Backgrounder: Cervical Cancer in India

The Government of India is planning to launch the Human Papilloma Virus (HPV) vaccine in the universal immunisation programme to check cervical cancer cases in India. Currently, the union health ministry is considering the pros and cons of introduction of HPV vaccine.

What is Human Papilloma Virus (HPV)?

The HPV refers to a group of more than 150 different viruses that causes warts on skin and on the moist mucous membranes lines in the body such as mouth, anus and genital areas. Genital HPV infections are most common. They are usually spread through skin-to-skin contact including sexual activity with a person having genital HPV infections. HPV affects both men and women. Many infected persons don not know that they are infected with it or transmitting it to others. HPV infection of genital areas may cause genital warts. In woman, sometimes, certain HPV virus infects cervix that can lead to cancerous if not treated.

What are the causes for cervical cancer?

Cervical cancer is one of the most common cancers developed in woman worldwide. The major cause for cervical cancer is HPV. HPV is a necessary cause but may not be a sufficient cause for development of cervical cancer. There are other co-factors that are responsible for progression of a cervical HPV infection to cancer. Use of birth control pills for long periods, more sexual partners, early age at first intercourse, smoking, and weak immune system with HIV are some of the co-factors responsible for causing cervical cancer.

What are the available HPV vaccines?

Recombinant DNA technology is used for development of virus-like particles (VLP). The VLPs have same outer protein coating as HPV but without genetic material. The HPV vaccines use the VLPs as antigens to induce immunity system of the body. Gardasil marketed by Merck is a quadrivalent vaccine whereas Cervarix marketed by the GSK is a bivalent vaccine. Gardasil provides protection against both genital warts and cervical cancer whereas Cervarix provides protection against cervical cancer only.

At what age the HPV vaccines are administered?

The age of 9-12 years is recommended for initiation of vaccination. It can be administered to both boys and girls of that age. Catch-up vaccination is permitted up to 26 years. A total of three doses are recommended. If there is an interruption in the schedule, the vaccine series need not be restarted but the remaining does should be administered as early as possible.

What are the other methods to control cervical cancer?

Condoms offer some protection against HPV infection but they don’t cover all the genital skin. Countries such as United States opted for use of vaccines as well as screening of women in the reproductive age group. In India the issue with screening is lack of availability of trained personnel.

What is the status of cervical cancer in India?

In India, cervical cancer is the second most prevalent cancer among the woman after breast cancer. Around one-third of cervical cancer deaths in the world are reported from India. According to the available data, more than 90,000 cases of cervical cancer cases are reported in India in 2013. In the last few years, promotion of hygiene, late initiation of sexual activity, and late first time pregnancies are some of the factors responsible for marginally lowering the cervical cancer cases in India.

Why HPV vaccine became controversial in India?

In 2009, several school children from tribal areas in Khammam district of undivided Andhra Pradesh were administered with HPV vaccine as part of a trail campaign. The vaccine used was Gardasil, manufactured by Merck. After few months, many girls fell ill and few death cases were reported.  At the same time in Gujarat also few death cases were reported with administering Cervarix, another HPV vaccine manufactured by GSK. Later it was found that the girls were administered with HPV vaccine without requisite consent from their families, who are illiterates. Due to furore in public and media, the trail campaigns were discontinued. Currently, the issue is sub-judice. The campaign caused a negative impression on HPV vaccines.