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Journalism of Courage
Written by Dr Abhishek Shankar
Like any Indian mother, a 45-year-old woman patient of mine, who was undergoing treatment for cervical cancer, was not so much worried about herself as she was about her children. “What kind of test/s or precautions should they take since we read that cancer is genetic in nature?” she asked me. This is the most frequently asked question in my OPD. Patients, caregivers and family members are always very keen to know about the possibility of the cancer gene passing down the family tree. I told her about the role of Human Papilloma Virus (HPV) vaccine to prevent cervical cancer and the importance of screening to detect it early. With the correct detection at the right time, precious lives can be saved.
Last month was dedicated to cervical cancer awareness but I think there should be a sustained campaign. This year, we are focusing on the goal of ending cervical cancer within a few generations. So, what are the key takeaways?
HPV makes up a group of viruses that are extremely common worldwide – there are more than 100 types, of which at least 14 cause cancer. HPV 16 and 18 are together responsible for about 70 per cent of the global disease burden. It is the most common sexually transmitted infection. The higher rates of cervical cancer incidence and mortality in India are not attributable to differences in cervical infection with HPV types. Instead, they are because of the absence of the HPV vaccination programme, the relative lack of high-quality cervical cancer screening and the lack of access to cervical cancer treatment.
Vaccination is the best prevention. Cervarix and Gardasil are the currently available HPV vaccines. Cervarix is a bivalent vaccine that protects you against HPV type 16 and 18. Gardasil is available in quadrivalent and non-valent forms that protect you against HPV strains 6, 11, 16 and 28 (and additionally 31, 33, 45, 52, and 58 in nine-valent or Gardasil 9).
The WHO now recommends one or two-dose schedules for girls aged between nine and 14 years, one or two-dose schedules for girls and women aged between 15 and 20 years and two doses with a six-month interval for women older than 21 years.
HPV vaccines are safe and part of the immunisation programme in many of the countries. Efficacy of the vaccine is reported between 95 and 100 per cent for HPV 16 & 18. Also, studies have confirmed the cross protection from HPV 31, 33 and 45.
Who should go for cervical screening and when? As per the recommendations, women aged between 21 and 29 years should be screened with cervical cytology examination (pap smear or test) every three years. Women aged between 30 and 65 years should go for cervical cytology examination every three years, a HPV DNA test every five years or co-testing with Pap Smear and HPV DNA test every five years. No screening is recommended for women below 21 years.
The elimination of cervical cancer will require not only bold strategic actions that are designed to improve community awareness in India but also to encourage women to adopt vaccination and go for screening. It also needs efforts to make the vaccine and screening accessible, rapidly expand workforce capacity, strengthen health systems; lower vaccine prices and accelerate the introduction of affordable technology into screening and treatment algorithms. Remember cervical cancer is preventable.
