Editorial Published on December 30, 2023
War Against Cervical Cancer
Kavitha Ravia
a. Department of Pathology, Government Medical College, Thiruvananthapuram*
Cervical cancer continues to be a substantial health concern globally, despite the advancements made by medical science in the early detection and treatment of the disease.
Cervical cancer has been persistently claiming lives, especially in middle and low-income countries. In India, it is the second most common cancer in women between the ages of 35 and 55.
Researchers have revealed that most cases are associated with persistent infection by high-risk HPV subtypes such as 16,18,31,33,35,39,45,51,52,56,58,59,68 and others.1 70% of Squamous cell carcinomas are associated with HPV 16 and 18 and 90% of Endocervical adenocarcinomas are associated with HPV 18.2
The high rate of the spread of the disease and mortality are reported from regions with low rates of awareness about the causes of the disease and its preventive measures including vaccination. Bridging this gap to save the lives of women is a challenge for governments and health workers.
Cervical cancer is a preventable disease which in early stages is completely curable with treatment. There are effective ways of screening and detecting the disease at the pre-cancerous stage by PAP smears and HPV testing. Also, vaccinating the girls against Human Papilloma Virus has been found effective in preventing the disease.
Worldwide medical research has succeeded in achieving remarkable efficacy of the HPV vaccine in preventing HPV infections and, consequently, cervical cancer.
Since 2003, WHO has declared January as the cervical cancer awareness month with the aim of ending the cancer within a few generations. The month-long awareness campaign comes with the slogan, Get informed, Get screened and Get vaccinated.
Society needs to be made aware of the causes especially about the causative organism, HPV.
Campaigns to generate willingness among women from the age of 30 and above to get periodically screened for the disease and to sensitise the parents about HPV vaccination to girls in the 9-14 age group are being held.
The WHO has also set 2030 as the target year for achieving the 90-70-90 goal so that Cervical Cancer can be eliminated by 2060.3
The strategy delineates specific objectives regarding HPV vaccination, cervical cancer screening, and treatment effectiveness that need to be accomplished. The campaign has set the target of ensuring that 90 per cent of girls receive full HPV vaccination by age 15, screening 70 per cent of women with a high-performance test by ages 35 and 45, and providing treatment to 90 per cent of women diagnosed with pre invasive and invasive cervical cancer.
It would be a humongous task to accomplish this trifecta goal.. Intensive vaccination drives to get 9 out of 10 girls in the target age group vaccinated is the most significant step towards this direction.
In India, Sikkim took a significant stride in its campaign against cervical cancer in 2018 by vaccinating 25,000 school girls in the age group of 9 to 13 years.4 The State achieved a vaccination coverage of over 95% among the targeted group. It was the unwavering political support, insisting on vaccination as a mandatory condition for school enrolment, the collaboration between health and education departments at all levels, and well-executed social mobilization strategies that paved the way for the success of the programme in the north-eastern State.
In 2022, the National Technical Advisory Group on Immunization recommended the introduction of the HPV vaccine in universal immunization with a one-time catch-up for 9-14-year-old adolescent girls followed by routine introduction at nine years.5 This was based on the effectiveness of a single dose of the HPV vaccine, clinical trial data and the Sikkim experience.
Currently, the HPV vaccine CERVAVAC (quadrivalent vaccine targeting HPV 6,11,16 and 18), which is India’s first indigenous vaccine produced by the Serum Institute of India is available in the market.
GARDASIL 4 (quadrivalent vaccine targeting HPV 6,11,16 and 18), from Merck and Co is also available in India.
Researchers have suggested the vaccination in women before their sexual debut and hence, women above 26 years and who have been sexually active should be informed regarding reduced efficacy of the vaccine in older age groups and the importance of periodic screening.6
Dispelling myths and addressing concerns surrounding the vaccine empowers individuals to make informed health decisions.
The efforts for sensitization shall go beyond the general public and should also cover healthcare professionals, who have a pivotal role in vaccine advocacy. Partnership among healthcare providers, policymakers, and advocacy groups is vital to formulating a comprehensive sensitization strategy.
There shall be a united effort to enhance awareness about the effectiveness of the HPV vaccine against cervical cancer. Sensitization campaigns must be appealing, robust and evidence-based. They shall also be tailor-made campaigns for diverse audiences. The war against the killer disease can be won only through collaborative programmes, which promote the understanding of the disease and realising the role of vaccination in preventing the occurrence of the disease.
End Note
Author Information
Dr Kavitha Ravi
Editor, KMJ; Professor, Department of Pathology, Government Medical College, Thiruvananthapuram
Conflict of Interest: None declared
References