Is cancer still scary at the time of Covid and the threat of a nuclear war? To the Italians, yes, they fear cancer more than any other disease. Today – on the occasion of the International HPV Awareness – attention is focused on women: more than a thousand die every year due to cervical cancer. Outlining the picture of the current situation is the new Censis Report, created with the unconditional support of Msd Italia, which analyzes the perception of cancer risk from HPV and the prevention strategies adopted through a survey conducted on two samples, one of parents and one of women.
The fears of parents and women
Every year in Italy there are more than 3,000 cases of cervical cancer caused by the Papillomavirus. Cervical cancer still represents a major cause of death for women. It is estimated that, among the new cases, in 2020, 1,011 women died from this pathology. The latest Censis Report lays bare the fears of Italians. In particular, it emerges that cancers are the most feared diseases of all by parents (69.6%) and by women in particular (67.7%). Lower down are the fear of dementia (feared by 42.7% of parents and by 47.7% of women), the fear of diseases that cause physical non self-sufficiency (by 28.9% both among parents and among women) and fear of cardiovascular disease (respectively by 18.0% and 11.9%).
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The prevention we have lost
The many awareness campaigns carried out over the years on the importance of prevention seem to have worked. 69% of parents and 65% of women, in fact, are of the opinion that cancers can be prevented. “Among the prevention strategies – he explains Ketty Vaccaro, head of the Censis Welfare and Health Area – first of all the preventive medical and diagnostic checks indicated by 79.9% of parents and 84.2% of women are reported “. But, due to the pandemic, cervical screening coverage among women between the ages of 25 and 64 has declined: it went from 81% in 2019 to 77.3% in 2020. Due to the concentration of services on contrast the pandemic also reduced the operation of vaccination services: the parents who received the active call for anti-HPV vaccination decreased from 56.0% in 2019 to 43.3% in 2022.
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Increase knowledge of the Papillomavirus
In 2022, the number of parents who know what Papillomavirus is has increased: they went from 85% in 2017 to 89%. Knowledge is more widespread among mothers (95.5%) and among people with a higher education level (94.0%). “Even the deeper knowledge of this virus improves,” Vaccaro points out. “In 2019, only half of parents knew that HPV is responsible for other cancers in addition to that of the cervix, while in 2022 this awareness rose to 62.7%”. The percentage of parents who know that HPV is responsible for genital warts remains in the minority, but is still on the rise, going from 42.6% in 2019 to 46.9% in the last year. For 24.8% of parents of both sexes (gradually decreasing compared to previous years) it is a virus that affects only women.
Sources of information and the role of the school
Where do parents and children find out? “The gynecologist prevails among the sources of information indicated by mothers (34.6%) and women (32.3%), while the family doctor is indicated by 34.6% of fathers”, explains Vaccaro. 22.2% of both parents and women, on the other hand, indicate information materials (brochures, posters, awareness campaigns) and 20.2% websites. The shares of those who indicate the ASL vaccination service are lower (the share falls from 25.6% in 2019 to 18.0% in 2022) and the pediatrician (13.0%). “This is a public health problem that not only affects women but everyone, but there is the absence of school and it is a very serious thing since prevention concerns adolescents”, she comments Giovanni Swaps, president of Agui (Association of Italian University Gynecologists). Just before the pandemic, we signed an agreement with the Ministry of Education to bring gynecologists to train in middle and high schools. We need to talk to the young people about HPV and vaccination because today it is not permissible for people to die again from a gynecological tumor “.
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Women prefer screenings
Pap test and HPV test are the checks that women reported having performed the most in the last three years (62.9%). The Pap test is a well-established prevention tool, known by almost all women. Less well known is the more recently introduced HPV-test, which still only 51.3% of parents are familiar with. 88.4% of women said their gynecologist recommended the Pap test, while the HPv test was only recommended in 42.6% of cases. Regarding prevention behaviors, 61% of both women and mothers say that they adopt preventive checks such as screening, examinations and visits even in the absence of symptoms. It is women of more mature age (between 46 and 55 years) who carry out more screening to prevent breast cancer (79.8%) and cervical cancer (67.3%). 51.5% of parents and 45.0% of women say they engage in healthy lifestyles, 39.0% in both cases say they resort to vaccination.
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Vaccination for HPv
57.3% of women were made aware by the specialist on the importance of treating Hpv infection because it can cause cervical cancer, while only 25.4% were recommended vaccination. Even women who reported at least one HPv-related problem were advised to vaccinate only in 22% of cases. Of these, 71.6% say that if they came back, they would get vaccinated or vaccinated against HPv first. But parents want to vaccinate their children grows. Parents who have decided to vaccinate at least one child against Papillomavirus have increased over time, going from 33.3% in 2017 to 43.3% in 2019 (the 2017-2019 National Vaccine Prevention Plan has extended the free indication to males), up to 46% today. The number of people interested in anti-HPV vaccination who have not yet vaccinated their children also increased compared to 2019, from 25.4% to 28.1%, and in parallel there is a reduction in parents who say they are not interested in vaccination ( they were 30.6% in 2017, they are 11.3% in 2022).
The lessons of Covid-19
Carlo Signorelli, president of Nitag (National Advisory Group on Vaccinations) also stressed the importance of HPV vaccination: “When the phenomenon of vaccination hesitation began in an important way in 2010, there was a decline in vaccination coverage for HPV then further slowed down by the pandemic. Unfortunately, after Covid-19 we are faced with new forms of vaccination hesitation. On adolescence, decisive action is needed and I believe that a focus will be foreseen in the National Plan, allowing, for example, recovery of vaccines even beyond the calendar age. Covid-19 has taught us that extending vaccination points is a measure that works as well as including Covid.19 boosters in new vaccination plans and calendars “.
Learn to communicate
How to convince the undecided of the importance of the HPv vaccine? “The weapon we have at our disposal responds precisely to the fundamental requirements that we ask of all prevention tools, namely safety, efficacy and tolerability”, he explains. Giovanni Gabutti, coordinator of the Vaccines Working Group of the Siti (Italian Society of Hygiene, Preventive Medicine and Public Health). “First of all, it is good that there is a sharing between us health professionals in order to disclose these aspects to the general population. We must explain that by now a lot of data has been accumulated on the effectiveness of this vaccine in all age groups to communicate its positive value and convince even the most doubtful by increasing vaccination coverage “. But it is not enough to address oneself only to women, it is necessary to broaden the reference audience as suggested Adriana Bonifacinopresident of IncontraDonna Onlus: “We need to talk more about prevention and health promotion and less about disease. We need to give more precise information not only to women or children but to all citizens, for example, explaining what the HPV mechanism is. because there are still no clear ideas about sexually transmitted diseases “.