Cervical Cancer – Vaccination and Prevention

Cervical cancer is a major health concern among women. About 90% of cervical cancers are preventable. Human Papillomavirus (HPV) infection that causes genital warts will affect a certain percentage of women at some point in their lives. Approximately 80% of women successfully clear the infection with their own immunity, but in about 20% of women, HPV infections can manifest as cervical cancer gradually over a period of 10-15 years.

Unfortunately, cervical cancer is the second largest cancer among Indian women and it is important to know how best to prevent it.

Several methods to prevent cervical cancer are known, and prevention by vaccination has emerged as the most effective option besides early screening for carcinoma in-situ or dysplasia through PAP smear testing. It is estimated that HPV vaccination can prevent about 700 cervical cancer-related deaths every year.
HPV vaccination prevents new HPV infections, but does not treat existing infections or diseases. Hence, HPV vaccine works best when given early before there is any exposure to HPV.

HPV vaccination is recommended for preteens aged 11-12 years by World Health Organization, however certain studies have shown that it can be given as early as 9 years. HPV vaccine also is recommended for everyone until 26 years of age, if they are not vaccinated already. However, some adults aged 27-45 years who are not already vaccinated may decide to get the HPV vaccine after discussing with their doctor about their risk for new HPV infections and the possible benefits of vaccination. Notably, the effectiveness of the vaccine is better at younger ages than it is at older ages.

If vaccination is started before 15 years, a two-dose schedule is recommended, with the doses given 6 to 12 months apart.

For people who start the series after their 15th birthday, the recommendation is to give three doses. HPV vaccines include the 9-valent (includes 9 variants of Human Papilloma virus), the quadrivalent (4-strains), and the bivalent (2 strains) HPV vaccine.

All three HPV vaccines protect against HPV types 16 and 18 that cause nearly 70% of the HPV cancers.
Cervavac, a quadrivalent vaccine, is the first Made in India cervical cancer, or HPV vaccine. This vaccine has generated real hope to fight against cervical cancer and being cost-effective, is within the reach of all women. It protects against HPV types 6, 11, 16, and 18.

Even after receiving the HPV vaccine, it is recommended to have cervical cancer screenings with Pap cervical smears and HPV strains detection tests to find any precancerous lesions and treat them.
Other established preventive strategies for cervical cancer include abandoning the child marriage tradition, delaying first sexual intercourse until 21 years (the surface lining of cervix matures by this age), limiting the number of sexual partners, practicing safe sex practices by using condoms, avoiding sexual intercourse with people who have had many partners, avoiding sexual intercourse with people who are infected with genital warts.

It is recommended that all women receive HPV test to screen for cervical cancer in their lifetime besides PAP smear test starting 10 years after first intercourse. The recommendation is to have once every year PAP test for 3 years there-after.

If the three year PAP tests are negative then the Gynaecologist may extend the screening to 2-3 years depending upon the clinical examination of the person till the age of 65 years.

Since cervical cancer is preventable, and with HPV vaccination being a highly effective way to reduce the risk, it is vital that the female population in the recommended age groups consider taking the vaccine. Continued follow-up with regular screening can further reduce the morbidity and mortality associated with cervical cancer.