On the occasion of Cervical Cancer Awareness Month, South First speaks to a specialist about the HPV vaccine, cancer screening, and more.
Cervical cancer screening should start at the age of 25 years. (Supplied)
Cervical cancer stands as the second-most prevalent cancer affecting women in India, yet there’s a concerning gap in the adoption of preventive measures.
Despite the availability of a cervical cancer vaccine in India for over 17 years now, including an indigenous option, uptake remains low. This is compounded by a lack of awareness, with 63 percent of Indian women unaware of vaccines and screenings that could significantly reduce mortality rates.
In an exclusive interview with South First, Dr V Annapurna, Senior Consultant and Head of the Department of Gynaecologic Oncology at Sri Shankara Cancer Hospital and Research Centre, highlights the imperative need for both daughters and sons to receive the HPV vaccine.
Q. For the layperson to understand, could you tell us about the cervix?
A. The cervix is located at the mouth of the uterus, which is shaped like a pear. This area, referred to as the cervix, is where cervical cancer typically begins. The uterus is positioned between the pelvic bones and is not palpable through the abdomen unless it enlarges due to pregnancy or conditions like fibroids.
Q. What causes cervical cancer?
A. Cervical cancer is mainly caused by infections of the Human Papillomavirus (HPV), a very common virus comparable to the common cold, in terms of prevalence. Most sexually active individuals will contract HPV at some point in their lives, but the immune system usually clears the virus. Persistent infections, especially with high-risk HPV types, and in the presence of a weakened immune system, can lead to changes in the cervical cells and result in cancer.
Q. Who is at a higher risk for cervical cancer?
A. Women who start sexual activity at an early age, those with multiple sexual partners, and individuals with a weakened immune system, such as those with HIV or those undergoing treatments that suppress the immune system are at higher risk. Additionally, lifestyle factors like tobacco use and obesity can increase the risk.
Q. There is a lot of stigma attached to cervical cancer, making screening difficult. What are some myths around this cancer?
A. Many women do not reveal these aspects of their life, even when we ask them directly. Whatever be one’s sex life, please go to the doctor and get screened. Screening is becoming difficult as many women don’t want to take this seriously or they think they don’t have any problem.
Now, to avoid all of this, there are testing kits available in the market. There are swabs which are available even on Amazon. One just needs to order those kits and they can test at home. Collect swabs as per instructions and then submit it to any lab in the vicinity of their house.
The main inhibition I see from women is “I don’t have anything. I’m fine, hail, and healthy”. That is the perception that everyone has.
Stages of cervical cancer. (Supplied)
Q. What are the symptoms of cervical cancer?
A. HPV infection will not cause any symptoms. The virus will just sit there. It won’t cause a fever like Covid, it won’t cause a cold, runny nose or any vaginal discharge. You will not know you have it unless you test for it, which is why we are encouraging preventative measures early on.
When women come to us with advanced stages, they all say that they never had any symptoms. This virus can enter the body when you are in your 20s and remain dormant for many years before expressing as cervical cancer.
Q. At what age do we begin testing for cervical cancer?
A. I would recommend every woman to get tested from the age of 25 years, not at 40. Every five years once is all that you have to go. You don’t have to run to a clinic every six months or three months like diabetes, hypertension or nothing. Once in five years is all the testing you need.
Once you get yourself cleared, then there’s no question of going for cancer. This disease can be completely prevented.
Q. Despite the long availability of the HPV vaccine, a significant number of women are still unaware of it, and there’s an ongoing effort to include it in immunisation schedules. What are your thoughts on the reasons behind this lack of awareness and uptake?
A. The HPV vaccine was introduced to India in 2009 by an NGO, but faced setbacks due to misinformation and social media propaganda linking the vaccine to deaths, which were later disproven. This led to the government withdrawing the vaccine, affecting its availability and public trust. Additionally, there’s a general lack of awareness about the connection between the vaccine and cancer prevention. Many people are familiar with cancer as a terminal illness but are not informed about preventive vaccines like HPV, which can significantly reduce cancer rates. The WHO advocates for vaccinating at least 90% of the population to eliminate cervical cancer, highlighting the vaccine’s importance. There is definitely no harm from HPV vaccines.
Q. At what age do you recommend HPV vaccine?
A. According to pediatric guidelines, HPV vaccination is recommended starting at age 11, with one dose sufficient for those aged 11 to 18. Individuals aged 18 to 26 should receive two doses, six months apart. Over 135 million doses have been administered globally without any vaccine-related deaths. The vaccine contains no live virus or DNA, only virus-like particles made from the outer protein shell, which safely stimulate the immune system to produce antibodies. This makes it ideal for pre-sexually active individuals around 11, ensuring they develop immunity early, preventing future HPV infections.
Q. Not just girls even boys need to be vaccinated?
A. Both boys and girls should receive this vaccination as HPV virus is known to cause several range of cancers in men as well. This can be avoided with the vaccine. This approach is based on the understanding that HPV does not discriminate by gender; it can cause various cancers in both men and women, including penile, anal, and head and neck cancers in men. By vaccinating boys, we not only protect them from these potential cancers but also reduce the transmission of the virus, contributing to herd immunity and further protecting the entire population.
Q. Suppose somebody has missed this initial vaccination window and their sexual activity is already begun. Can they still take the vaccine?
A. At the age of 30-40, if someone has been sexually active for about 10 years, their body may have already developed immunity to clear the virus. In such cases, screening every five years is recommended to check for any existing infections or changes in the cervix. This screening helps identify if any HPV infection has occurred and caused changes in the cervix during the time when not tested. The process involves either self-sampling for the virus or a doctor’s visit for a pap smear, which is a simple and quick procedure to collect cells from the cervix to check for any abnormalities.
Q. If someone has reached menopause. Do they still have to screen for cervical cancer?
A. Yes. Even after menopause, it’s important to continue screening until the age of 65, as recommended. However, I suggest to continue screening till 85 years of age. I have seen older women ending up with cervical cancer. This applies even if you’ve never been screened before, as a single screening can significantly reduce cancer risk. Despite menopause, screening is crucial because HPV can persist and cause changes in the cervical cells. Therefore, screening helps ensure that any precancerous changes are caught and treated early, preventing the development of cervical cancer.
Screening programs can be intensified from the state governments and bringing HPV vaccination into the immunisation schedule can definitely help in eliminating cervical cancer.
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