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Cervical cancer is a widespread disease affecting the female population of the world. Globally, it is the 4th most common cancer which is responsible for over 310,000 deaths per annum.  In 2018, about 570,000 new cases of cervical cancer were diagnosed and more than 80 percent of the cases were from low and middle income countries.1

How Do You Get Cervical Cancer?

Most cervical cancer cases are attributed to Human Papillomavirus (HPV). The virus enters the cervix through intercourse or through skin-to-skin or skin-to mucosa contact of the genital area. Overtime, it causes the development of abnormalities with the cells which can lead to cancer. This process usually takes from fifteen to twenty years. However, certain conditions like poor immunity may decrease that time interval.1

About HPV

Human Papillomavirus is extremely widespread. Almost every sexually active person will get this virus at some point in their life. However, the majority of HPV-positive individuals were first infected shortly after their sexual encounter.

Nowadays, the number of HPV types has reached two hundred. Some of them are transmitted sexually. There are two main groups of HPV: 1, 3

  • High-risk HPVs (about 14 types from this category can cause cancer)
  • Low-risk  HPVs ( responsible for warts)

Human Papillomavirus types 16 and 18 are the most dangerous. They are responsible for over 70% of all cervical cancer cases and pre-cancerous abnormalities. 1 Moreover, some of the other cancer types may also be attributed to HPV. The list of those cancer types include: 3

  • Anal
  • Vaginal
  • Vulvar
  • Penile
  • Oropharyngeal

It is important to mention that the majority of infected individuals get rid of the HPV within two years and only chronic infection (when the virus persists in the organism) leads to cancer formation.1

Today, vaccines against Human Papillomavirus have almost 100% effectiveness which makes them capable of preventing all of the HPV-related health complications.

Note that condoms do not offer 100% protection from the virus. The underlying reason for this is the probability of HPV contraction through skin-to-skin or skin-to mucosa contact. The virus spreads from an infected person to the susceptible one when the skin and mucosal membranes of the genital area contact each other. Sexual intercourse is not necessary for its spread. 3

The Situation in Caribbean Communities

Cervical cancer is a major public health issue in the Americas. It is known to be the 3rd most prevalent cancer type diagnosed in women of the region. Annually, more than 70,000 cervical cancer cases and 34,000 deaths are reported among the female population of the South American and Caribbean countries. 4

Back in 2017, the HPV vaccine was already available in seventeen Caribbean countries. At that moment, on average 50%-55% of the target population got the HPV vaccine. 5 The coverage level of the vaccine differs from country to country. However, in order to reduce the incidence rate of cervical cancer, at least 80% of the eligible population should be vaccinated against Human Papillomavirus.4

The situation in African countries is even more alarming. According to Surveillance, Epidemiology, and End Results (SEER) Program for 2013 to 2017, more black women are diagnosed with cervical cancer than white women, American Indians, and Asian women. 12

African countries have the highest burden of cervical cancer. However, only 1-2 percent of women eligible for the vaccine actually get vaccinated. 13

An important fact regarding a higher rate of cervical cancer in Africa is that women who are HIV positive are 6 times more likely to get cervical cancer as compared to their HIV-negative counterparts; and of the 34 million HIV-positive individuals worldwide, more than 60 percent live in Africa. Moreover, about 91 percent of HIV-positive children live in Africa. So, it is no coincidence that countries with a higher burden of HIV also have a greater number of cervical cancer cases. In fact, about 65 percent of cervical cancer cases in Southern Africa are in women who are HIV-positive; whereas, there are 27 percent such cases in eastern Africa, 12 percent in central Africa, and 10 percent in central Africa. 14

Vaccination against HPV is an important step in reducing the prevalence of (preventable) cervical cancer.

