Fight cervical cancer by getting vaccinated against HPV
Get vaccinated against HPV:The following two recombinant HPV vaccines are readily available in India:
a.Gardasil, which is a vaccine against HPV types 16 and 18 (oncogenic) and types 6 and 11 (these HPV types account for 90% of genital warts in the western countries - exact data for India is not available). Approximate cost per injection is Rs 2,800, which is given intramuscularly. Side effects are almost negligible - commonest is soreness at injection site. Other mild side effects are headache, mild fever, itching at injection site and, sometimes, fainting (common after any injection especially in teenage girls). Therefore the women/girls are advised to lie down or sit for 15 minutes after reciving the injection. Rare case reports of muscle weakness in girls have been reported (Guillain-Barré Syndrome,GBS). Analysis of this rare adverse event has shown that this was not related to the vaccine, and the US FDA continues to recommend Gardasil for vaccination. It is manufactured by Merck and is recommended for girls between 9 and 13 years of age (before sexual exposure). If not given at this time, it can be given till 26 years of age. Doses are given at day 0, and then 2 months and 6 months after the 1st injection.
b.Cervarixis a vaccine against HPV types 16 and 18 (oncogenic), which currently cause 70% of cervical cancer cases worldwide and 90% of cancers in India. Approximate cost is Rs 3200 per injection. Recommendations for vaccination are same as for Gardasil. The recommended dosage schedule is the same. In India, Cervarix is being administered to women up to 45 years of age. It is manufactured by GlaxoSmithKline (GSK).
Both companies do not recommend testing for HPV prior to giving vaccine (not cost effective, according to them). However, in women who are already sexually active a baseline Pap smear is a must, prior to giving vaccine, and colposcopy (if indicated).
Also, though almost 90% of cervical cancers in India are caused by HPV types 16 and 18, it must be brought to the knowledge of the woman / parent of girl receiving the vaccine that she needs to be continuously screened for cervical cancer by Pap smear (for the girl child, after she becomes sexually active). This is because the vaccine will not protect against the 11 other oncogenic HPVs. Counselling of the woman or the parents of the minor girl prior to vaccination is essential.
Research is on for evaluating the benefits of the vaccine in boys / men, as HPV causes genital warts and penile cancer in men. The issue about a booster dose is not yet resolved (research is on going). However, both companies say that it is definitely effective for five years.
The vaccine is contraindicated in girls and women with a known allergy to yeast and any component of the vaccine, or moderate or severe illness at time vaccine is scheduled. If the woman notes she has conceived after receiving the vaccine, she need not undergo a termination of the pregnancy. The vaccine has not shown to harm the pregnant woman or unborn baby, but as such vaccination is not recommended during pregnancy. A woman can receive the vaccine during lactation.
Additional advantages of HPV vaccine
These oncogenic HPV types cause majority of vulval and vaginal cancer; therefore, the vaccine protects against these cancers as well (though vulvar and vaginal cancer are very rare). Recent studies have shown that some oral cancers are caused by these same oncogenic HPVs (transmiited through oral sex); vaccination can possibly protect against these cancers as well.
Challenges ahead
Although there are many options for preventing HPV infection and cervical cancer, all have limitations. Preventing HPV infection is challenging because the virus is easily transmitted and generally does not produce any symptoms. Genital warts caused by some types of HPV can be treated, but no treatment can eliminate the underlying infection and the virus can remain infectious for years. Condom use has been shown to have a limited preventive effect because HPV can reside throughout the anogenital region. Nonetheless, women can protect themselves from HPV infection to some degree by ensuring regular condom use and limiting the number of sexual partners. While it is clear that vaccines will not eliminate the need for effective cervical screening and treatment for many years to come, they can substantially reduce the burden that cervical cancer imposes on women and health services.
In developing countries like India, lack of effective screening programmes for cervical cancer further adds to the menace. As a result, no clinically significant reduction in the incidence of cervical cancer has occurred during the past three decades in India. In developed countries, by contrast, there has been a major decline in cervical-cancer mortality after the introduction of large-scale screening by Pap smear cytology. The limited success of such screening in developing countries has stimulated evaluation of testing for human papillomavirus (HPV) and visual inspection of the cervix with acetic acid (VIA).
Things all women should know about cervical cancer
Cervical cancer is preventable – screening and vaccination are key interventions.
Most women will have HPV, but only few will develop cervical cancer.
Only HPV infections that persist can lead to cancer.
Using an HPV test with a Pap test in women over 35 years can better identify women at risk for cancer.
An HPV vaccine that prevents 70-90% of cervical cancers is now available.
