HPV = Warts = Cancer. That is an equation we should all remember.
The burden of human papillomavirus (HPV) infection has long been a worldwide healthcare concern and still not many people know the link between HPV and cancer. Despite the availability of HPV vaccination since 2006, it is estimated that less than five percent of eligible Filipina women have availed it.
In a roundtable discussion entitled "Bridging HPV and Cancer: Why It Matters," medical professionals specializing in HPV studies underscored the burden of HPV and how it can prohibit people, especially women, from having a healthy future. HPV infection causes cervical cancer, which is a prolific killer and the fourth most common cancer among women across the globe.
Dr. F. Xavier Bosch, a senior consultant with the Cancer Epidemiology Research Program (CERP) at Catalan Institute of Oncology (ICO) Information Centre in Spain, and Dr. Sybil Bravo, ob-gyn, an infectious diseases specialist, and a clinical associate professor at the University of the Philippines - College of Medicine and Philippine General Hospital, shared insights on the incidence of HPV infection, the relevance of the different HPV types, and their association with several cancers, and the major barriers and success stories surrounding its prevention.
There are more than 100 types of HPV strains, and approximately 30-40 types affect the genital area. HPV infection is usually transmitted through sexual intercourse, but any kind of genital contact, even if it's just the skin of the genital of an infected person, can result in transmission. It is interesting to note that while the use of condoms is a common method of contraception among Filipinos, it does not fully protect males from cancer because the condom does not cover the scrotal area, which may be exposed to mucus infected with HPV.
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HPV can also be spread from mother to child at birth, although it is not common.
Cervical cancer = HPV HPV causes virtually 100 percent of cervical cancer cases, according to the the "Human Papillomavirus and Related Diseases Report" recently published by the ICO Information Centre, which is based in Barcelona, Spain. It is also known to cause other genital cancers in both males and females. And while genital warts themselves are not cancerous, you will have to undergo certain surgical procedure to have them removed.
However, many people with HPV are also not symptomatic, but can infect others.
In the Philippines, cervical cancer is the second leading cause of cancer-related deaths among Filipino women, next to breast cancer. Although cervical cancer screening tests are readily available for early treatment or prevention, more than 6,000 Filipinas are still diagnosed with cervical cancer every year. Within five years from diagnosis, more than half of those women will die.
Says Dr. Bravo, "In the past, we've only had one to two HPV cases in the hospital per day, but over the last 10 years we've had an increase [in cases of] genital warts and cervical cancer [and it's now] 17 to 20 per week.
"The age of first contact of the infection is getting younger and younger. Our youngest patient with cervical cancer is 15 years old," she reveals.
Thus, the Department of Health (DOH), with support from multi-stakeholder groups, recently included quadrivalent HPV vaccine in its school-based national immunization program to protect young girls against diseases caused by HPV infections.
The immunization initiative was previously implemented through the community-based approach. Armed with expert recommendations on the ideal model for service delivery given the target beneficiaries, the recent shift was brought by the DOH's goal to vaccinate 720,000 young girls this year. From 20 provinces, the scope of the expanded program now spans 56 provinces and cities across the country.
The quadrivalent HPV vaccine used by the DOH in its immunization program is available in more than 130 countries globally, with many countries also utilizing this as part of their national immunization programs. It covers HPV types 6, 11, which are the most common causes of genital warts, and types 16 and 18, which have been specifically identified as the main cause of cervical cancers globally.
The latest HPV vaccine, which is nonavalent, covers nine HPV types, including seven of the most common high-risk types and the one said to be the most common cancer-causing type in the Philippines.
Collectively, HPV strains 16, 18, 45, 52, 58, 31 and 33 are known to cause approximately 85 to 95% of anal, vulvar, and vaginal cancers. HPV strain 16 also causes 35 percent of penile cancers.
The average person's lifetime risk of contracting HPV is 75 to 80%. Worldwide, there are approximately 527,624 new cases of cervical cancer reported every year; 7,200 new cases of anal cancer; and 1,800 new cases of penile cancer.
So what is the best way to avoid cancer? Dr. Bravo says kids as young as 9 can already be vaccinated, while adults age 21 and up are encouraged to get HPV screening every three years, until age 30. For middle aged women, a pap smear is advised every three years until age 65.
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Dr. Bosch highlighted the need to focus on HPV strains that local epidemiology is able to show, in order to address these appropriately with vaccination -- the primary means of prevention that is readily available. "We have the possibility to prevent cancer by vaccinating," he stressed.
Both Bosch and Bravo emphasized the need for continued multi-sector collaboration to help achieve an HPV-free future, and further spread awareness on the threat posed by HPV and the significance of cervical cancer screening and immunization. This includes government agencies, non-government organizations, the academe, medical community, private sector, members of the media, and particularly mothers who have the primary role of helping their daughters lead a brighter future away from the burden of vaccine-preventable diseases such as cervical cancer.