Cervical cancer prevention in women through HPV vaccination

Prof L Ranjit Singh *

HPV Vaccination Services launched by Karkinos Healthcare Manipur on 24th November 2023 :: Pix - Virtual Communication

Cancer, aptly described 'the emperor of maladies' has been a scourge of mankind since time immemorial . In fact, the very mention of this diagnosis at the doctor's office, entails dread and despair universally. Therefore, the concept and possibility of preventing cancers in the human body before it actually appears offers tremendous benefits in terms of lives saved and suffering avoided.

And if we talk about women in particular, cervical canceris are of the principal players in this morbid game of life and death. In fact, cervical cancer is one of the most common cancers and is the fourth leading cancer in women. As a result, it poses a significant public health challenge for resource constrained countries like India.

Globally 77,348 cervical cancer deaths occur annually and India alone accounts for 25% of all deaths. Based on this data there is an urgent need for our country to initiate steps to protect its women from cervical cancer because "An ounce of prevention is better than one pound of cure" Human Papilloma Virus (HPV) is the causal agent for cervical cancer.

Besides cancer of the cervix, HPV infection also causes genital warts, vaginal cancer, anal cancer, throat and mouth cancers. We can protect almost every woman from cervical cancer through HPV vaccination administered in early age and adopt strong measures to increase uptake of HPV vaccination as a primary preventive measure.

How many types of HPV: The initiating event in cancer cervix is infection with HPV. Out of more than 200 types of HPV, over 40 types infect the ano-genital tract in females and all types of HPV live in one type of cell called squamous cell in the human body. Of all HPV infections, 75 per cent are spontaneously cleared within 1 to 2 years but can be reinfected with other types.

As many as 75% of sexually active men and women have HPV infections in their lifetime. Even though HPV infections are usually spontaneously cleared, some women can have persistent infection leading to genital warts and cervical cancer . Hence, even infected persons should also get HPV vaccine and strictly follow screening protocols.

The Government aims to eliminate cervical cancer in the coming decades by immunizing adolescent girls with HPV vaccine in addition to other existing secondary preventive measures like Pap test that is scheduled every three years.

Cervical Cancer Elimination in India: The Cervical Cancer Elimination Consortium-India will collaborate with the Government wherever appropriate to pilot "100 Cervical Cancer Mukt (Cancer Free) Districts" through their integrated SAVE Strategy: screening, access to treatment, vaccination and education.

Collaborative Effort: The Indian Medical Association (IMA), the largest medical body in the country and Federation of Obstetric and Gynaecological Societies of India (FOGSI), signed a memorandum on 8th January, 2025 for eliminating cervical cancer in India.

The collaboration also aligns with IMA's mission to improve the health of every citizen of the country and this will definitely be a historic milestone in our fight against cervical cancer. The joint venture also signals shared commitment to eliminating cervical cancer through HPV vaccination. The secondary preventive measures for cervical cancer like Pap tests are also essential for elimination of cervical cancer.

But India being a vast country with a huge population, the number of women undergoing Pap tests as per guidelines is dismal, thereby further emphasizing the need for HPV vaccination in eliminating cervical cancer.

Myths and Misconceptions about HPV vaccine: The HPV vaccine hesitancy or refusal to vaccinate is mainly because most of the people are ignorant of cervical cancer. It may be due to concern about safety of the vaccine and also lack of doctors' recommendation. The general perception that HPV vaccine is unnecessary or can cause some harm to their children may lead to vaccine hesitancy.

Some parents also think their children are too young for HPV vaccination as the initial dose of vaccine is administered at an early age of 9 years. Others also question why vaccination for such a rare illness in young children.

Lastly, may be because the vaccine is not easily accessible or affordable for most of the people both in developing and underdeveloped countries that includes India. HPV vaccine does not protect against any other sexually transmitted infections.

It may also be noted that there is no need to delay pregnancy atter HPV vaccination as vaccines are simply HPV-like particles and inactive. The life-time risk for cervical cancer in the USA stands at 129 per 100,000 women born and the US Government planned tailored-approaches to minimize vaccine hesitancy so that 100% of young girls receive HPV vaccine.

The National Strategy of Australia aims to eliminate cervical cancer by 2035. Australia is the first country in the world to introduce a National Publicly-funded HPV Vaccination Program in 2007. Similarly, Canada has a goal to eliminate cervical cancer by 2040. England also pursues elimination of cervical cancer by 2040.

HPV vaccine is one of the safest vaccines that prevents cancers and has strong scientific evidence for its effectiveness. Another interesting fact is that the protection of HPV vaccine against HPV infection lasts for at least 12 years.

Truly speaking, cervical cancer is now considered preventable and no woman in India should die from it in the coming decades. We may presume that the cervical cancer is on its way to eradication globally. In this regard, one key strategy is to vaccinate 90% young girls (9-14 years) against HPV infection to prevent cervical cancer in adulthood as a primary prevention strategy.

The National Technical Advisory Group on Immunization in India recommended inclusion of HPV vaccination in Universal Immunization Program to enhance both uptake of HPV vaccine and its recommendation. The Government may include the HPV vaccine in the Universal Immunization Program as early as by year end or early next year.

In India, the countdown is on for an indigenous and gender-neutral vaccine that may be rolled out soon. The State of Bihar has launched a free HPV vaccination drive for girls aged 9-14 as part of the Mukhyamantri Balika Cancer Pratirakshan Yojana, this is a separate initiative and not part of the regular UTP.

The political will and commitment for such an important initiative is a cue for other States. The Nation definitely needs more and more physicians to strongly advocate HPV vaccination to happen "Cervical Cancer Mukt Bharat" and that will be a dream come true for our nation.

I am optimistic that cervical cancer is on its way to elimination in our country too.

Till then our slogan remains "Do Teeke Zindagi Ke". Capsule: "Do Teeke Jindagi Ke" (Two doses of HPV vaccine) for Cervical Cancer prevention, fourth leading cancer in women.