Can this vaccine check cervical cancer?

The Indian Express 30/12/2015

The health ministry is keen on introducing the human papilloma virus (HPV) vaccine in the universal immunisation programme, hoping to check the incidence of cervical cancer, the second most common cancer among Indian women. Abantika Ghosh explains..

What is HPV?
Human Papilloma Virus, commonly known by its abbreviation HPV, is a group of more than 150 viruses that cause papilloma or warts in parts of the body, including genital areas. They spread by skin-to-skin contact and are responsible for a number of diseases, including cancers, though they are most commonly associated with cancer of the cervix (neck of the uterus).

Is HPV the sole cause of cervical cancer?
No, but it is the most common cause of cervical cancer, which ranks second among all cancers in Indian women. HPV is associated with more than 80 per cent cervical cancers — not all HPV infections go on to become cancerous. Dr K Karthigeyan of the Department of Paediatrics at McMaster University in Ontario, Canada, published an article in the Indian Journal of Medical and Paediatric Oncology that said: "HPV is a necessary cause of cervical cancer, but it is not a sufficient cause. Other co-factors are necessary for progression from cervical HPV infection to cancer. Long-term use of hormonal contraceptives, multiple pregnancies, early initiation of sexual activity, multiple sex partners, tobacco smoking and co-infection with HIV have been identified as co-factors.

What is the incidence of cervical cancer in India?
The leading cancer among Indian women is of the breasts, followed by cervix. Data from the national cancer registry shows that in 2013,92,731 cases of cervical cancer were reported in India, a figure that is projected to go up to 1,00,479 in 2020 (Source: National Health Profile). India accounts for about a third of the global cervical cancer deaths. This is a slight improvement from before when cervix was the leading cancer site. Increase in the age of sexual activity initiation, better hygiene, education among women, late first pregnancy etc. are believed to have marginally improved the cervical cancer scene in India. The anti-HPV vaccine is expected to further check the incidence of the disease.

Who will be administered the HPV vaccine? Is it available now?
The vaccine will be administered under the country's universal immunisation programme, where a set of vaccines are administered free of cost at government institutions, all of them currently to children. The vaccine is recommended for girls at the age of 11-12 years though it can be administered to both boys and girls of that age. The US National Cancer Institute recommends "vaccination of females aged 13 through 26 years and of males aged 13 through 21 years who have not been vaccinated previously or who have not completed the three-dose vaccination series. Males aged 22 through 26 years may be vaccinated". In India, it is marketed by two companies, Gardasil and Glaxosmithkline, and is administered largely in the private sector, if the doctor feels the need or if the patient demands it The vaccine currently costs less than $5 a dose.

When will the vaccine be part of the universal immunisation programme?
Not any time soon. For now, the ministry has asked a sub-committee of the National Advisory Group on Immunisation, a body that recommends new vaccines for the na- tional programme, to weigh the pros and cons of introduction of HPV vaccine.

Is the vaccine controversial?
In 2009, a project anchored by an international NGO to inject 32,000 children in Andhra Pradesh and Gujarat with the cervical cancer vaccine ran into rough weather after some deaths were reported. It later came to light that the vaccines had been administered without the requisite consent of the families. The project had to be discontinued and was cited by activists as one of the instances of multinational companies exploiting the poor for their clinical trials.

The matter is still sub-judice but the incident cast a shadow on HPV vaccination in India. The other challenge involved in introducing the HPV vaccine in India is convincing parents about the need to vaccinate their pre-puberty daughters for a disease that is essentially spread by sexual contact.

Is HPV vaccine the only way to control cervical cancer?
No. Opinions vary on whether condoms prevent HPV infection. However, countries such as the United States, which has successfully arrested incidence of cervical cancer, have relied as much on vaccines as on mandatory screening of all women of reproductive age.

What is the status of cervical cancer screening in India?
Cancer of the cervix is one of the few kinds of cancer (breast, oral etc) that can be isolated during screening. However, despite a national programme for screening, there is very little emphasis on it. The primary reason is said to be the lack of trained personnel. However, a low-cost screening method using vinegar — a test that is easy to administer — has not been popularised either.