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HPV Chronicles: Safeguarding Futures with the Cancer-Preventing Vaccine


Summary: Cervical cancer, ranked as the fourth most common cancer in women globally, poses a significant health threat with 604,000 new cases in 2020. Sub-Saharan Africa, Central America, and Southeast Asia experience the highest incidence and mortality rates. Human papillomavirus (HPV) is a key factor, causing persistent infections that may lead to cervical cancer. Cervical cancers manifest as squamous cell carcinoma or adenocarcinoma. Early-stage cervical cancer is often asymptomatic, with advanced symptoms including abnormal bleeding, discharge, pain during sex, and pelvic pain. Prevention involves HPV vaccination, recommended at ages 9-14, and screening starting at age 30. Three FDA-approved vaccines exist, with India introducing the cost-effective "CERVAVAC" in 2023. WHO endorses a flexible vaccination schedule, prioritizing girls aged 9-14. Public awareness and access to information are crucial for prevention and control. Early detection and treatment remain vital for those with symptoms or concerns.

Keywords: Cervical Cancer Prevention; HPV Vaccination; Cervical Cancer Symptoms; Cervical Cancer Screening; CERVAVAC Vaccine.



What is Cervical Cancer?

Cervical cancer stands as the fourth most prevalent cancer among women globally, registering 604,000 new cases in the year 2020. Alarming statistics reveal that approximately 90% of cervical cancer-related deaths occur in low- and middle-income countries. Regions such as sub-Saharan Africa (SSA), Central America, and South-East Asia bear the brunt of this health crisis, exhibiting the highest rates of incidence and mortality (1).

India, a significant contributor to this global burden, witnesses cervical cancer as the second most common cancer affecting women, making up 10% of all female cancers (2).

This formidable health challenge manifests as an abnormal growth of cells originating in the cervix, the lower portion of the uterus that connects to the vagina (3). As we grapple with the staggering impact of cervical cancer on women's health worldwide, it is imperative that we unite in a concerted effort to raise awareness, enhance preventive measures, and provide accessible healthcare solutions. Together, we can strive towards a future where cervical cancer is no longer a pervasive threat to women's well-being.




Understanding the Cause and Risk Factors

Human papillomavirus (HPV) stands as a prevalent sexually transmitted infection impacting the skin, genital area, and throat. Given its widespread nature, most individuals engaging in sexual activity will inevitably contract the virus at some point in their lives, often without presenting any noticeable symptoms. Typically, the immune system successfully eliminates HPV from the body. However, persistent high-risk HPV infections within the cervix pose a significant threat, as they can lead to the formation of abnormal cells, ultimately progressing to cervical cancer (1).

Cervical cancer is further classified into two primary types, each presenting unique characteristics:

Squamous cell carcinoma (SCC): This is the most common type, originating from cells in the ectocervix.

Adenocarcinoma: Developing in the glandular cells of the endocervix, cervical adenocarcinomas represent another variant of cervical cancer (4).

Several risk factors contribute to the progression of cervical cancer, including the oncogenicity grade of the HPV type, immune system status, the presence of other sexually transmitted infections, the number of births, early age at first pregnancy, hormonal contraceptive use, and smoking (1). Understanding and addressing these risk factors are crucial components of comprehensive strategies aimed at preventing and managing cervical cancer effectively.


Recognizing Signs and Symptoms

Cervical cancer typically progresses silently in its early stages, often devoid of noticeable symptoms. It is during the advanced stages that symptoms manifest, indicating the urgency of timely detection. Key symptoms include:

  • Abnormal Vaginal Bleeding: This encompasses bleeding after vaginal intercourse, post-menopausal bleeding, spotting between periods, or experiencing longer and heavier menstrual periods. Notably, bleeding may also occur after douching.

  • Unusual Vaginal Discharge: An abnormal discharge from the vagina, potentially containing blood, may occur between periods or after menopause.

  • Pain During Intercourse: Pain experienced during sexual activity can be indicative of cervical cancer.

  • Pelvic Pain: Discomfort or pain in the pelvic region is a significant symptom associated with advanced stages of cervical cancer.


Advanced stages of the disease may present additional signs and symptoms, including:

  • Swelling of the Legs: An observable swelling in the legs may be indicative of advanced cervical cancer.

  • Urination and Bowel Issues: Difficulties in urination or bowel movements can signal more progressed disease.

  • Blood in the Urine: The presence of blood in the urine is another critical indicator of advanced cervical cancer (5).

