
KOCHI: The fourth leading cause of cancer among women globally and the second that affects Indian women is cervical cancer. Recent data reveal a staggering reality: approximately 1.24 lakh women in India are diagnosed with cervical cancer annually, and about 77,348 succumb to the disease. These numbers underscore the urgent need for awareness, prevention, and action.
Causes
The primary cause of cervical cancer is infection with the Human Papillomavirus (HPV), a sexually transmitted virus prevalent worldwide, including India. HPV infections are alarmingly common, with nearly every sexually active individual contracting the virus at some point in their life. Young adults are particularly susceptible, making HPV a significant public health concern.
HPV spreads through skin-to-skin contact, primarily during sexual activity. While condoms can reduce transmission risk, they are not foolproof. Several factors increase the likelihood of HPV infection, including early sexual activity, multiple sexual partners, smoking, and a weakened immune system.
High-Risk HPV Types
Among the 200+ identified HPV genotypes, two main categories emerge:
Low-Risk Types (6 and 11): These cause benign genital warts in both men and women.
High-Risk Types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66): These are associated with various cancers, including cervical, vulvar, vaginal, penile, anal, and certain head and neck cancers.
HPV types 16 and 18 alone account for approximately 66% of cervical cancers, while types 31, 33, 45, 52, and 58 contribute an additional 15%.
The Importance of Screening
Most HPV infections are asymptomatic and resolve within one to two years. However, persistent infection can lead to cervical cancer but this will occur over 15-20 years. Regular cervical cancer screening is vital for early detection and prevention. The World Health Organization (WHO) has set ambitious targets to eliminate cervical cancer as a public health problem by 2030:
Vaccination: 90% of girls fully vaccinated with the HPV vaccine by age 15.
Screening: 70% of women screened with a high-performance test by ages 35 and 45.
Treatment: 90% of women with precancerous lesions treated and 90% of invasive cancer cases managed.
Vaccination
Three types of HPV vaccines are available:
Bivalent: Protects against HPV types 16 and 18.
Quadrivalent: Protects against types 16, 18, 6, and 11.
Nonavalent: Offers comprehensive protection against nine types (16, 18, 6, 11, 31, 33, 45, 52, 58).
The nonavalent vaccine provides the broadest protection, covering nearly all HPV-related diseases and cancers.
When to vaccinate:
Ages 9-14: Two doses at 0 and 6 months.
Ages 15 and above: Three doses at 0, 2, and 6 months.
Vaccination is most effective when administered before exposure to HPV, emphasising the importance of vaccinating children early. These vaccines have been rigorously tested through robust clinical trials spanning over 10 years demonstrating safety and tolerability. It has shown immunogenicity, efficacy and effectiveness across diverse populations globally. No adverse effects have been seen for the vaccinations performed so far.
Take Action
As we observe Cervical Cancer Prevention Week from January 22 to 28, let us pledge to get informed, get screened, and get vaccinated. Together, we can eliminate cervical cancer and protect future generations.
Mind and body
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The writer is a consultant at the obstetrics and gynecology department in SP Medifort, Thiruvananthapuram