Cervical Cancer is responsible for more than any gynecologic-related deaths world wide than any other malady, making it the most important preventable disease in women's health today. Worldwide each year 4, 93,243 women are diagnosed of cervical cancer of whom 2,40,000 women die of this disease (WHO). India contributes more than ¼ of the global burden. Each year about 1,32,082 cases of this cancer are diagnosed and more than 74,118 women die of this disease, this cancer being most common cancer of women in our country.
Human Papilloma Virus (HPV) infection is now a well established cause of cervical cancer. Human papilloma virus is a double stranded DNA virus of papovaviride family. More than 100 types described; 30 infect ano genital tract. High risk types of 16, 18, 31, 33, 35, 45, 51, 52, 56, 58, 59 and 68 are associated with neoplasia. HPV 16 and 18 in 70% of this cancer cases world wide and 45 and 31 with a further 10% of this cancer case. Low risk types 6, 11, 42, 43, 44 associated with genital warts (cardyloma) and do not cause cancer. Almost 100% cancer cases of cervix are associated with HPV, 90% cases of anal cancer, 40% cases each of vulva, vagina, penis and about 12% cases of oral cavity and pharynx are HPV related cancers.
Cervical Cancer ranks the first most frequent cancer among the women between 15-44 years. According to WHO/ICO information centre on HPV and cervical cancer, India has the population of 365.71 million women ages 15 years and older who are at risk of developing cancer. About 6.6% of women in general population are estimated to harbor cervical infection at a given time and 76.7% of invasive cervical cancer in India are attributed to HPVs 16 & 18. Human papilloma virus spread primarily through sexual intercourse. Infection can occur in as little as one month after the fist sexual contact.
Though HPV is a necessary cause of cervical cancer but is not a sufficient cause. Other Cofactors are necessary for progression from cervical HPV infection to cancer. High parity, tobacco smoking, longterm use of oral contraceptives and coinfection with HIV have been identified as established co-factors; co-infection with chlamydia trachomatis and herpes simplex virus type -2, immunosuppression and certain dietary deficiencies are other probable co-factor.
With the knowledge of HPV (Oncogenic types) as the causative agent of this cancer, two types of vaccination strategies have been aimed at prophylactic vaccine is virus like particle (VLP) <1 vaccine which prevents HPV infection before it occurs and therapeutic vaccine which eliminates existing HPV infection. Therapeutic vaccines are still under trial and are not available globally. The cervarixTM (GlaxoSmithkline) against HPV 16 and 18. The GardasilR (MSD) against HPV types 16 and 18, 6 and 11 both these prophylactic vaccines are approved for use in India. Vaccines are effective against human papilloma virus 16 and 18 responsible for causing 70% of all cervical cancer cases but in phase II as well as in phase III trials these have also shown the additional protection against human papilloma virus types that cause more than 20% of all cervical cancer cases and these have demonstrated efficacy of more than 90%. The most effective time to vaccinate girls and young women is before they become sexually active. The vaccine is ideally administered before potential exposure to HPV through sexual contact. Centers for disease control and prevention's advisory committee on immunization practices (ACIP) recommended vaccination of young girls and adolescents between the age of 9 to 26 years. Emerging data suggest that the vaccine may be safe and effective in boys, young men and adult women upto the age of 27 – 45 years. Screening for HPV DNA or antibodies are not needed before vaccination. Women with abnormal pap tests or genital warts can be vaccinated. The need for the booster dose has not been established yet.
HPV vaccine is given in three doses at 0, 1, 2, and 6 months by intramuscular injection (0.5ml prefilled syringe) single dose. This requires the refrigeration at 2 – 8 0 c. These are safe as there is no viral DNA in the vaccine and tolerable. The common side effects are injection site reactions, redness, swelling and soreness of mild to moderate severity. These are not recommended for pregnant women due to limited safety data.
Following HPV vaccination these women are required to undergo regular screening programme with pap test as vaccine does not offer 100% protection, hence a need for counseling every woman undergoing primary prevention with HPV Vaccination.
