by Marshaneil Soumi D’ Rozario | 09th March, 2019
In the wake of International Women’s Day, it is imperative to understand the growing threat of Cervical Cancer globally. The worldwide incidence of cervical cancer is approximately 510,000 new cases annually, with approximately 288,000 deaths worldwide. Unlike many other cancers, Cervical Cancer occurs early and strikes at the productive period of a woman's life. The incidence rises in 30–34 years of age and peaks at 55–65 years, with a median age of 38 years (age 21–67 years). Estimates suggest that more than 80% of the sexually active women acquire genital HPV by 50 years of age.
Cervical Cancer is ranked as the most commonly found cancer in women in India. India has a population of approximately 365.71 million women above 15 years of age, who are at risk of developing cervical cancer. The current estimates indicate approximately 132,000 new cases diagnosed and 74,000 deaths annually in India, accounting for nearly 1/3rd of the global Cervical Cancer deaths. Indian women face a 2.5% cumulative lifetime risk and 1.4% cumulative death risk from Cervical Cancer. At any given time, about 6.6% of women in the general population are estimated to harbor cervical HPV infection. HPV serotypes 16 and 18 accounts for nearly 76.7% of Cervical Cancer in India. Sexually transmitted Human Papilloma Virus (HPV) infection is the most important risk factor for cervical intraepithelial neoplasia and Invasive Cervical Cancer.
Non-oncogenic HPV serotypes-6 and 11 contribute to over 90% of benign genital infections such as genital warts. Oncogenic HPV serotypes have also been implicated in the causation of anal, vulvar, vaginal, penile and oropharyngeal cancers.
Dr.Sahithya, Consultant Gynaecologist, CARE Hospitals Hitech City, is of the opinion that Indian women can be protected against Cervical Cancer if the Cervical Cancer Vaccine is given at the right age. It is money well spent for future health as well as a protection against Cancer in later stages, when treatment is expensive and death can occur if detected late. Parents should insist on this vaccination for their daughters, as part of the Immunisation Program sponsored by the Government.
According to Dr.Sahithya, “HPV is a necessary cause of Cervical Cancer, but it is not a sufficient cause. Other cofactors are necessary for progression from Cervical HPV infection to Cancer. Long-term use of hormonal contraceptives, high parity, early initiation of sexual activity, multiple sex partners, tobacco smoking and co-infection with HIV have been identified as established cofactors; co-infection with Chlamydia trachomatis and herpes simplex virus type-2, immune suppression, low socioeconomic status, poor hygiene and diet low in antioxidants are other probable cofactors. Currently, all genital HPV infections cannot be prevented, except by abstinence and lifetime mutual monogamy. There is no clear evidence that barrier methods of contraception, most notably use of condoms, are effective. Secondly, except for genital warts, the infection is asymptomatic.”
THE AVAILABLE VACCINES: Two vaccines licensed globally are available in India; a quadrivalent vaccine (Gardasil™ marketed by Merck) and a bivalent vaccine (Cervarix™ marketed by Glaxo Smith Kline). Both vaccines are manufactured by recombinant DNA technology that produces non-infectious VLPs comprising of the HPV L1 protein.
These vaccines do not protect against the serotype with which infection has already occurred before vaccination.
Gardasil™: This vaccine confers protection against both Cervical Cancer and genital warts.
Cervarix™: This vaccine confers protection only against Cervical Cancer.
The two HPV vaccines are commercially available in India and approved by the Drug Controller General of India (DCGI), US Food and Drug Administration, European Medicines Agency and prequalified by the World Health Organization. The primary obstacle to HPV vaccination is financial. Because of the high cost of the present vaccines, the affordability and accessibility of these vaccines is a major concern for a mass vaccination program in developing countries like India. But, to date, no deaths have been causally associated with HPV vaccination in India or elsewhere.
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