Dr Deepak Bharti
Cervical cancer is the fourth most prevalent cancer amongst women worldwide and in India, it is the second most common cancer among women. “According to latest statistics, every year in India about 1,20,000 women are diagnosed with Cervical cancer and about 67,000 women die from the disease every year. India has a population of about 400 billion women, aged 15 years and older who are at a risk of cervical cancer.” Cervical cancer is caused by chronic infection with human papilloma virus (HPV), which is a sexually transmitted virus. One can prevent getting this virus by taking vaccination. If the vaccine is given to girls before sexual exposure between 9-14 years, it is more than 99% effective in preventing cervical cancer. The vaccine also protects against genital warts and some other cancers also like anal, vulval vaginal, penile, oropharyngeal cancers as well some cancers of head and neck.
Trials have shown that HPV vaccines are nearly 100% effective in preventing cervical cancers caused by highest HPV viruses. These vaccines also provide protection against vulvar and vaginal cancers. Meanwhile, India’s first indigenously developed vaccine to prevent cervical cancer, CERVAVAC, is all set to be available by December 2022, costing between Rs. 200-400 a shot. CERVAVAC will be effective against at least four variants of HPV.
Why is HPV vaccination recommended?
* One out of 4 women who die of cervical cancer is from India.
* Every seven minutes one woman dies of cervical cancer in India.
* Cervical cancer kills roughly 67,477 Indian women annually.
* Human Papilloma Virus (HPV) has been detected in 99.7% of all cases of Cervical Cancer worldwide.
* This is the highest level of the associated pathogen known to be a major cause for a human form of Cancer.
* HPV types 16 and 18 are responsible for 82%of cervical cancers in India.
What are HPV virus strains against which Cervical Cancer vaccine offers protection?
The quadrivalent vaccine available in India targets four strains of human papillomavirus (HPV) – HPV-6, 11, 16, and 18. Both have 70% efficacy against Cervical cancer. HPV-16 and HPV-18 account for about 70% of all cervical cancers. HPV-6 and -11 cause about 90% of genital warts.
What is the best time for married women to “Catch Up” with HPV Vaccination?
For married women with no previous immunization against HPV, they would have to visit gynaecologists for initial screening which would decide whether the Vaccination will be of any help or not. Results indicate that acceptance and compliance to vaccination are best after delivery and it is absolutely safe to take it during lactation.
Who should not take HPV vaccine?
* Anyone who has ever had a life-threatening allergic reaction to yeast, to any other component of HPV vaccine, or to a previous dose of HPV vaccine should not get the vaccine. Tell your doctor if the person getting the vaccine has any severe allergies.
* Pregnant women should not get the vaccine. The vaccine appears to be safe for both the mother and the unborn baby, but it is still being studied. Receiving HPV vaccine when pregnancy is not a reason to consider terminating the pregnancy. Women who are breast feeding may safely get the vaccine.
What are the risks from HPV vaccine?
HPV vaccine does not appear to cause any serious side effects. However, a vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of any vaccine causing serious harm, or death, is extremely small. Several mild problems may occur with HPV vaccine:
*Pain at the injection site (about eight people in 10)
* Redness or swelling at the injection site (about one person in four)
* Mild fever (100 F) (about one person in 10)
* Itching at the injection site (about one person in 30)
Should the vaccine be given to women who are already infected with HPV or have cervical cell changes?
CDC recommends that women who have an HPV infection and/or an abnormal Pap test result that may indicate an HPV infection should still receive HPV vaccination if they are in the appropriate age group because the vaccine may protect them against high-risk HPV types that they have not yet acquired. However, these women should be told that the vaccination will not cure them of current HPV infections or treat the abnormal results of their Pap test
Although HPV vaccines have been found to be safe when given to people who are already infected with HPV, the vaccines do not treat infection. They provide maximum benefit if a person receives them before he or she is sexually active.
What is the dose schedule of HPV Vaccine?
* The vaccine is given in a 2 or a 3 dose schedule depending on the age of the patient.
* For age 9- 14 years – 2 doses at 0 month and 6 months.
* For age 15 to 45 years- 3 doses at 0 month, 1 month and 6 months.
India’s first HPV vaccine against cervical cancer: All you need to know
There was a shortage in the global market. Now, after the launch of Indian vaccine, we will be able to take care of our requirements within our made-in-India vaccine. It is very effective and prevents cervical cancer because, 85% to 90% of cases, cervical cancer is because of this particular virus and this vaccine is against those viruses. So, if we give it to our young children and daughters, they are protected from the infection and consequently probably 30 years later, there is a possibility that cervical cancer does not occur. The Department of Biotechnology (DBT) announced the scientific completion of India’s first locally made quadrivalent human papillomavirus vaccine (qHPV) against cervical cancer. The cervical cancer vaccine, Quadrivalent Human Papillomavirus vaccine (qHPV), is developed by the Serum Institute of India (SII) and the Department of Biotechnology(DBT). It will be launched soon in the National Immunisation programme for 9-14-year-old girls.
Prevention of Cervical Cancer
* Regular screening by Papanicolaou (PAP) Test: This is a test where in a doctor performs an internal examination and uses a special tool to scrap or brush the cervix to remove the cells from the cervix for testing. The pre-cancer stage can be treated before it progresses to Cervical cancer. It is recommended that every woman who is sexually active should have a test in every 3 years.
* Getting vaccination for cervical cancer: Cervical cancer vaccines protect against infection with human papillomavirus types which most commonly leads to cancer. These vaccines can only work to prevent HPV infection. They cannot treat an HPV infection on the cervix which is already present. It is also important to know that no vaccine can provide complete protection against all cancer causing HPV virus. So even after vaccination, routine PAP Test is important.
(The author is Cancer Specialist at Narayana Hospital, Jammu)
HPV vaccination against Cervical Cancer
Dr Deepak Bharti