When discussing cervical cancer, what often gets left out is that it is one of the most preventable of cancers. Despite this, cervical cancer continues to be a cause of thousands of deaths among women every year, not only in India, but in many parts of the world. In many such cases, the condition is detected far too late, leaving limited room for intervention. The issue therefore, is not a gap in science, but a gap in awareness
What causes cervical cancer
The main culprit in cervical cancer is a virus that is very common, human papillomavirus, or HPV for short. HPV primarily spreads through close skin-to-skin contact, most often during sexual intercourse. The virus is so widespread that virtually everyone, both men and women, at some point in their lifetime, will be infected without even realising it. More often than not, the immune system gets rid of the virus without causing any damage.
However, some types of HPV are more dangerous than others. A few high-risk strains can stay in the body for years, and slowly cause changes, altering the cells of the cervix, which is the lower part of the uterus. Over time — sometimes a decade or more — these changes can turn into cervical cancer. This slow progression is what makes prevention possible.
The HPV vaccine
This is where the HPV vaccine enters the picture. The HPV vaccine is not used to cure cancer; it also does not cure HPV if it is present. What it does, is ensure that some of the most detrimental types of HPV do not enter and infect the body in the first place. You could think of it as immunisation ahead of time.
Over the past 20 years, a lot of attention has been focused on the HPV vaccine, more than on nearly all other vaccinations combined. Major studies around the world indicate that the overall result is very promising if pre-adolescent girls are administered this vaccine before exposure to the virus, as this helps to eradicate potential precancerous stages of the cervix with greater effect. In countries where the HPV vaccine has been administered early, fewer cervical cancer cases are being observed among young women, pointing to good results.
Administration and safety
The vaccine is most effective if administered to children before the commencement of their sexual activity, which is why it is advised that it is given to girls between the ages of 9 and 25. At this age, the immune system responds well to the vaccine, providing a level of protection before any possible exposure can occur.
Sometimes this creates unease among parents who may feel that such a vaccine promotes sexual activity among children; however, this belief is entirely misplaced. When it comes to safety concerns, there is no doubt that the vaccine is safe, having been administered to hundreds of millions of people throughout the world. The side effects are harmless, involving pain or a swelling where the shot was given, a slight temperature, or dizziness, which lasts momentarily. The vaccine is safe, with the risk of serious side effects being small, and extensive follow-up studies have failed to find a relationship between the vaccine and infertility or chronic diseases.
Another positive note is that there has been some research now to show that even a single dose of HPV vaccine could provide excellent immunity, even though the schedule calls for two or three doses. If this phenomenon is reported in larger, more widespread studies, it would make immunisation easier and more accessible in many countries like India.
Low coverage
Despite all this evidence, HPV vaccination coverage remains low in many parts of the world. In India, lack of awareness plays a major role. Many families have never heard of HPV or its link to cervical cancer. Others worry about cost or assume the vaccine is unnecessary if there are no symptoms. Unfortunately, HPV infections are silent — by the time symptoms appear, cancer may already be advanced.
But the story does not end when it comes to vaccination. Cervical screening is also relevant even for women who have been vaccinated. This is because screening tests can identify changes in the cells of the cervix well before the development of any cancers.
Also Read: Eliminating cervical cancer: goal, strategies and action taken
Moving forward
The bigger picture looks encouraging. Some countries are planning to make cervical cancer a disease of the past. And this is not a a distant scenario anymore: through proper vaccination, cervical cancer can soon become a rare occurrence. For families, the message is clear. This is not just another shot to be given. It is a measure that will help in the prevention of cancer, benefitting not just this generation, but the next one too.
(Dr. Esha R. Shanbhag is associate consultant, gynaecological oncology, Aster Whitefield, Bengaluru. eshars@gmail.com)