Recognizing and understanding these symptoms is paramount for early diagnosis and effective intervention. Heightened awareness and proactive health measures can contribute significantly to the successful management of cervical cancer.




Prevention Strategies

Elevating public awareness and ensuring widespread access to information and services are pivotal elements in the comprehensive prevention and control of cervical cancer throughout the various stages of life.

  • Commencing vaccination at the age of 9–14 years emerges as a highly effective strategy to thwart HPV infection, cervical cancer, and other cancers linked to the human papillomavirus.

  • Initiating screening protocols from the age of 30 (or 25 years for women living with HIV) plays a crucial role in the early detection of cervical disease. Timely intervention upon detection not only prevents the progression of cervical disease but also serves as a potent deterrent against cervical cancer.

  • Regardless of age, individuals experiencing symptoms or harboring concerns can benefit significantly from early detection initiatives, coupled with prompt and high-quality treatment. Early detection, followed by comprehensive treatment, holds the potential to cure cervical cancer, underscoring the importance of proactive healthcare measures (1). Through these concerted efforts, we can collectively strive towards a future where cervical cancer is not only preventable but also effectively manageable.



The Role of HPV Vaccination

Three HPV vaccines — the 9-valent HPV vaccine (Gardasil 9, 9vHPV), the quadrivalent HPV vaccine (Gardasil, 4vHPV), and the bivalent HPV vaccine (Cervarix, 2vHPV) — have received approval from the U.S. Food and Drug Administration (FDA), signifying significant advancements in preventive healthcare (6). Notably, India has taken a remarkable stride in this arena with the introduction of "CERVAVAC," the country's first indigenously developed vaccine aimed at preventing cervical cancer. Launched in 2023, CERVAVAC is a quadrivalent vaccine (targeting serotypes 6, 11, 16, 18) and stands out for its cost-effectiveness (7).


Aligned with these groundbreaking developments, the World Health Organization (WHO) has revised its recommendations, advocating for a flexible vaccination schedule:

  • A one or two-dose schedule for girls aged 9-14 years.

  • A one or two-dose schedule for girls and women aged 15-20 years.

  • Two doses with a 6-month interval for women older than 21 years.

The primary focus of vaccination remains on girls aged 9-14, emphasizing the importance of administering the vaccine before the onset of sexual activity. However, WHO also recognizes the significance of extending vaccination to secondary targets, including boys and older females, wherever feasible and economically viable (8). These advancements underscore the global commitment to proactive and inclusive healthcare strategies, aiming to curb the prevalence of HPV infections and cervical cancer worldwide.


Author: Dr. Priyali Singh, MBBS, Baba Raghav Das Medical College, Gorakhpur, India.


Editor: Dr. Sidhant Ochani, MBBS, Khairpur Medical College, Khairpur, Pakistan.


References:

  1. WHO. Cervical cancer. World Health Organization. Accessed February 1, 2024. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer

  2. Sathishkumar K, Sankarapillai J, Mathew A, et al. Survival of patients with cervical cancer in India – findings from 11 population based cancer registries under National Cancer Registry Programme. The Lancet Regional Health - Southeast Asia. Published online October 2023:100296. doi:10.1016/j.lansea.2023.100296 

  3. MC. Cervical cancer. Mayo Clinic. September 2, 2023. Accessed February 1, 2024. https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501

  4. NCI. What is cervical cancer? National Cancer Institute. Accessed February 1, 2024. https://www.cancer.gov/types/cervical

  5. ACS. Cervical cancer symptoms: Signs of cervical cancer. Cervical Cancer Symptoms | Signs of Cervical Cancer. Accessed February 1, 2024. https://www.cancer.org/cancer/types/cervical-cancer/detection-diagnosis-staging/signs-symptoms.html

  6. CDC. HPV vaccination: What everyone should know. Centers for Disease Control and Prevention. November 16, 2021. Accessed February 1, 2024. https://www.cdc.gov/vaccines/vpd/hpv/public/index.html

  7. SII. CERVAVAC - quadrivalent human papilloma virus (serotypes 6, 11, 16 and 18) vaccine (recombinant). Accessed February 1, 2024. https://www.seruminstitute.com/product_ind_cervavac.php

  8. WHO. WHO updates recommendations on HPV vaccination schedule. World Health Organization. Accessed February 1, 2024. https://www.who.int/news/item/20-12-2022-WHO-updates-recommendations-on-HPV-vaccination-schedule

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