Cervical cancer in Nepal: The prevention strategy
Half a million women worldwide develop cancer of the cervix every year of which 50 per cent die. Of the cancers reported every year, 80 per cent are in the developing countries. A recent multi-institution hospital-based cancer incidence data reveals cervical cancer as the most common cancer among women in Nepal. The cancer toll in our country is due to the fact that the majority of the cases are detected in the last stages. The patients report for treatment at a very advanced stage when the pain and misery to the patients are extreme. Furthermore, it also causes an economic impact on the family which is already devastated.
Cervical cancer is the second most common cancer and a leading cause of cancer mortality among women worldwide. In most instances, cancer cervix can be prevented but is killing millions of woman worldwide. The majority of women with cervical cancer die in our country as screening and optimal treatment are not adequately available. However, screening awareness has begun even in our country, especially in institutions where proper screening is done as in the Gynae /Obs Deprtment in Tribhuvan University Teaching Hospital and other major hospitals. NGOs are also lending support for screening cancer cervix and one such NGO is Nepal Network for Cancer Treatment and Research (NNCTR) with its office in Banepa. This has helped in screening thousands of women, which helps a long in detecting cervical cancer at the very onset. A method to prevent this form of cancer in women is providing vaccination against Genital Human Papilloma Virus (HPV) infection to them before they become sexually active.
HPV infection is the most common sexually transmitted infection among sexually active women. Around seventy five per cent of sexually active men and women have been exposed to HPV at some time or other of their lives.
In the majority of cases, HPV 16 and 18 infections are observed. This clearly leads to the fact that if HPV infection is prevented, cervical cancer can be prevented. At Georgetown University Medical Center’s Department of Pathology, the long research on HPV research led to a major breakthrough. The vaccine against HPV was developed in the late 1980s. HPV vaccine efficiency in preventing cervical dysplasia and cancer has been recommended globally on population based studies. The HPV vaccine has been approved by the US Food and Drug Administration (FDA).
The first step in the prevention of cervical cancer is to make a strong impact through screening 90 per cent of women who are sexually active in the risk age group of 30-55. That can do much to reduce the incidences of the form of cancer. However, taking up screening all the sexually active women in Nepal is a big challenge, and it is another matter to have the school children vaccinated with HPV vaccination before they become sexually active is another demand. Now vaccination is complementary to screening, so that our women do not develop cancer. It also aids in early detection if any so that the number of women who come for treatment at the last moment would decline. It would also help in checking the spread of this form of cancer among women. And, it would save the women from the pain and misery that the women have to go in the advanced stages of the cancer. As or the vaccination, three doses have been recommended: the second dose is given a month after the first dose, and the third one month after the second dose.
NNCTR received 3,300 vials of quadrivalent human papilloma virus (types 6, 11, 16, 18) recombinant vaccine (Gardasil,) as a gift by Australian Cervical Cancer Foundation (ACCF). ACCF aims to provide HPV cervical cancer vaccine for women in developing countries who cannot afford the relevant vaccination. HPV vaccine was offered to 1096 girls between the ages of 10 and 26 years, attending secondary schools. In total, 1091 (99.5%) received the second dose and 1089 (99.3%) received the third dose of the vaccine. No serious vaccine related adverse events were reported except mild pain at the injection site in 7.8 per cent of the vaccine recipients.
With the progress done by NNCTR in vaccinating school going children, the government of Nepal has given permission to allow free of cost HPV vaccination to children There are also plans to making this vaccination a part of the national immunization programmes. High cost and lack of awareness are the main reasons for difficulties in the implementation of the HPV vaccination program in a low resource country like Nepal.
HPV vaccine has been found to be safe with high acceptability in Nepalese school girls. However, a large population study with longer follow up is needed . It will really be a feat when all Nepalese school going girls will be vaccinated with HPV vaccination which could eventually lead to very few cervical cancer cases in the country. The prevention strategy through the vaccination programme backed up by proper screening on a regular basis would do much to fight the cancer that takes a heavy toll of women lives globally.