Cervical cancer has the possibility of elimination and can be eradicated from many countries in the world in four to five decades, said Dr. R. Sankaranarayanan, Special Advisor on cancer control and head of screening group with the World Health Organisation (WHO), at the Asia-Oceania Research Organisation in Genital Infection and Neoplasia (AOGIN) conclave held in Singapore last week.
The three-day conclave was attended by gynaecologic oncologists, scientists and representatives of pharmaceutical majors. Dr. Sankaranarayanan said that cervical cancer incidence was falling globally by about 1 to 3 per cent per annum, and that screening as well as vaccination are effective interventions to tackle the malady.
He outlined WHO’s guidance note on cervical cancer that puts vaccination against the Human Papilloma Virus (HPV) of girls in the 9 to 13 age group as primary prevention, and screening of women aged over 30 as secondary prevention.
He said that 34 low- and middle-income countries have HPV vaccine in their national immunisation programmes, but India (which recorded 67,400 deaths due to cervical cancer in 2012) was lagging behind.
“When India hesitated (to implement it) in 2010, Bhutan implemented it. There are important lessons to learn from the Bhutan programme that followed it up and evaluated its impact and coverage,” Dr. Sankaranarayanan said.
He said Malaysia too has successfully implemented cervical cancer vaccine in its National Immunisation Programme (NIP). Other countries including Thailand and Sri Lanka are introducing the HPV vaccine in their NIPs in 2017, he said. “And these (implementations) are based on evidence and not hearsay.
WHO considers HPV vaccine as one of the best strategies in cancer control,” he said. HPV infection can cause cervical, vaginal and vulvar cancer among women and penile cancer in men.
On safety concerns around the vaccine, Dr. Sankaranarayanan said, “WHO has clearly stated that based on experience of clinical trials and national programmes, HPV vaccine is as safe as any other vaccine.”
Dr. Anuj Walia, Regional Director, Medical Affairs (Asia Pacific) with MSD Pharmaceuticals, said Australia had implemented the vaccine six years ago and has shown significant impact. He cited the safety reviews that Centres for Disease Control and Prevention (CDC) has published that have shown the vaccine as safe.
Gardasil, the cervical cancer vaccine from the MSD stable, has been in the global market for 10 years. Officials of MSD said the vaccine is approved in 132 countries and implemented in 65 NIPs. In India, doctors in private practice prescribe it but its cost of Rs. 2,700 per dose has limited its reach. WHO recommends two doses of the vaccine at a gap of six to 12 months for girls in the 9 to 13 age group.
An advisory on Gardasil on the CDC website cites studies conducted between 2011 and 2014 that have found the vaccine safe. Apart from a 2012 study that has noted the possibility of a skin infection where the shot is given within two weeks of vaccination, other studies cited by CDC have ruled out any link between allergic reactions, stroke, seizure among other medical conditions with the vaccine.
The India story
“India has 23% of the global burden of cervical cancer. The vaccine has been around, but the uptake has not been significant,” said Dr. Neerja Bhatla, president, AOGIN and chairperson of Federation of Obstetric and Gynaecological Societies of India’s oncology committee.
Dr. Bhatla, who is professor of gynaecology at the All India Institute of Medical Sciences, said the vaccine was an important intervention India, more so with regard to the country’s young demographic. Besides, she said it is a generation of sexually active people and need protection from HPV, the most common sexually transmitted infection.
Dr. Sankarnarayanan said he was optimistic about the vaccine’s implementation in India, given that some states such as Punjab and Tamil Nadu are showing interest in it. “The government of Punjab has constituted a technical committee to study the vaccine. The Central Health Ministry has also asked the national advisory group on vaccination to look at the possibility of HPV vaccination. So there is a change of mind,” he said.
