It was in her late 40s that Meena (name changed), a mother of two, was diagnosed with cervical cancer after her routine check-up. “She was reluctant to undergo testing and came for routine check-ups as her daughter compelled her to. The test was positive. So we sent the samples for biopsy and referred her to the department of surgical oncology,” said Dr Teena Anne Joy, a senior consultant in obstetrics and gynaecology at Aster Medcity, Kochi.
As the condition was diagnosed at an early stage, she was provided with effective treatment and interventions to cure the condition.
“When it comes to human papillomavirus (HPV)-related conditions and cancers, early identification and screening are important, as the condition is asymptomatic in the early stages. Because the condition is quite common among people, screening is important. All women in the age of 26-65 years should undergo screening every three years. The prevalence of the condition is on the rise in the country,” Dr Teena said, emphasising the significance of the prevention of HPV-related cancers in women as well as men.
According to Dr K Pavithran, head of medical oncology at Amrita Hospital, Kochi, human papillomavirus is a significant factor causing cancers in youngsters.
“HPV infection is most commonly asymptomatic. Low-risk strains of HPV can cause warts, while high-risk strains are associated with cervical intraepithelial neoplasia (CIN) and cervical, vaginal, vulvar, anal, penile, and oropharyngeal carcinomas. It is estimated that 90% of cervical and anal cancers, 70% of vulvar and vaginal cancers, 60% of penile cancers, and 70% of oropharyngeal cancers are due to persistent, high-risk HPV infection,” he said.
India contributed to 7% of the global cancer incidence and 24% of global HPV-related cancer incidence in 2020, according to the study ‘Epidemiology of human papillomavirus-related cancers in India: findings from the National Cancer Registry Programme’, published in 2022. Four out of five cervical cancers reported in India were caused by infections from HPV types 16 and 18.
The study also indicates that cervical and oropharyngeal cancers were the most common HPV-related cancers among females and males, respectively, in India. These cancers together contributed to around 85% of total HPV-related cancers.
Other findings of the study
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According to the study, six out of 10 HPV-related cancers among males in India were oropharyngeal cancers
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Vulval and vaginal cancers are rare cancers that showed a minor decline in incidence during the long term in India
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Penile and anal cancer together constitute 1.2% of total cancer cases in India
According to Dr Aju Mathews, there is a decline in HPV-related cervical cancers, but at the same time, they are increasing in oral cancers. “HPV-related cancers are preventable, and therefore more awareness in HPV screening and vaccination will help prevent future cancers, especially cervical cancer. Screening is very important for early detection of cervical cancer. These tests are very easily done through the HPV DNA test or the Pap smear test,” he said.
“Though HPV is often associated with cervical cancer in females, it also causes serious illness in men,” according to Dr Rema P, additional professor and head of gynaecologic oncology at the Regional Cancer Centre.
Screening
As there is no symptom for human papillomavirus, Dr Rema emphasised the significance of routine screening in early detection and treatment of the condition. “Unlike other diseases, HPV-related cancers affect people at a young age, in their forties and fifties. Thus, it affects productivity as well as quality of life. Awareness about the virus, its spread, and prevention is important,” said Dr Rema.
“The state governments and non-governmental organisations have been organising mass screening programmes to prevent the spread of the condition. Healthcare facilities are easily accessible to the public now. Thus, utilising such opportunities can help identify the condition early. Early detection helps in curing the condition as well as improving the quality of life,” added Dr Teena.
Screening helps in the early detection of cervical cancer:
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If you are in the 21-29 years age group, consider getting a Pap smear test at 21 years, followed by Pap testing every 3 years
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If you are in the 30-65 years age group, screen for cervical cancer using one of the following methods: HPV test every 5 yrs | HPV/Pap co-test every 5 yrs | Pap test every 3 yrs
Vaccination
“Almost everyone will get HPV once in their lifetime. Vaccination and screening go hand in hand in preventing HPV-related cancers. Vaccination is given to girls and boys, from the age of nine, and young adults. There is a section of people who believe that vaccination is only for girls. However, boys also need the HPV vaccine to protect against HPV-related cancers, including penile, anal, and oropharyngeal cancers, and to help prevent the spread of the virus. It also protects their partners,” she added.
“HPV vaccines are highly effective in preventing HPV infections and related diseases. Efficacy is more than 90% against HPV infection,” emphasised Dr Pavithran.
The condition should not occur in people or cause difficulties in people when we have effective vaccination available, according to Dr Teena.
WHO recommended dosage
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Girls aged 9–14 years: One or two doses
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Young women aged 15–20 years: One or two doses
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Women over 21 years: Two doses spaced six months apart
“HPV vaccination is not included in the national immunisation programme yet. But the vaccination is available. Administering vaccination in children above nine can prevent the disease. The immunity level differs from person to person. We don’t know who will contract the virus. It is safe to get vaccinated,” she added.
“Prevention can be effectively done through HPV vaccination. When the uptake of prevention and screening is very high, we effectively eliminate cervical cancer from our society. HPV-related cancers will rise if vaccination and screening are not adopted in our community,” said Dr Aju, adding that initially the numbers were high and have now dropped due to improved hygiene.
Awareness
Youngsters should be aware of the spread of HPV and the issues caused by the condition as changes in culture and lifestyle add to the risk of infection. “Safe sexual practices and HPV vaccination are important. Parents should also take the initiative to educate children about the prevalence and risk caused by HPV. Better awareness regarding safe sexual practices and vaccination can help prevent HPV-related diseases,” Dr Teena said, adding that several non-governmental organisations and governments have also taken initiatives to educate the public.
Dr Pavithran also emphasised the significance of better awareness among youngsters about the virus and how it spreads. “HPV is the most common sexually transmitted infection (STI) worldwide, and nearly all sexually active people will get HPV at some point in their lives. Teenagers and young adults have the highest prevalence of HPV. Better awareness about viruses and their spread can significantly reduce the occurrence of related conditions by promoting preventive behaviours, early detection, and timely interventions,” he added.