While there is an outpour of COVID-19 vaccine-related news on social media, television, newspaper, and government information channels, little awareness has been spread around the vaccine for cervical cancer, which is the cause of second-highest cancer-related deaths among Indian women.
On world cancer day, here's all you need to know about cervical cancer, and how HPV vaccine, which is currently available in India, can help prevent it.
Cervical cancer is caused by a persistent infection by a sexually transmitted virus called papillomavirus (HPV) and is easily detected through a simple screening procedure called the pap smear test. However, health experts claim that most Indian women do not opt for such routine health check-ups since there is still a lot of stigma and shame associated with women's reproductive health. Hence, by the time they consult doctors, in most cases, cancer had already progressed to an advanced stage, thereby causing a higher number of deaths.
Dr Rakesh Badhe, Surgical oncologist, Apollo Spectra Hospital, Mumbai, pointed out that one of the main reasons cervical cancer impacts so many women is poor genital hygiene in our country.
"Cervical cancer happens because of the papillomavirus, which is an STD. If you combine the virus, with poor genital hygiene, especially post-coital hygiene, then the chances of developing cervical cancer amplify," said Badhe.
"There are studies which very clearly prognosticate the fact that in communities where genital hygiene is followed more rigorously, lesser cases of cervical cancer are noticed," Badhe added. Generally, cervical cancer impacts rural women more than their urban counterparts.
Badhe pointed out that the HPV vaccine prevents sexually transmitted diseases, thereby averting cervical cancer. "It also prevents cervical intraepithelial neoplasia, which is caused by HPV and can lead to cancer if it goes untreated," he said.
How does the vaccine work?
HPV, since it is an STD is generally found in sexually active adults, pointed out Neha Kumar, Sr Consultant- Gyneoncology, BLK Cancer Centre, BLK Super Speciality Hospital. "However, more than 95 per cent of such adults can fight this virus through their immunity. In some cases, in which the virus persists over many years, it leads to cervical cancer," said Kumar.
"There are two types of HPV vaccines, bivalent and quadrivalent. Bivalent covers two strains of HPV, while quadrivalent covers four strains of the virus. The most common being used nowadays is the quadrivalent vaccine which covers 16 and 18 HPV strains, which are responsible for cervical cancer, as well as HPV strains 6 and 11, which are responsible for 90 per cent of genital warts," added Kumar.
Who are eligible for this vaccine?
As of now, the HPV vaccine is being given to adolescent girls, before the onset of sexual activities, around the age of 11 to 12 years, pointed out Kumar.
"In young girls, the vaccine prevents the infection caused by the previously mentioned strains of HPV. However, it covers only 70 per cent of cervical cancer. Therefore, it doesn't mean that you can never develop cervical cancer if you had an HPV vaccine. It only means that your chances of having cervical cancer are greatly reduced," said Kumar. Kumar suggested that since this vaccine does not provide a complete guarantee, sexually active women should continue with routine screenings even after vaccination.
Apart from adolescent girls, young-adults between 13-26 years can also take this vaccine. However, their doses differ. "In the USA, the HPV vaccine has been approved for older women too, up to the age of 45 years. But we need to understand that this is a preventive vaccine and not a therapeutic one. Therefore, if someone already has an HPV infection, the vaccine will not cure it," Kumar said.
Dr Manjula Patil, consultant obstetrician and Gynaecologist, Motherhood Hospitals, Bangalore said that for young girls, who are vaccinated before the onset of sexual activity, there are enough antibodies to fight against the HPV, which might not be the case, if the immunization happens in later years, for sexually active women.
Should boys be vaccinated?
"There are various HPV strains that can cause oral HPV infection and penile, vaginal and valval cancer. It is also responsible for genital warts. Therefore, there is also a trend to immunize boys in developed countries, not just girls," said Patil.
"Another reason boys are vaccinated is because they are always the carrier of HPV, and most women contract the HPV infection from men. Therefore, the idea behind immunizing boys is that the HPV injection is being targeted at the source so that it can be irradicated from its origin itself," added Patil.
Can pregnant women take this vaccine?
Dr Surabhi Siddhartha, Consultant, Obstetrician & Gynaecologist, Motherhood Hospital, Kharghar said, "there are two brands of the vaccine currently available in India, Cervarix and Gardasil."
"The vaccines can be taken any time, and it is given in separate doses, and as a shot in the arm. However, Pregnant women should avoid taking this vaccine. In fact, the vaccination process takes six months to complete. During this time, it is advisable to avoid pregnancy altogether," said Siddhartha.
What kind of vaccine doses are needed?
Experts claim that below 15 years of age, two doses are required six months apart, and after 15 years of age, three doses are required – the first dose at 0-month, second dose at the third month, and the third dose at sixth month. For women older than 26-years-old, it is generally given on a case-by-case basis.
"In 106 countries globally, the HPV vaccine is a part of the national immunization schedule. In our country, it has not yet been incorporated in the national immunization schedule but what we do here is opportunistic vaccination, which means that when we see girls or patients who have adolescent daughters, we recommend it," pointed out Kumar.
"It is a safe vaccine as far as efficacy is concerned. Otherwise, the side effects are the same as most vaccines cause, like local pain and tenderness. However, there had been very few cases of other issues, but those are sparse and rare. They have not been documented or proved conclusively. So, if 106 countries have incorporated it in their immunization schedule, it speaks for the fact that efficacy of this vaccine is good," she added.
Other gynecological cancers that impact women are uterus cancer, ovarian, vaginal, and valval cancer. Uterine cancer is generally detected in the post-menopausal age group and sometimes in younger women who have irregular vaginal bleeding for a prolonged time. Ovarian cancer is also known as the silent killer, and it is challenging to detect because its symptoms are non-specific. Therefore, it has a high fatality rate. Vaginal and valval cancers are rare. Valval cancer mostly occurs in older women in their 60s or 70s. Those women with polycystic ovaries should also monitor their status, and go for transvaginal sonography to avoid any cancerous development.