INR and clinical articles: the case of cervical cancer

Abstract

INR's Aims and Scope are designed to ‘forward ICN's mission worldwide by representing nursing, advancing the profession and shaping health policy’, and ‘authors are encouraged to explore beyond local or national interests to the more general, global application of the principles underlying their work’.1 These terms of reference can make for difficult editorial decisions regarding nurses' accounts of their local clinical research. A decision to accept a clinical article, along with satisfactory peer review, usually considers the burden of disease represented by the clinical condition described; and also the author's ability to engage in a wider discussion of the study's policy implications. Two very different articles in this issue, each with cervical cancer as their core theme, illustrate the point. With the Papanicolaou (Pap) Smear screening test widely available in the developed world, it had generally been assumed that the fight against cervical cancer had been won. In the United Kingdom this assumption was dispelled when Reality TV star Jade Goody died from the disease at age 27, leaving two sons aged five and four years.2 It has been reported that in medically advanced countries between 30% – 40% of women do not take advantage of available cervical screening.3 Globally, the statistics are awesome. A complication of the Human Papilloma Viruses (HPV) ‘cervical cancer is the second most common cancer in women, with 500 000 new cases each year, 80% of which occur in Africa, Latin America and South East Asia. More than half the women with cervical cancer will die, with deaths projected to rise by 25% over the next ten years’.4 In Botswana, where the first article originates, the Standardized Mortality Ratio is 275 per 100 000 women.5 The article explores women's beliefs about the causes of cervical cancer, and demonstrates the vital importance of nurses' health education with vulnerable women. Irrespective of the availability of cervical screening, or the question of whether less developed countries will in future be able to afford immunization against carcinogenetic HPV strains, this study found that some women engage in vaginal hygiene practices that may aggressively damage the cervical mucosa and provide a perfect medium for HPV growth. The second article, from Israel, explores the uptake of Pap smear tests amongst a group of lesbian women. Despite being undertaken in a developed country with a relatively low incidence of cervical cancer (28 per million population), the authors' research found that only 22.2% of women had undergone the Pap smear test in the past. Yet, they cite evidence from earlier research that the proportion of lesbian women who contract the HPV virus may reach 13% or even 21%, even among those who have never had sexual intercourse with a man. Here then are two clinically-related articles about a major public health issue with important messages for nurses in both the developed and less-developed world. Constant vigilance is needed to identify vulnerable groups in any society, and the need for health education by nurses, routinely on a day-by-day basis, never goes away.