Prophylactic HPV Vaccine offer effective primary prevention for these cancer and seems promising towards the reduction of this cancer burden globally especially in developing countries.
Human Papilloma Virus (HPV) infection is now a well established cause of cervical cancer. Human papilloma virus is a double stranded DNA virus of papovaviride family. More than 100 types described; 30 infect ano genital tract. High risk types of 16, 18, 31, 33, 35, 45, 51, 52, 56, 58, 59 and 68 are associated with neoplasia. HPV 16 and 18 in 70% of this cancer cases world wide and 45 and 31 with a further 10% of this cancer case. Low risk types 6, 11, 42, 43, 44 associated with genital warts (cardyloma) and do not cause cancer. Almost 100% cancer cases of cervix are associated with HPV, 90% cases of anal cancer, 40% cases each of vulva, vagina, penis and about 12% cases of oral cavity and pharynx are HPV related cancers.
Cervical Cancer ranks the first most frequent cancer among the women between 15-44 years. According to WHO/ICO information centre on HPV and cervical cancer, India has the population of 365.71 million women ages 15 years and older who are at risk of developing cancer. About 6.6% of women in general population are estimated to harbor cervical infection at a given time and 76.7% of invasive cervical cancer in India are attributed to HPVs 16 & 18. Human papilloma virus spread primarily through sexual intercourse. Infection can occur in as little as one month after the fist sexual contact.
Though HPV is a necessary cause of cervical cancer but is not a sufficient cause. Other Cofactors are necessary for progression from cervical HPV infection to cancer. High parity, tobacco smoking, longterm use of oral contraceptives and coinfection with HIV have been identified as established co-factors; co-infection with chlamydia trachomatis and herpes simplex virus type -2, immunosuppression and certain dietary deficiencies are other probable co-factor.
With the knowledge of HPV (Oncogenic types) as the causative agent of this cancer, two types of vaccination strategies have been aimed at prophylactic vaccine is virus like particle (VLP) <1 vaccine which prevents HPV infection before it occurs and therapeutic vaccine which eliminates existing HPV infection. Therapeutic vaccines are still under trial and are not available globally. The cervarixTM (GlaxoSmithkline) against HPV 16 and 18. The GardasilR (MSD) against HPV types 16 and 18, 6 and 11 both these prophylactic vaccines are approved for use in India. Vaccines are effective against human papilloma virus 16 and 18 responsible for causing 70% of all cervical cancer cases but in phase II as well as in phase III trials these have also shown the additional protection against human papilloma virus types that cause more than 20% of all cervical cancer cases and these have demonstrated efficacy of more than 90%. The most effective time to vaccinate girls and young women is before they become sexually active. The vaccine is ideally administered before potential exposure to HPV through sexual contact. Centers for disease control and prevention's advisory committee on immunization practices (ACIP) recommended vaccination of young girls and adolescents between the age of 9 to 26 years. Emerging data suggest that the vaccine may be safe and effective in boys, young men and adult women upto the age of 27 – 45 years. Screening for HPV DNA or antibodies are not needed before vaccination. Women with abnormal pap tests or genital warts can be vaccinated. The need for the booster dose has not been established yet.
HPV vaccine is given in three doses at 0, 1, 2, and 6 months by intramuscular injection (0.5ml prefilled syringe) single dose. This requires the refrigeration at 2 – 8 0 c. These are safe as there is no viral DNA in the vaccine and tolerable. The common side effects are injection site reactions, redness, swelling and soreness of mild to moderate severity. These are not recommended for pregnant women due to limited safety data.
Following HPV vaccination these women are required to undergo regular screening programme with pap test as vaccine does not offer 100% protection, hence a need for counseling every woman undergoing primary prevention with HPV Vaccination.
Prophylactic HPV Vaccine offer effective primary prevention for these cancer and seems promising towards the reduction of this cancer burden globally especially in developing countries.