Women should talk to their healthcare providers about screening for cervical cancer and immunization.
a.Gardasil, which is a vaccine against HPV types 16 and 18 (oncogenic) and types 6 and 11 (these HPV types account for 90% of genital warts in the western countries - exact data for India is not available). Approximate cost per injection is Rs 2,800, which is given intramuscularly. Side effects are almost negligible - commonest is soreness at injection site. Other mild side effects are headache, mild fever, itching at injection site and, sometimes, fainting (common after any injection especially in teenage girls). Therefore the women/girls are advised to lie down or sit for 15 minutes after reciving the injection. Rare case reports of muscle weakness in girls have been reported (Guillain-Barré Syndrome,GBS). Analysis of this rare adverse event has shown that this was not related to the vaccine, and the US FDA continues to recommend Gardasil for vaccination. It is manufactured by Merck and is recommended for girls between 9 and 13 years of age (before sexual exposure). If not given at this time, it can be given till 26 years of age. Doses are given at day 0, and then 2 months and 6 months after the 1st injection.
b.Cervarixis a vaccine against HPV types 16 and 18 (oncogenic), which currently cause 70% of cervical cancer cases worldwide and 90% of cancers in India. Approximate cost is Rs 3200 per injection. Recommendations for vaccination are same as for Gardasil. The recommended dosage schedule is the same. In India, Cervarix is being administered to women up to 45 years of age. It is manufactured by GlaxoSmithKline (GSK).
Both companies do not recommend testing for HPV prior to giving vaccine (not cost effective, according to them). However, in women who are already sexually active a baseline Pap smear is a must, prior to giving vaccine, and colposcopy (if indicated).
Also, though almost 90% of cervical cancers in India are caused by HPV types 16 and 18, it must be brought to the knowledge of the woman / parent of girl receiving the vaccine that she needs to be continuously screened for cervical cancer by Pap smear (for the girl child, after she becomes sexually active). This is because the vaccine will not protect against the 11 other oncogenic HPVs. Counselling of the woman or the parents of the minor girl prior to vaccination is essential.
Research is on for evaluating the benefits of the vaccine in boys / men, as HPV causes genital warts and penile cancer in men. The issue about a booster dose is not yet resolved (research is on going). However, both companies say that it is definitely effective for five years.
The vaccine is contraindicated in girls and women with a known allergy to yeast and any component of the vaccine, or moderate or severe illness at time vaccine is scheduled. If the woman notes she has conceived after receiving the vaccine, she need not undergo a termination of the pregnancy. The vaccine has not shown to harm the pregnant woman or unborn baby, but as such vaccination is not recommended during pregnancy. A woman can receive the vaccine during lactation.
Additional advantages of HPV vaccine
These oncogenic HPV types cause majority of vulval and vaginal cancer; therefore, the vaccine protects against these cancers as well (though vulvar and vaginal cancer are very rare). Recent studies have shown that some oral cancers are caused by these same oncogenic HPVs (transmiited through oral sex); vaccination can possibly protect against these cancers as well.
Challenges ahead
Although there are many options for preventing HPV infection and cervical cancer, all have limitations. Preventing HPV infection is challenging because the virus is easily transmitted and generally does not produce any symptoms. Genital warts caused by some types of HPV can be treated, but no treatment can eliminate the underlying infection and the virus can remain infectious for years. Condom use has been shown to have a limited preventive effect because HPV can reside throughout the anogenital region. Nonetheless, women can protect themselves from HPV infection to some degree by ensuring regular condom use and limiting the number of sexual partners. While it is clear that vaccines will not eliminate the need for effective cervical screening and treatment for many years to come, they can substantially reduce the burden that cervical cancer imposes on women and health services.
In developing countries like India, lack of effective screening programmes for cervical cancer further adds to the menace. As a result, no clinically significant reduction in the incidence of cervical cancer has occurred during the past three decades in India. In developed countries, by contrast, there has been a major decline in cervical-cancer mortality after the introduction of large-scale screening by Pap smear cytology. The limited success of such screening in developing countries has stimulated evaluation of testing for human papillomavirus (HPV) and visual inspection of the cervix with acetic acid (VIA).
Things all women should know about cervical cancer
Cervical cancer is preventable – screening and vaccination are key interventions.
Most women will have HPV, but only few will develop cervical cancer.
Only HPV infections that persist can lead to cancer.
Using an HPV test with a Pap test in women over 35 years can better identify women at risk for cancer.
An HPV vaccine that prevents 70-90% of cervical cancers is now available.
Women should talk to their healthcare providers about screening for cervical cancer and immunization.
Labels: by getting, cervical cancer, Fight, HPV, vaccinated against
posted by G S Iyer at 7:21 AM
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