HPV vaccination will play a crucial role in ending cervical cancer – ET HealthWorld

Mumbai: January is globally earmarked as cervical health awareness month. Cervical cancer poses a huge burden, despite being preventable. It poses a significant health threat in India as it comprises 18.3 per cent of female cancers. The mortality rate is 11.7 per cent, and the impact is substantial as 212 women succumb to cervical cancer daily.

According to the World Health Organisation (WHO), cervical cancer is the fourth most common cancer in women globally, with an estimated 6,04,000 new cases and 3,42,000 deaths in 2020. The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. This reflects major inequities driven by a lack of access to national HPV vaccination, cervical screening and treatment services, and social and economic determinants.

ETHealthworld interacted with some experts from the Indian healthcare sector to explore the current status of cervical cancer in India, preventive measures, and the importance of training healthcare professionals in advocating for HPV vaccination. Healthcare professionals stress the primary preventive measure of the human papillomavirus (HPV) vaccine, recommended for girls aged 9 to 14 in two doses, six months apart, and a three-dose schedule for those aged 15 to 45.

Emphasising the significance of HPV vaccination, healthcare providers highlight various formulations, such as quadrivalent (targeting high-risk HPV types, particularly 16 and 18) and non-valent (targeting high-risk HPV types, 31, 32, 45, 52 and 58 in addition to 16 and 18), targeting high-risk HPV types, particularly types 16 and 18. The recommended vaccination age range is from 9 to 14, with a catch-up option for individuals up to 45 years old. The vaccine’s effectiveness is paramount for achieving the goal of eliminating cervical cancer by 2030.

Secondary prevention entails screening women for high-risk HPV, employing various modalities such as pap smears, HPV tests, colposcopy, and visual inspection with acetic acid (VIA). Detecting precancerous conditions early allows for timely intervention and treatment, significantly lowering the risk of cervical cancer.

Importance of programmatic accessibility

While physical accessibility to cervical cancer services exists, healthcare professionals highlight the importance of programmatic accessibility, especially in densely populated countries like India. The challenge lies in reaching remote areas, and healthcare providers suggest leveraging artificial intelligence (AI) for colposcopy diagnosis in these regions.

Dr Hrishikesh D Pai, Medical Director, and President, FOGSI, stated, “The government needs to make a policy decision, considering the intricate infrastructure investments. Scientifically, there is a clear need to incorporate vaccination into the national programme. Logistically and programmatically, the implementation is a decision for the government. As a voluntary organisation and federation, we collaborate with the government on various programmes, and their respect for our opinions has been commendable. These pro-people programmes are likely to be incorporated into the national programme in due course.”Male HPV vaccination

Extending the conversation to male vaccination, emphasising that once a significant proportion of girls are vaccinated, herd immunity is achieved. Young boys can receive two doses, while older boys up to 26 years old can receive three doses.

Sharing her views on male HPV vaccination, Dr Manisha Ranjan, Consultant, Obstetrician & Gynaecologist, Motherhood Hospitals, Noida, mentioned, “Administering the HPV vaccine is not merely a shield against a single adversary; it is a powerful armour defending not only against the insidious cervical cancer but also guards against a spectrum of diseases and cancers in women and men.

For women, the vaccine remains a stalwart defender against cervical cancer, but it also guards against other cancers, such as those of the vulva, vagina, and anus. Equally crucial, however, is its role in protecting men from a range of HPV-related conditions, including cancers of the penis, anus, and oropharynx. Furthermore, the vaccine serves as a potent shield against genital warts for individuals of all genders.

Men account for four out of ten incidences of cancer linked to HPV. There is no special screening for HPV-related malignancies in men. This emphasises how crucial it is to vaccinate men against HPV in order to prevent the disease. By recognising and promoting the equal importance of the HPV vaccine for both men and women, we not only foster gender-inclusive healthcare but also contribute to a comprehensive strategy for eradicating the potential harms posed by HPV across diverse populations. In doing so, we prioritise the health and well-being of everyone, breaking down barriers to create a more equitable landscape of preventive medicine.”

