HPV VACCINATION AND CERVICAL CANCER

Cervical cancer, mainly caused by Human Papillomavirus infection, is the leading cancer in Indian women and the second most common cancer in women worldwide. Though there are several methods of prevention of cervical cancer, prevention by vaccination is emerging as the most effective option, with the availability of two vaccines.

Cervical cancer is ranked as the most frequent cancer in women in India. India has a population of approximately 365.71 million women above 15 years of age, who are at risk of developing cervical cancer. PATH claims that ‘in raw numbers, India has the largest burden of cancer of the cervix of any country worldwide.

Some facts about HPV vaccine -

1. Reduces your risk of getting HPV infection

Studies say majority of the unvaccinated adult individuals who are sexually active will likely contract the HPV at some point. In fact, millions of Indians are believed to get infected with the virus every year. While most HPV infections resolve on their own, some can lead to cancer. Therefore, it is best to get the HPV vaccine to avoid getting infected in the first place. 

2. The HPV vaccine is very effective

Since the introduction of HPV vaccine, new cases of HPV infections, cervical precancers, and genital warts have declined considerably. Other countries that have implemented HPV vaccination programmes have also observed a similar drop in new cases, proving the effectiveness of the vaccine.

3. Prevention is better than cure

HPV infection puts millions of Indians at risk of different types of cancer. Except for cervical cancer, most other cancers caused by the virus largely remain undetected until they become severe. While treatment for such cancers exists, it can take a toll on your physical, emotional, and financial well-being. On the other hand, HPV vaccination is a low-cost option to prevent the infection that increases the risk of these cancers. 

4. The HPV vaccine is completely safe

HPV vaccines are completely safe. The follow-up monitoring and reviews have proved that the benefits of inoculation far outweigh the potential risks. However, like all other vaccines, HPV vaccines can produce mild side effects such as pain and swelling in the arm where the shot was given.

Who Should Get the Vaccine

All individuals aged 9 – 26 years should receive the HPV vaccine. Some adults aged 27 – 45 years may choose to get the vaccine if they haven’t been vaccinated already.

If you start the HPV vaccine series before age 15, you’ll need 2 doses of the vaccine given 6 months apart. If you are 15 years or older when you start the vaccine series, you’ll need 3 doses given over 6 months.

If you are late to get the 2^nd or 3^rd dose of the HPV vaccine (even by months or years), you don’t need to restart the series: just pick up where you left off.

Which are the vaccines available against the HPV and what is the schedule?

1. Bivalent (HPV2): this vaccine contains HPV types 16 and 18

2. Quadrivalent (HPV4): this vaccine contains HPV types 6, 11,16 and 18

3. Nonavalent (HPV9): this vaccine contains HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58.

This vaccine is expected to broaden the protection against cervical cancer by ~15%.

Does the HPV vaccine Work?

Yes! All vaccines presented exceptional protection against HPV infection, cervical intraepithelial neoplasia of grade 2 or 3 (CIN2 or CIN3), and adenocarcinoma in situ associated with HPV 16/18 infection.

In India, the Bivalent vaccine (HPV2) and the Quadrivalent HPV vaccine (HPV 4) is expected to prevent ~ 83% of cervical cancers, whereas the Nonavalent vaccine (HPV 9) is expected to prevent ~ 98% of cervical cancers. All the 3 vaccines are very effective in preventing cervical cancers caused by the types contained in the vaccine.

Why is it essential to start the schedule at 9-10 years and not later?

1. Young adolescents mount a superior immune response compared to older individuals.

2. Prevention of disease is better if started earlier

3. Only 2 doses are necessary in this age group versus 3 doses beyond 15 years of age. There is no recommendation for any booster doses.

My child Isn’t sexually active, why should she get the Vaccine?

The vaccine is most effective if it’s delivered before exposure. Protection against HPV will extend into adulthood, and most individuals are sexually active at some point in their lifetime. HPV is transmitted from person to person through sexual activity: vaginal or anal sex is the typical route of transmission, but HPV can also be spread through oral sex or sex play. If your child has already been sexually active, they should still receive the vaccine.

Most unvaccinated people who are sexually active will get exposed to HPV at some point in their life. Thankfully, most HPV infections go away on their own, but those that don’t can cause cancer.

How do I explain to my child that this vaccine doesn’t mean It’s OK for them to have unprotected sex?

If you haven’t discussed sexually transmitted infections with your tween, now might be the right time to share your values and educate your tween about abstinence and/or safe sex. If that’s not a conversation you’re ready to have, you can say that the vaccine is to protect them against future disease. Studies show that there is no increase in sexual activity or risky sexual behaviors after receiving the HPV vaccine.

If My Daughter Receives the HPV Vaccine, Does She Still Need a PAP Test in the Future?

Yes. While the HPV vaccine greatly reduces the risk of HPV-related cervical cancer and genital warts, getting a PAP test is still necessary to screen for any abnormal cervical cell changes or cervical cancer.

As per the International recommendations, the age of screening is 21 years. In our country due to low resources for screening, national recommendations are to start screening at 30 years of age. Women who are 30 years and above should undergo a Pap test once in every 3 years until the age of 65 years.

Having your child immunized against HPV is an excellent opportunity to protect them from future disease. Bottom line: the HPV vaccine is cancer protection that is safe AND effective.

If you have additional questions, you can DM me and discuss in details.