India has an expanding population, with the current population of over1.2 billion, making it the most populous democracy in the world. The best of healthcare is available to the rich in the private sector. It is also offered by the state to the poor, but access to health care is difficult as specialized healthcare is available mainly in the urban areas. Hence the prevention and management of cancer remains a perogative of the urban rich amongst whom we see the best of 5 year survival rates. On the other hand, the 5 year survival rates after cancer amongst the rural poor is disastrous.
Studies have shown that majority of cervical cancers are caused by HPV virus, hence HPV vaccination combined with regular screening is important for cervical cancer prevention.
HPV is the short form for human Papilloma Virus, which is the most common sexually transmitted virus. This small, double-stranded DNA virus infects the epithelium of the cervix during sexual acitivity.
To detect HPV infection, a swab is taken from the cervix and is tested for the presence of DNA of the HPV. Though most HPV infections spontaneously regress without causing any symptoms, this infection should not be ignored as it can cause cervical cancer in women. There are more than 100 types of HPV. Some of them are known to cause cancer whilst most of them are at present not found to be clinically relevant. The low-risk or non-oncogenic types of virus, such as types 6 and 11, can cause benign or low-grade abnormalities in the cevis of the cervix, genital warts and warts in the voice box or larynix. High-risk HPV types, such as types 16 and 18, are found in 99% of cervical cancers. Type 16 is found to cause approximately 50% of cervical cancers across the world and types 16 and 18 together cause about 70% of cervical cancers.
Direct genital contact during sexual intercourse (vaginal or anal) could result in HPV infection if the partner is infected. However, the disease does not spread through body fluids as the virus does not survive in any body organs or in blood. Though HPV infection through genital contact without sexual intercourse is rare, there have been cases where women without a history of intercourse have been infected with the virus. Some type of genital HPVs could transmit through oral–genital or hand–genital contact. An infected mother can transmit the virus to the newborn baby during child birth. Though rare, this can result in respiratory papillomatosis, which causes development of warts in the baby’s throat.
The HPV vaccine offers very good protection, if taken prior to becoming sexually active usually lasts for a long time. There have been continuing studies to monitor the vaccine’s effectiveness, as it is a relatively new vaccine. The total vaccination consists of taking 3 doses over a period of 6 months.
Side effects of HPV vaccination are very mild. The most commonly seen mild side effects include soreness, redness or swelling at the site of injection for a few days. There can also be other mild side effects such as sickness, slightly high temperature, itching, rash, diarrhoea and pain in joints.
The chances of a sexually active person having HPV infection are very high, hence HPV vaccination is recommended mainly to protect against the two most serious types of HPVs that can cause cancer later.
Two types of HPV cause 70% of cervical cancers and the HPV vaccine protects against these two viruses. A vaccinated person is still vulnerable to other types of HPV. So cervical screening every three years is recommended to detect any cervical abnormalities. Thus, the best level of protection against cervical cancer can be achieved by vaccination and regular screening.
The effectiveness of other medications or contraceptive pills is not found to be affected by the HPV vaccine.