Healthcare professionals’ role in advocating for HPV vaccination

Healthcare providers play a vital role in advocating for HPV vaccination, serving as messengers to reassure patients about the vaccine’s safety and effectiveness. Training programmes are crucial to educating healthcare professionals about the vaccine and equipping them to effectively communicate its benefits to patients.

Training strategies encompass counselling sessions to address misinformation and myths surrounding the HPV vaccine. Scientific data and role play assist healthcare professionals in building conviction and effectively communicating the importance of vaccination.

Dr Priya Ganesh Kumar, Chairperson, FOGSI Oncology Committee, said that the WHO recognises the importance of HPV vaccination as a key strategy to prevent cervical cancer and other HPV-related diseases. The primary goal of HPV vaccination is to prevent cervical cancer, which is a major public health issue worldwide. HPV vaccines target the most common high-risk HPV types that cause cervical cancer. Vaccination can significantly reduce HPV infection rates and the subsequent development of cervical precancerous lesions and cervical cancer in India.

Dr Rishma Dhillon Pai, Past President, FOGSI, said, “India accounts for approximately one-fifth of the global burden of cervical cancer cases. Cervical cancer is one of the leading causes of cancer-related deaths among women in India. HPV infection is the leading cause of cervical cancer. Thus, cervical cancer can be prevented through HPV vaccination. FOGSI has recommended HPV vacation for women and girls from nine years to 45 years for the primary prevention of HPV infection.”

Collaborations with educational institutions, community organisations, NGOs, and the government are crucial for the success of HPV campaigns. This collective endeavour targets a wider audience, ensuring both healthcare providers and the community are well-informed and engaged.

A comprehensive approach involving vaccination, screening, and awareness required

Addressing the challenge of cervical cancer in India requires a comprehensive approach involving vaccination, screening, and awareness. Healthcare professionals play a pivotal role in advocating for HPV vaccination, dispelling myths, and fostering partnerships to enhance accessibility and coverage. As the nation progresses towards cervical cancer elimination, collaboration and informed healthcare practices continue to be the cornerstones of this public health initiative.

Dr Jaideep Tank, President-Elect, FOGSI, said, “Cervical cancer claims one life every eight minutes in India, with nearly 95 per cent of cases attributed to HPV. Current estimates indicate that every year, around 1,23,907 women are diagnosed with cervical cancer, and an estimated 77,348 die from the disease. Trends and projections in the number of cervical cancer cases in India in 2015, 2020, and 2025 are 65,978; 75,209; and 85,241, respectively, as per ICD, International Classification of Diseases 10th Revision.”

Dr Nandita Palshetkar, Past President, FOGSI, said, “Cervical cancer ranks as the second most frequent cancer among women between 15 and 44 years of age. The high incidence is linked to low literacy, inadequate screening, limited awareness, social inequality, stigma, and poverty.”

Dr Rishubh Gupta, Managing Director, Roche Diagnostics India, added, “Cervical cancer poses a paradoxical situation in India. Despite being the most preventable cancer among women, it claims the lives of approximately 77,000 Indian women. Unfortunately, lack of awareness, gender disparity, inadequate policy implementation, and lack of national screening guidelines are crippling issues in the fight against cervical cancer.”

He emphasised that cervical cancer screening and population-based HPV DNA testing can demonstrate better outcomes over both conventional cytology and visual inspection under acetic acid (VIA) testing in reducing the incidence, and that should be encouraged, along with the introduction of a self-sampling solution. The elimination of cervical cancer can be achieved through the powerful integration of diagnostics, pharmaceuticals, data, and the evolution of personalised healthcare.

Addressing India’s cervical cancer burden requires a comprehensive, inclusive strategy that involves awareness, HPV vaccination, and screening. Since cervical cancer comprises 18.3 per cent of female cancers, resulting in 212 daily fatalities, healthcare professionals emphasise the pivotal role of the HPV vaccine in cancer prevention, building herd immunity, and eventually eliminating cancers caused by HPV.

Public-private partnerships (PPP), collaboration with relevant stakeholders, training of healthcare professionals, and promotion of HPV vaccination underscore the need for cervical cancer elimination by 2030. For India to succeed by 2030, integration/deployment of advanced technologies in remote locations and a holistic approach will play a pivotal role in achieving this ambitious goal.

  • Published On Jan 23, 2024 at 06:07 PM IST

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