HPV and Cervical Cancer
Almost all cervical cancers are caused by HPV, a common virus that can be passed from one person to another during genital contact, skin to skin contact, oral and penetrative sex. There are many types of HPV. Most types do not cause cervical cancer.
Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer over time, while other types can cause genital or skin warts. Cervical cancer usually develops after 10 to 20 years of persistent HPV infection.
How do you get HPV?
HPV is transmitted during genital sexual contact. It includes unprotected vaginal or anal sex and possibly oral sex with the infected person. A person can get HPV even if years have passed since he or she had unprotected sex.
In India, cervical cancer is the second most common cancer among women and also the second most common cancer (breast cancer being the first) among women between 15 and 44 years of age, says a study by the government in 2016.
Who is at risk?
According to an estimate, nearly 96,922 new cases of cervical cancer were registered in 2018. Women, between the ages of 30 and 59 years are at risk of developing cervical cancer in India. Following are the conditions which put women on risk for cervical cancer:
- Women who have been using oral contraceptives for more than a decade
- Women who have had multiple full-term pregnancies
- Women who have had multiple sex partners
- Women whose partners have had multiple sex partners
- Having HIV (the virus that causes AIDS) or another condition that makes it hard for your body to fight off health problems.
- Weak immune system
- Other STI/STDs
- Early sexual activity at a very young age
Men at risk too
HPV is the virus that causes cervical cancer in women and genital warts in both men and women. These are considered a lesser risk because they are seldom linked to cancer.
Men cannot develop cervical cancer, but can have other cancers from HPV such as penile cancer and cancers of the anus, mouth and throat in both men and women.
What are the symptoms
- Not visible at an early stage.
- Only at the advanced stage woman may experience pain and bleeding during or after sexual intercourse.
- Foul-smelling discharge from their vagina
- Abnormal bleeding during periods.
- Pelvic pain during sex
- Loss of appetite
- Weight loss
- Back pain
- Swollen legs
You can go to a specialised doctor and get a Papanicolaou test (Pap test) done. This test screens and reveals pre-cancerous developments in the cervix. If the result is negative, you’re okay.
But in case it turns out positive, it means you may have to proceed with either surgical treatment or chemotherapy. More information about that can be provided by a trained doctor. It is advisable to get your Pap test done at least once every two years starting either from the age of 21 or after getting sexually active.
To reduce your risk of cervical cancer:
- HPV vaccine: Receiving a vaccination to prevent HPV infection may reduce your risk of cervical cancer and other HPV-related cancers.
- Pap tests: Have routine pap tests beginning rat age 21 and repeating them every few years.
- Practice safe sex: Use a condom every time you have sex. Limit the number of sexual partners.
- Quit smoking: If you do smoke, get medical help to quit smoking. Smoking is associated with squamous cell cervical cancer.
Cervical cancer/HPV vaccine
Cervical cancer can be prevented by the HPV vaccine. This vaccine works best when given to a girl who is not yet sexually active and is aged 9 to 26 years. The vaccines do not treat pre-existing HPV infections and so must be administered before initiation of sexual activity.
In men, the HPV vaccine may prevent genital warts, penile cancer, anal cancer and the spread of HPV to sexual partners.
Who should avoid this vaccine?
People who should not have the HPV vaccine are:
- people with a yeast allergy
- pregnant women
- people with a bleeding disorder
- people with serious allergy to a previous dose of the vaccine
- If you are a sexually active man/woman, who has already been exposed to HPV, then the vaccine will not be useful for you if you are under 26 years of age
Cost of vaccine in India?
There are three types of HPV vaccines –bivalent, quadrivalent, and nonavalent. However, in India only first two forms are available and are sold by two companies – Gardasil, and GSK (Glaxosmithkline). They are bivalent (Cervarix, INR 2190 per dose) and quadrivalent (Gardasil, INR 3000 per dose.)
All vaccines are administered intramuscularly and need to be taken thrice within a span of 6 months depending on the age and administered intramuscularly. Your doctor can guide you more.
A recently introduced nonavalent (nine valent) vaccine protects against five HPV types and is currently not available in India as it is still not approved by the Drug Controller General of India (DCGI).
Is it available in govt hospitals?
No. The vaccine is not a part of the country’s Immunization Programme yet. Administered mostly in private sector hospitals, the vaccine is provided only when patients ask for it, or if a doctor prescribes it.
Of more than 100 HPV types, about 15 are found to be high risk. In India, HPV types 16 and 18 are responsible for 82 percent of cervical cancers.
The quadrivalent vaccine available in India targets four strains of human papillomavirus (HPV) -- HPV-6, 11, 16, and 18. Both bivalent and quadrivalent offer 70 percent efficacy against Cervical cancer.
HPV-16 and HPV-18 account for about 70 percent of all cervical cancers. HPV-6 and -11 cause about 90 percent of genital warts.
The vaccine protects against HPV infection for at least 10 years, although experts expect protection to last for much longer.
HPV vaccine for men and transgender
In 2018, US approved Gardasil 9 a nine-valent HPV vaccine for women and men aged 27 through 45 years. Gardasil 9 prevents certain cancers and diseases caused by the nine HPV types covered by the vaccine. This vaccine that works by stimulating an immune response against nine different antigens.
Men who have sex with men, and trans men and trans women are also eligible for the vaccine.
HPV vaccine controversy
HPV vaccines are not approved by the government in India and are not cost effective. Apparently for this reason they are also not covered under the immunization programme. Hence not everyone can afford this vaccine.
These vaccines are also a recent development and not much data is available to indicate the efficacy of the vaccine - whether its protection lasts for five years or even longer. Also, this vaccine does not protect against all types of HPV that can cause cervical cancer hence everyone (even after vaccination) is advised to get regular cervical screening after they attain the age of 25.