A Preventable Disaster: HPV-Caused Cervical Cancer in India

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NEW DEHLI — Cervical cancer causes the largest portion of cancer-related deaths in India, accounting for about 17 percent of all cancer-related deaths in women aged 30-69 years. Of the 17 percent of women killed by cervical cancer in India, 83.2 percent of them contracted cancer as a result of Human Papillomavirus (HPV).

Not only does cervical cancer affect a very large number of women worldwide, but its prevalence has spread in recent years and is continuing to spread by more than 510,000 new cases annually. These new cases occur disproportionately in low to middle-income countries where proper HPV vaccines and treatments are not readily available. However, HPV is treatable and vaccines are available in developed countries. Through efforts from the World Health Organization (WHO), the U.N. and NGOs, HPV-caused cervical cancer in India is being addressed.

What is HPV?

HPV is the most common viral infection of the reproductive tract, according to the WHO. It is a sexually-transmitted disease (STD) that does not require penetrative sex for transmission—it can also be transmitted through skin-to-skin contact of the genitals. The majority of sexually-active people contract HPV at some point in their lives, but the majority of the 100 different identified types of HPV do not cause significant complications and clear up within two years at the most. However, 15-20 types of HPV are known to be oncogenic, meaning they cause cancer, and are classified as “high-risk.”

Overwhelmingly, the most common type of cancer associated with HPV is cervical cancer. Types 16 and 18 have the strongest link to cervical cancer, causing 70 percent of all cervical cancer cases.

The most common symptom of HPV is genital warts that appear anywhere from soon after sexual contact to years later. They can appear as a rough bump or cluster of bumps and are typically painful. These warts are treated through topical use of salicylic acid as well as prescription drugs to prevent the reappearance of warts–however, the virus never entirely leaves one’s system once contracted.

The most effective way of preventing contraction is by taking a multi-shot, effective vaccine before sexually active years (usually 14 and under). HPV causes cancer by affecting the infected person’s immune system and slowly transforming cells around the infected area into cancerous cells. This process could take many years to fully develop into a serious condition.

Cervical Cancer in India

Every year, there are more than 96,000 new cases of cervical cancer, adding to the already disproportionately high prevalence of HPV-caused reproductive cancer in India. HPV types 16 and 18 cause a slightly higher percentage of cervical cancer cases in India as compared to the world average; in India, the percentage of HPV-caused cases is 76.7 percent. When HPV is combined with smoking tobacco, multiple sexual partners and long-term use of hormonal contraceptives, the risk of developing cancer becomes higher.

As is the case anywhere in the world, HPV can only be totally prevented through abstinence. Since this is an unrealistic expectation for the majority of the human population, vaccination and regular pap smear screenings are the best ways to prevent HPV and/or catch it before it develops into a much more serious condition. However, large-scale screenings and vaccinations are very hard to make a reality in India. The largest population concentration is in the northern half of India, where many communities have no ready access to health care and even electricity in some cases. The risk of contracting STDs is also higher in these areas due to a lack of adequate sanitation and proper sexual protection. These are both effects of poverty and directly lead to a steadily maintained prevalence of serious HPV infections in India.

Steps Taken to Tackle Cervical Cancer in India

In May 2018, the WHO Director-General made a call to action urging countries around the world to implement the three most effective methods of HPV control: HPV vaccination, regular screening for pre-cancerous lesions and effective management of cervical cancer through oncological means. As a result of the WHO call to action as well as pressure from the educated, politically active population in India, there has been somewhat of an increased push in the Indian government to more adequately fund health care research towards HPV-caused cervical cancer control. The Indian Academy of Pediatrics Committee on Immunization (IAPCOI) has also made their wishes for pre-sexually active vaccination for Indian youths to be more widespread.

However, despite all the recommendations and calls to action, much of the Indian population remains skeptical of the vaccines–mainly of the prices that go along with them. Because India operates mainly through private providers instead of supplying vaccines and treatment in bulk to healthcare institutions, the price of vaccines can rise out of the realm of affordability for much of India’s impoverished population. Since the impoverished population is the one most affected, control of HPV-caused cervical cancer has yet to be seen. The solutions are available for Indians, but ultimately it is a matter of the Indian government complying with public health institutions’ wishes, subsidizing vaccination measures and making vaccines more affordable and readily available to people who need it most.

– Graham Gordon
Photo: Pixabay

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