Regular
cervical cancer screening, vaccination save lives
Cervical cancer, a
preventable cancer, continues to be the second-most-common cancer among women
globally. Scientists and researchers from around the world brainstormed in
sessions on cervical cancer management and control at the International
Conference on "Emerging Frontiers and Challenges in Management and Control
of STIs and HIV" organized by National Institute for Research in
Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), and MGM
Institute of Health Sciences.
Dr Joel Palefsky,
Professor of Medicine, University of California, San Francisco, US, said that
although cervical cancer incidence has come down in India despite absence of
any big cancer-prevention efforts in India yet it continues to be a leading
form of cancer for women (breast cancer has the highest rates among women
followed closely by cervical cancer).
Dr Neeta Singh, Professor
and Head of Department of Biochemistry, All India Institute of Medical Sciences
(AIIMS), said 528,000 cases of cervical cancer occur globally, out of which
132,082 are in India. 273,500 women die of cervical cancer globally every year,
out of which 74,118 deaths occurred in India.
Dr Smita Joshi, Associate
Professor, Department of Preventive Oncology, Hirabai Cowasji Jehangir Medical
Research Institute, Pune, said that almost 85% of cervical-cancer deaths occur
in countries where there is a lack of population-based cervical
cancer-screening programmes for all eligible 30- to 50-year-old women. Almost
200 women died every day due to cervical cancer in India, which is essentially
preventable.
Dr Neeta Singh said that
majority of the people who have HPV infection will clear the virus in 1-2 years
and do not develop cervical cancer. Human body's immune system usually
eliminates the HPV infection on its own. Cervical HPV infection usually becomes
undetectable within 2 years in 90% of women. She cautioned that we need to
watch out for women where HPV infection persists and can cause a variety of
serious health problems.
Health problems that can
be caused by HPV include: genital warts; cervical cancer (cancer on a woman's
cervix); and cancers of the vulva, vagina, penis, or anus; and a type of
head-and-neck cancer called oropharyngeal cancer.
Dr Singh added that
lifetime risk to ever contract HPV infection is 80% so it is better to get
screened regularly. She said that even if the person has been vaccinated it is
recommended to go for regular screening as there are a number of HPV strains.
Dr Paelfsky said that in a
study, 92% tested positive for HPV. Out of these HPV positive tissues, 79.6%
were HPV 16 or HPV 18. Remaining most common types of HPV were: 45, 73, 31, 56,
52, 58, 59, 33, 68, 51, 35, 26 and 39.
NOT
JUST FEMALES, MALES TOO AT RISK OF HPV CANCERS
Dr Palefsky said that HPV
infection sets in about 5cm inside the anal canal. Mean age for development of
anal cancer is 62 and for cervical cancer is 49 as progression of anal cancer
is slow. Anal cancer rates in a North American AIDS Cohort Collaboration on
Research and Development (1996-2007) were no less alarming: 131 per 100
thousand among HIV-infected men who have sex with men (MSM), 36 per 100
thousand among men who have sex with women, and 30 per 100 thousand among
women. Just like cervical cancer, anal cancers are also potentially
preventable.
In a study on anal HPV
infection in Indian HIV-positive men who have sex with men (MSM) at two sites
in India, Christian Medical College (CMC) Vellore and Humsafar Trust Mumbai,
rates had set the alarm bells ringing. 90% HPV infection was reported from CMC
Vellore site and 95% HPV infection among study participants at Humsafar Trust
Mumbai. In CMC Vellore those HIV positive MSM who participated in the study
were more likely to be married and elder than the cohort in Mumbai (which was
less likely to be married and younger in age).
VACCINE
EXISTS FOR SOME STRAINS OF HPV
Dr Palefsky said that
quadrivalent vaccine is effective in preventing HPV infection and cancers. It
is effective against the following HPV types: 6, 11, 16, and 18, among others.
In USA, this vaccine is
approved for routine use to prevent genital warts; vulvar, vaginal, cervical,
and anal cancers in girls and women aged 9-26 years; and genital warts and anal
cancer in boys and men aged 9-21 years and in immunocompromised or HIV-positive
men who have sex with men (MSM) aged 9-26 years.
Dr Palefsky argued that
current vaccines may reduce cervical cancer by up to 70%, and newer vaccines
may further reduce rates by more than 90%. HPV vaccines have an excellent
safety record with no evidence of any serious adverse events attributed to it,
said Dr Palefsky.
Dr Palefsky recommended
rolling out HPV vaccination in India. School-based approach is good as trying
to vaccinate young girls outside of schools will be extremely challenging. In
USA, one-third of young girls get vaccinated in schools. School-based roll-out
may help to reach out to young girls and boys to prevent them from HPV-related
cancers and other complications later in life.
ARE
WE DOING CERVICAL CANCER SCREENING IN A MAJOR WAY?
Dr Balaiah Donta, who is a
senior scientist at National Institute for Research in Reproductive Health
(NIRRH), an Indian Council of Medical Research (ICMR) institute, and also one
of the organizing secretaries of this conference, said a very small percentage
of women undergo pap-smear screening due to lack of awareness and due to
deep-rooted patriarchy, as men continue to play a key role in women's
health-seeking behaviour. Dr Smita Joshi added that according to a study, less
than 10% women in India access cervical cancer-prevention services. Unless we
improve the cervical cancer screening in our country, its rates are unlikely to
decline in our country.
Dr Palefsky argued that
HPV vaccination is thus the best approach to prevention of HPV-related cancers
in India because current approaches to cervical cancer control in India are not
working well enough. HPV vaccines are safe and immunogenic in HIV-infected men
and women too