Risk Factors of HPV Chronic HPV infection

As it was mentioned before, in the majority of cases, HPV disappears by itself. Sometimes, our body becomes unable to fight against the virus which leads to its persistence. Several factors contribute to HPV persistence, such as: 1, 3

  • Having a weakened immune system
  • Smoking
  • Having other Sexually Transmitted Infections (STIs)
  • Long-term use of contraceptives
  • Having many kids

HPV Vaccine

HPV vaccines are made to prevent HPV-associated genital warts, pre-cancers, and cancers. It is important to mention that these vaccines only prevent and not treat HPV-related health consequences. 1

Back in 2006, the HPV vaccine was approved by the U.S. Food and Drug Administration (FDA). Since that moment, continuous clinical studies proved the long-term effectiveness and safety of the vaccine. Thousands of individuals, both males and females participated in HPV vaccine trials. 6 Globally, more than a hundred million individuals received this vaccine. Even though, there have reports of some adverse events after HPV vaccine administration, such as formation of blood clots, fainting, and even death, there is no evidence of those events being definitively caused by the vaccine.7, 8

How the HPV Vaccine Works?

Vaccines against Human Papillomavirus contain virus-like particles. The latter are collected in labs from the surface of the virus. These particles are not dangerous and are unable to cause disease by themselves. However, after being injected into the body, they start to promote the production of specific antibodies against HPV. These antibodies persist in our blood and once they encounter the actual HPV virus, they destroy it and protect from further cell infection. 9

Does Getting the HPV Vaccines Guarantee You Won’t Get Cervical Cancer?

Three HPV vaccines are available worldwide: bivalent (Cervarix®), quadrivalent (Gardasil®), and nonavalent (Gardasil 9®). All of them offer full protection against the most dangerous types of HPV, i.e., HPV 16 and HPV 18.. Roughly, seventy percent of all cervical cancer cases and precancerous cervical lesions are attributed to these two types The latest, nonavalent vaccine prevents 5 additional cancer-causing types of the virus, which are responsible for over twenty percent of all cervical cancer cases. Thus, the HPV vaccine may decrease almost 90% of all anal, vaginal, vulvar and cervical cancers. Moreover, quadrivalent and nonavalent vaccines protect against  HPV type 6 and 11, which are responsible for  anogenital warts.

The information regarding HPV vaccine protection is summarized in the table below. 1, 7, 8

HPV Vaccine Type Types of HPV Prevented by the Vaccine Protection from Cervical Cancer

(%)

Protection from Genital Warts

(%)

Bivalent 16, 18 70% 0%
Quadrivalent 6, 11, 16, 18 70% 90%
Nonavalent 6, 11, 16, 18, 31, 33, 45, 52, 58 90% 90%

 

In clinical trials for the HPV vaccine, all three types of vaccines have shown desirable results in close to 100 percent of the recipients.

HPV Vaccine Recommendations

HPV vaccine works best when administered before any sexual interaction. Just two doses of the vaccine ensure life-long protection from certain HPV strains. Children may get the vaccine as soon as they turn 9 years old. However, according to the CDC, the optimal age for the first dose of HPV vaccine administration is 11-12 years.

The catch-up vaccines are recommended for those individuals who  were not adequately vaccinated at age 11-12. . So, the susceptible men and women may get vaccinated till their 21st and 26th birthday, respectively. However, those who receive the vaccine at the age of 15 or after turning 15, will need three doses of HPV vaccine given over 6 months . 10, 11

Nowadays, adults aged 27 and more may also receive the HPV vaccine. However, the effectiveness of the vaccine is low when administered among people of that age-group. 10, 11

CDC recommends the following schedule for HPV vaccination: 10

Dose  Time of the vaccine administration
First 11-12 years
Second 6-12 months after the first dose

Limitations and Risks of the HPV Vaccine

The HPV vaccine, such as any other medicine, is not completely free of unpleasant adverse events. However, there are no  serious adverse effects that should be attributed to any type of HPV vaccine. Some of the patients may experience: 6

  • Local pain
  • Local redness and swelling
  • Headache
  • Tiredness
  • Feeling dizzy
  • Fever
  • Muscle pain
  • Joint pain

