Cervical cancer prevention in the era of HPV test and vaccine

Cervical cancer is the fourth most common cause of death among females worldwide. The high-risk Human Papilloma Virus (HPV) is the major cause of cancer of the cervix. Although preventable as well as curable, it is still the 2^nd most common cause of death in developing nations. ¹

In the United Kingdom, the incidence of cervical cancer is highest among women of the age group 30-34 years. There has been an 18% drop in cervical cancer deaths in the UK over the last decade.¹ However, when it comes to cervical cancer burdens and deaths, the picture is very different in the rest of the world.

The symptoms of cervical cancer

• Vaginal bleeding
• Postmenopausal spotting or bleeding
• Bleeding after sexual intercourse
• Increased vaginal discharge
• Unexplained back pain

Does HPV cause cervical cancer?

Despite the fact that there are more than 200 types of HPV, high-risk HPV infections are most commonly associated with cervical cancer. ^2,3,4

Five interesting facts about HPV infection

The risk factors for acquiring HPV infection^6,8

• Using oral contraceptives for a long time
• Smoking and alcohol consumption
• Poor immune system
• Existing sexually transmitted infection
• Multiple pregnancies
• Unprotected sexual intercourse and multiple sexual partners

Barrier’s to the cervical cancer screening program⁶

When to attend cervical cancer screening?

American Cancer Society Screening in 2020 advised the screening for cervical cancer between the age group of 25 to 65. Co-testing (PAP smear and HPV test) is the most preferred method.^4,10

There is a remarkable reduction in the rate of cervical cancer with a single HPV test when compared to a cervical PAP smear.⁹

The HPV vaccine: What one should know ^4,6,11

Take home message

Cervical cancer prevention requires a collaborative effort by various stakeholders. Despite campaigns and awareness programmes worldwide, there is a lack of participation, especially among women in low socioeconomic countries. Therefore, there is a need to make cervical cancer screening programmes more women-friendly.

Several studies confirm the effectiveness of HPV vaccination when immunized before the age of puberty. Hence, it is necessary to convey a similar message to parents and carers regarding the benefits of the HPV vaccine along with the potential side effects of the HPV jab.

References

1. _{Cancer Research UK (2021) Cervical cancer statistics. Cancer Research UK. http://www.cancerresearchuk.org}
2. ^{https://www.who.int/news-room/fact-sheets/detail/cervical-cancer}
3. ^{Human papillomavirus (HPV): the green book, chapter 18a. Public Health England, 2019}
4. ^{Rosalik K, Tarney C and Han J. Human Papilloma Virus Vaccination. Viruses. 2021, 13, 109}
5. ^{GLOBOCAN 2012 database. Cervical Cancer: Estimated Incidence, Mortality and Prevalence Worldwide in 2012. International Agency for Research on Cancer; Accessed July 15, 2018}
6. ^{Okunade KS. Human papillomavirus and cervical cancer. J Obstet Gynaecol. 2020 Jul;40(5):602-608}
7. ^{Rositch AF, Koshiol J, Hudgens MG, Razzaghi H, Backes DM, Pimenta JM, et al. Patterns of persistent genital human papillomavirus infection among women worldwide: a literature review and meta-analysis. Int J Cancer. 2013 Sep 15;133(6):1271-85}
8. ^{Quinlan JD. Human Papillomavirus: Screening, Testing, and Prevention. Am Fam Physician. 2021 Aug 1;104(2):152-159}
9. ^{Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med 2009; 360: 1385–94}
10. ^{Wentzensen N, Schiffman M, Palmer T, Arbyn M. Triage of HPV positive women in cervical cancer screening. J Clin Virol. 2016 Mar;76 Suppl 1(Suppl 1):S49-S55}
11. ^{Tsikouras P, Zervoudis S, Manav B, Tomara E, Iatrakis G, Romanidis C, et al. Cervical cancer: screening, diagnosis and staging. J BUON. 2016 Mar-Apr;21(2):320-5}