HPV Vaccination And Cervical Cancer Prevention
Cervical Cancer is responsible for more than any gynecologic-related deaths world wide than any other malady, making it the most important preventable disease in women's health today. Worldwide each year 4, 93,243 women are diagnosed of cervical cancer of whom 2,40,000 women die of this disease (WHO). India contributes more than ¼ of the global burden. Each year about 1,32,082 cases of this cancer are diagnosed and more than 74,118 women die of this disease, this cancer being most common cancer of women in our country.
Human Papilloma Virus (HPV) infection is now a well established cause of cervical cancer. Human papilloma virus is a double stranded DNA virus of papovaviride family. More than 100 types described; 30 infect ano genital tract. High risk types of 16, 18, 31, 33, 35, 45, 51, 52, 56, 58, 59 and 68 are associated with neoplasia. HPV 16 and 18 in 70% of this cancer cases world wide and 45 and 31 with a further 10% of this cancer case. Low risk types 6, 11, 42, 43, 44 associated with genital warts (cardyloma) and do not cause cancer. Almost 100% cancer cases of cervix are associated with HPV, 90% cases of anal cancer, 40% cases each of vulva, vagina, penis and about 12% cases of oral cavity and pharynx are HPV related cancers.
Cervical Cancer ranks the first most frequent cancer among the women between 15-44 years. According to WHO/ICO information centre on HPV and cervical cancer, India has the population of 365.71 million women ages 15 years and older who are at risk of developing cancer. About 6.6% of women in general population are estimated to harbor cervical infection at a given time and 76.7% of invasive cervical cancer in India are attributed to HPVs 16 & 18. Human papilloma virus spread primarily through sexual intercourse. Infection can occur in as little as one month after the fist sexual contact.
Though HPV is a necessary cause of cervical cancer but is not a sufficient cause. Other Cofactors are necessary for progression from cervical HPV infection to cancer. High parity, tobacco smoking, longterm use of oral contraceptives and coinfection with HIV have been identified as established co-factors; co-infection with chlamydia trachomatis and herpes simplex virus type -2, immunosuppression and certain dietary deficiencies are other probable co-factor.
With the knowledge of HPV (Oncogenic types) as the causative agent of this cancer, two types of vaccination strategies have been aimed at prophylactic vaccine is virus like particle (VLP) <1 vaccine which prevents HPV infection before it occurs and therapeutic vaccine which eliminates existing HPV infection. Therapeutic vaccines are still under trial and are not available globally. The cervarixTM (GlaxoSmithkline) against HPV 16 and 18. The GardasilR (MSD) against HPV types 16 and 18, 6 and 11 both these prophylactic vaccines are approved for use in India. Vaccines are effective against human papilloma virus 16 and 18 responsible for causing 70% of all cervical cancer cases but in phase II as well as in phase III trials these have also shown the additional protection against human papilloma virus types that cause more than 20% of all cervical cancer cases and these have demonstrated efficacy of more than 90%. The most effective time to vaccinate girls and young women is before they become sexually active. The vaccine is ideally administered before potential exposure to HPV through sexual contact. Centers for disease control and prevention's advisory committee on immunization practices (ACIP) recommended vaccination of young girls and adolescents between the age of 9 to 26 years. Emerging data suggest that the vaccine may be safe and effective in boys, young men and adult women upto the age of 27 – 45 years. Screening for HPV DNA or antibodies are not needed before vaccination. Women with abnormal pap tests or genital warts can be vaccinated. The need for the booster dose has not been established yet.
HPV vaccine is given in three doses at 0, 1, 2, and 6 months by intramuscular injection (0.5ml prefilled syringe) single dose. This requires the refrigeration at 2 – 8 0 c. These are safe as there is no viral DNA in the vaccine and tolerable. The common side effects are injection site reactions, redness, swelling and soreness of mild to moderate severity. These are not recommended for pregnant women due to limited safety data.
Following HPV vaccination these women are required to undergo regular screening programme with pap test as vaccine does not offer 100% protection, hence a need for counseling every woman undergoing primary prevention with HPV Vaccination.