Also, very rarely, a person  may  faint right after vaccine administration. This may result in serious injuries. So, to prevent injuries, it is necessary to follow the vaccine administration recommendations, which are: 6

  • The vacinee should remain seater or lay down  during vaccine administration
  • The vacinee should not move for 15 minutes after vaccine administration
  • The vaccinator should follow the vacinee during the whole period

Vaccines are contraindicated in some people. For example, people who have allergies  and pregnant women should not receive the HPV vaccine. The negative effect of the vaccine on the health of pregnant women or the fetus has never been proved. However, the Centers for Disease Control and Prevention (CDC) recommends to delay the vaccine inoculation among this particular population.6, 9

Myths and Facts about HPV Vaccine

Here are some of the widespread HPV vaccine-related myths and facts. 9, 10

Myth Fact
The HPV vaccine cause infertility There is no evidence for the link between  HPV vaccine and infertility. However,HPV-associated infection can cause infertility. So, not getting HPV vaccine may lead to HPV-associated health complications (cervical cancer, pre-cancer) which may affect fertility.
The HPV vaccination leads to the development of cancer and/or HPV infection The vaccine does not contain any type of HPV. It is made from virus-like particles (VLPs) that are able to activate the immune response. VLPs lack the virus DNA and hence, they do not cause infection. So, it cannot cause HPV infection or cervical cancer.
The HPV vaccine is not safe For more than a decade, HPVvaccine has been monitored and tested all over the world. There is no evidence of the HPV vaccine being unsafe or dangerous. Researchers continue to prove the effectiveness and safety of this vaccine.

 

References

  1. Human papillomavirus (HPV) and cervical cancer. https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer . Accessed November 6, 2019.
  2. Cervical cancer – NHS. https://www.nhs.uk/conditions/cervical-cancer/. Accessed November 6, 2019.
  3. HPV and Cancer – National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer. Accessed November 6, 2019.
  4. PAHO/WHO | Cervical cancer is the third most common cancer among women in Latin America and the Caribbean, but it can be prevented. https://www.paho.org/hq/index.php?option=com_content&view=article&id=14947:cervical-cancer-is-the-third-most-common-cancer-among-women-in-latin-america-and-the-caribbean-but-it-can-be-prevented&Itemid=1926&lang=en . Accessed November 6, 2019.
  5. Trinidad, Tobago. THIRTY-THIRD MEETING OF THE CARIBBEAN IMMUNIZATION MANAGERS 33rd Caribbean EPI Managers’ Meeting-Final Report.
  6. HPV Vaccine is Safe and Effective | CDC. https://www.cdc.gov/hpv/parents/vaccinesafety.html. Accessed November 7, 2019.
  7. Gardasil Vaccine Safety | FDA. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/gardasil-vaccine-safety. Accessed November 7, 2019.
  8. 9 Types of Human Papillomavirus (HPV). https://www.merckvaccines.com/Products/Gardasil9/hpv-types. Accessed November 7, 2019.
  9. Human Papillomavirus (HPV) Vaccines – National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet. Accessed November 7, 2019.
  10. HPV | Who Should Get Vaccine | Human Papillomavirus | CDC. https://www.cdc.gov/hpv/parents/vaccine.html. Accessed November 7, 2019.
  11. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices | MMWR. https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm. Accessed November 7, 2019.
  12. HPV-Associated Cervical Cancer Rates by Race and Ethnicity. https://www.cdc.gov/cancer/hpv/statistics/cervical.htm. Accessed November 7, 2019
  13. Gender-neutral HPV vaccination in Africa | The Lancet, Global Health. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30073-7/fulltext Accessed November 7, 2019
  14. Women with HIV have sixfold increase in risk of cervical cancer | NAM ADISMAP https://www.aidsmap.com/news/dec-2020/women-hiv-have-sixfold-increase-risk-cervical-cancer Accessed November 7, 2019
  15. Vaccines and Preventable Diseases | About HPV Vaccines | CDC. https://www.cdc.gov/vaccines/vpd/hpv/hcp/vaccines.html Accessed November 7, 2019
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