Protecting Your Health: The Essential Guide to HPV and Cervical Cancer Prevention

- Author : Dr. Kiran R Konda, MBBS, MD, Assitant Professor, Department of Obstetrics & Gynaecology, BGS Medical College & Hospital

Cervical cancer remains a significant public health issue in India, ranking as one of the leading causes of cancer-related deaths among women in the country. Despite advancements in medical science, early detection and prevention strategies like the Human Papillomavirus (HPV) vaccination, awareness and implementation remain challenges. We would like to throw light on the prevalence of cervical cancer in India, the role of HPV in its development, the status of HPV vaccination, and the need for increased awareness and implementation of vaccination programs.

Prevalence of Cervical Cancer in India

Cervical cancer is the second most common cancer among women in India, following breast cancer. According to data from the National Cancer Registry Programme (NCRP), it accounts for nearly 16.5% of all cancers in women. The incidence and mortality rates of cervical cancer are particularly high in rural areas, where access to healthcare and cancer screening is limited. Factors such as early marriage, multiple pregnancies, poor genital hygiene, and limited access to screening programs contribute to the high prevalence of cervical cancer in these regions.

The high burden of cervical cancer in India can be attributed to several socio-economic and cultural factors. Many women lack awareness about the disease and the importance of regular screening. Pap smears and HPV testing, which can detect precancerous changes in the cervix, are not widely available or affordable for the general population. Consequently, many cases are diagnosed at advanced stages when treatment is less effective.

Role of HPV in Cervical Cancer

Human Papillomavirus (HPV) infection is the primary cause of cervical cancer. HPV is a group of viruses, with over 100 types, of which at least 14 are cancer-causing (high-risk types). HPV types 16 and 18 are responsible for approximately 70% of cervical cancer cases worldwide. The virus is transmitted through sexual contact, and most sexually active individuals will be infected with HPV at some point in their lives. However, in most cases, the infection clears on its own. Persistent infection with high-risk HPV types can lead to the development of cervical cancer over time.

HPV infection causes changes in the cells of the cervix, leading to the development of precancerous lesions. If these lesions are not detected and treated early, they can progress to invasive cervical cancer. The long latency period between initial HPV infection and the development of cervical cancer provides an opportunity for effective intervention through screening and vaccination.

HPV Vaccination

HPV vaccination is a highly effective method of preventing cervical cancer. The vaccines currently available target the high-risk HPV types 16 and 18, as well as other types that cause genital warts. The World Health Organization (WHO) recommends vaccinating girls aged 9-14 years before they become sexually active, as the vaccine is most effective when administered before exposure to HPV.

In India, the introduction and uptake of the HPV vaccine have faced several challenges. The vaccine was introduced in the country in 2008, but coverage remains low. Several factors contribute to the low uptake of the HPV vaccine in India, including lack of awareness, cultural barriers, cost factor and concerns about vaccine safety.

Awareness and Education

Lack of awareness about HPV and the HPV vaccine is a significant barrier to vaccination in India. Many people, including healthcare providers, are not adequately informed about the link between HPV and cervical cancer, the benefits of vaccination, and the safety of the vaccine. Public health campaigns and educational programs are essential to increase awareness and acceptance of the HPV vaccine. These programs should target not only the general population but also healthcare providers, who play a crucial role in recommending and administering the vaccine.

Cultural Barriers

Cultural attitudes towards sexuality and vaccines can also hinder the uptake of the HPV vaccine. In many parts of India, discussing sexual health is considered taboo, making it difficult to communicate the importance of the HPV vaccine. Additionally, there are misconceptions that the vaccine encourages promiscuity or that it is unnecessary for girls who are not sexually active. Addressing these cultural barriers requires culturally sensitive communication strategies and the involvement of community leaders to endorse the vaccine.

Safety Concerns

Concerns about the safety of the HPV vaccine have also impacted its uptake in India. Several long-term studies and data have shown the vaccine to be safe and effective. It can be safely administered to all eligible individuals.

Current Status of HPV Vaccination in India

Despite these challenges, there have been efforts to increase HPV vaccination coverage in India. Several states, including Punjab and Sikkim, have implemented school-based vaccination programs with promising results. The success of these programs highlights the importance of government commitment and the need for a coordinated approach to HPV vaccination.

In addition to government initiatives, non-governmental organizations (NGOs) and international organizations have played a crucial role in promoting HPV vaccination in India. These organizations have conducted awareness campaigns, provided financial support for vaccination programs, and worked with local communities to address cultural barriers.

The Need for a Comprehensive Cervical Cancer Prevention Strategy

To effectively reduce the burden of cervical cancer in India, a comprehensive prevention strategy is needed. This strategy should include the following components:

1. *Awareness and Education*

   - Public health campaigns to increase awareness about cervical cancer, HPV, and the benefits of HPV vaccination.

   - Educational programs for healthcare providers to ensure they have accurate information about the HPV vaccine and can effectively communicate its importance to patients.

2. *Screening and Early Detection*

   - Expanding access to cervical cancer screening programs, particularly in rural areas.

   - Integrating HPV testing with existing screening programs to improve early detection of high-risk infections.

3. *Vaccination Programs*

   - Implementing school-based HPV vaccination programs nationwide to reach girls before they become sexually active.

   - Addressing cultural barriers and safety concerns through community engagement and transparent communication.

CDC Advisory Committee on Immunisation Practices (ACIP) recommendations on HPV vaccination:

The Drugs Controller General of India (DCGI), India, recently approved the license for manufacturing the indigenously-developed India's first Quadrivalent Human Papillomavirus vaccine (qHPV) against cervical cancer.

 4. *Government Commitment and Funding*

   - Ensuring sustained government commitment to HPV vaccination programs, including adequate funding and resources.

   - Collaborating with NGOs and international organizations to leverage additional support and expertise.

5. *Monitoring and Evaluation*

   - Establishing robust systems for monitoring and evaluating the impact of HPV vaccination and cervical cancer screening programs.

   - Using data to identify areas for improvement and ensure that programs are effectively reaching the target population.

The World Health Organization (WHO) has set three targets that all countries must reach by 2030:

Let us join hands in getting rid of cervical cancer from India by making sure to vaccinate all girls and women, and by timely cervical cancer screenings. We are happy to assist you in case of any further doubts on this topic. Do reach to our expert doctors for further assistance.