Prophylactic HPV Vaccine offer effective primary prevention for these cancer and seems promising towards the reduction of this cancer burden globally especially in developing countries.
Questions and Answers
In India more women die because of cancer of cervix than by any other disease. This happens despite the fact it is easily preventable and curable. Out of 500,000 new cases of cancer cervix detected worldwide each year, India contributes 20 percent (100,000) of them.
Unusual presentations of cancer are well recognized by oncologists world over and at DHRC we get to see a fair number of them.
Eighty percent of cancer patients in India are diagnosed at a late stage, when inspite of spending Rs. 5 lacs to 50 lacs on treatment, it is not possible to save them. Research and development by scientists and medical professionals has made it possible to detect cancer at an early stage, when it completely curable.
Cancer surgeons in Indian hospitals are certified and have more than five to ten years of experience.
Cervical Cancer surgery in Indian hospitals is certified and has more than five to ten years of experience for the Cervical Cancer surgery in India.
Dr. Sartori is experienced in the use of ozone. He has also followed up on the cesium chloride research of Dr. Keith Brewer and has successfully used cesium chloride therapy for years in the treatment of cancer. The following papers are used with his permission. Dr. Sartori is no longer practicing and has trained a few Practitioner and specialized doctors to continue his work. Dr Pablo in Colombia at www.XYZ Wellbeing.com
Cancer translational research brings together scientists' and clinicians' suggestions to develop solutions to biomedical complications. This kind of applied research strives to offer strategies to questions surrounding the etiology, pathology, diagnosis, prevention and treating cancer.
Orbs are actually a lumpectomy or quadrantectomy combined with rotating the breast tissue or mobilize the flap into the cavity of the surgery time fill is removed. It also includes the comparative change in shape and size is doing in relation to breast and moved if necessary, does not affect the conversion of the breast. The deferred plan the reconstruction is not part of endoplasmic techniques. Both procedures are performed by specific thoracic surgeons.
What every woman fears for is losing her self confidence , losing hope and losing her personality. The term "Breast Cancer" is a very negative word and that it creates negative vibrations in her heart. So, to make her comfortable with the basics of breast cancer and to make her means any woman understand that this type of cancer is the least dangerous than all cancers and that if it is detected early then you will fight with it successfully. Causes, Symptoms, treatment, discussed in detail.
Mesothelioma is a rare cancer that originates in the mesothelium. The mesothelium is the protective lining that covers the body's internal organs. Mesothelioma occurs when the mesothelium cells start to divide uncontrollably.
Chemotherapy is a treatment for killing cancerous cells which is given intravenous or extra-venous to the cancer patient. Even breast cancer patients have to go through the treatment. This treatment mainly focuses on the cancerous cells that are spread in the blood stream in the whole body . If any cancerous cells are there then they are killed by the chemotherapy medicine. The medicine is very costly and it has to be taken for one or two days continuously for every 21 days .
Eighty percent of cancer patients in India are diagnosed at a late stage, when inspite of spending Rs. 5 lacs to 50 lacs on treatment, it is not possible to save them. Research and development by scientists and medical professionals has made it possible to detect cancer at an early stage, when it completely curable.
"CANCER," the dreaded six-letter-word, has been traditionally associated with a feeling of being handed over a "Death warrant" for most of the cancer patients and their family members. It's perhaps hard to believe if someone says, "Cancer is curable" but still harder to accept as true if someone pronounces, "Cancer is not only curable, but following treatment, one can lead almost a healthy and normal life."
Breast cancer is the commonest cancer amongst the Indian women and an estimated 400,000 women die annually from this disease worldwide. Though the mortality rates have fallen over last two decades, the incidence continues to rise with an average life time risk of approx.10 %.
Cancer of cervix and breast cancers is the commonest female cancers inIndia(NPBR, 2005). The incidence of cervical cancer has been brought down significantly in most developed countries, to 6-7 per 100,000 populations.
A number of diagnostic tests are required for detection and management of cancer of which imaging plays an important (pivotal) role in cancer management. Imaging has made rapid strides in the past few years with newer modalities and new indications getting added as time progresses
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