problem: What is the health problem?
Etiology: What is/are the contributory cause(s)?
Recommendations: What works to reduce the health impacts?
Implementation: How can we get the job done?
Evaluation: How well does/do the intervention(s) work in practice?
1. Problem: Cervical Cancer?
Cervical cancer is a cancer arising from the cervix or in any layer of the wall of the cervix. It is
due to the abnormal growth of cells that have the ability to invade or spread to other parts of the
body. The majority of cervical cancers are caused by different strains of the human
papillomavirus, or HPV. A frequent infection spread during intercourse is HPV. The body's
immune system usually stops HPV from causing damage when it is present. However, in a tiny
minority of individuals, the virus persists for years. This plays a part in the process that turns
certain cervical cells into cancerous ones.
In describing a health problem, we need to address the burden, course, and distribution of
disease.
Cervical cancer impacts over 600,000 women every year and causes approximately 340,000
deaths, with the majority occurring in low- and middle-income countries where access to
screening and HPV vaccines is limited. In wealthier countries, prevention programs have helped
reduce the burden, but in many parts of the world, this disease continues to claim lives,
particularly in underserved communities.
Cervical cancer often starts with an HPV infection, which can progress to precancerous changes
and, eventually, invasive cancer if left untreated. Early detection can save lives, with survival
rates over 90% for early-stage cases. Unfortunately, advanced cases are much harder to treat and
often lead to poor outcomes. The disease is most common in women between the ages of 30 and
50, especially in regions like sub-Saharan Africa and South Asia, where healthcare access is a
challenge. Bridging these gaps in prevention and care is critical to saving more lives.
2. Etiology: What is/are the contributory cause(s) of Cervical Cancer?
The primary cause of cervical cancer is persistent infection with high-risk strains of the human
papillomavirus (HPV), particularly types 16 and 18, which are responsible for about 70% of all
cervical cancer cases. HPV is a sexually transmitted virus, and most people will get infected with
it at some point in their lives, though in most cases, the infection clears on its own. However,
when the infection persists, it can lead to changes in the cervical cells, resulting in precancerous
lesions that can eventually develop into cancer.
Other contributory factors include smoking, which weakens the immune system and makes it
harder for the body to clear the HPV infection, and weakened immune systems (e.g., due to HIV
or immunosuppressive medications), which increase the risk of persistent HPV infection.
Additionally, early sexual activity, multiple sexual partners, and lack of regular screening (such
as Pap smears or HPV testing) also contribute to a higher risk of developing cervical cancer.
3.Recommendations: What works to reduce the health impacts of Cervical Cancer?
Several evidence-based strategies can significantly reduce the health impact of cervical cancer:


HPV Vaccination: Vaccinating girls and boys (ideally before sexual debut) against the
most common high-risk strains of HPV, particularly types 16 and 18, can prevent up to
70% of cervical cancers. The vaccine is most effective when given at a younger age,
ideally around 11-12 years old.
Routine Screening: Regular cervical cancer screening, such as Pap smears and HPV
testing, can detect precancerous changes before they develop into cancer. Screening is


recommended every 3-5 years for women aged 21 to 65, depending on the method used.
Early detection allows for treatment of precancerous lesions, preventing the development
of cancer.
Improved Access to Treatment: For women diagnosed with cervical cancer, timely
treatment options like surgery, radiation therapy, and chemotherapy are essential.
Ensuring access to these treatments, especially in low-resource settings, is key to
improving survival rates.
Health Education and Awareness: Raising awareness about the importance of HPV
vaccination and regular screening can empower women to take preventive actions.
Community-based education programs can help reduce stigma and encourage preventive
care.
4. Implementation: How can we get the job done?
To reduce the burden of cervical cancer, a comprehensive approach is needed:




Government Action: Governments should integrate HPV vaccination and screening
into national health programs, offering them for free or at low cost, particularly for
underserved populations.
Strengthen Healthcare Systems: Ensure accessible vaccination and screening
services, especially in rural areas, by training healthcare workers and using mobile
clinics for outreach.
Community Education: Raise awareness about cervical cancer prevention through
local leaders and community programs, focusing on the importance of vaccination
and early screening.
Global Collaboration: Partner with organizations like the WHO to provide
resources and support, ensuring vulnerable populations receive necessary care.
5.Evaluation: How well does/do the intervention(s) work in practice?
To see how well cervical cancer interventions are working, we need to look at a few key factors:


Vaccination Rates: We can measure the success of HPV vaccination programs by
tracking how many girls and boys are getting vaccinated. Higher vaccination rates
suggest that the program is reaching the people who need it most.
Screening Participation: It's important to track how many women are getting regular
screenings, like Pap smears or HPV tests. The more women participate, the more likely
we are to catch issues early and prevent cancer from developing.


Impact on Cancer Rates: Over time, we can look at whether cervical cancer rates (both
incidence and death) are going down, especially in areas where vaccination and screening
programs are strong. A decrease in these numbers would show that the interventions are
working.
Treatment and Survival: For women diagnosed with cervical cancer, we can measure
how many are getting the treatment they need, like surgery or chemotherapy, and look at
survival rates. If more women are surviving, it shows that access to treatment is
improving.
Sources:
1. ACS, Cervical Cancer https://www.cancer.org/cancer/cervical-cancer.html
2. WHO, Cervical cancer https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
3. Chapter 2, Public Health 101 Improving Community Health, THIRD EDITION by Richard
Riegelman, Brenda Kirkwood