Cervical cancer

In SA, HPV is the leading cause of cancer deaths among women

Here are some facts about human papillomavirus (HPV).

  1. HPV is a common virus that is transmitted sexually and by skin-to-skin contact.1
  2. HPV can cause cancer in men and women, including cancers of the cervix, throat, anus, and penis. It is also the cause of genital warts.2
  3. Some HPV types are responsible for warts, while others are responsible for cancers. HPV types 16 and 18 are responsible for about 70% of cervical cancers, whereas HPV types 6 and 11 cause about 90% of genital warts.2,3
  4. Adolescents and young adults aged 15 to 24 years of age are at highest risk of being infected by the virus. Studies from the US have shown that, at some time almost everybody who was sexually active (around 8 out of 10 people) had been exposed to the virus.1
  5. Most people who are exposed to HPV never develop any symptoms or disease. However, asymptomatic people may transmit the virus to others.1,2
  6. Studies indicate that among South Africans under the age of 25 years, more than 40% of women and approximately 20% of men are infected with HPV.3

About cervical cancer

  1. Cervical cancer affects the mouth of the uterus (womb).
  2. In SA, it is the most common cancer of women aged 15-44 years and the leading cause of cancer deaths among women in general.3
  3. Every year, nearly 8000 South African women are diagnosed with cervical cancer and more than 4000 die of the disease.3
  4. The most important risk factor for cervical cancer is infection with HPV. HPV causes virtually 100% of cervical cancers.3
  5. In women who do develop cervical cancer, the interval between acquiring the virus and progression to a cancer usually takes 10 years or longer.2
  6. In South Africa, cervical cancer is most commonly diagnosed in women between the ages of 30 and 60 years.3
  7. Other risk factors for cervical cancer include smoking, illnesses or medicines that lower immunity, other sexually transmitted infections (e.g. Chlamydia, gonococcal disease or herpes), a diet low in fruit and vegetables, being overweight, having a first pregnancy before the age of 17, and having a family history of cervical cancer (for example your mom, grandmother or aunt).2,4
  8. Because cervical cancer does not usually have any symptoms until it has reached an advanced stage, it is important for women to be screened for cancer every three years. This usually requires a pap smear, and possibly a HPV test.4

About HPV vaccines

  1. The HPV vaccine is 90%-100 % effective in inducing immunity to the HPV types included in the vaccine and preventing the development of precancerous lesions in the cervix.5
  2. Two types of HPV vaccines are available. The bivalent vaccine protects against two types of the virus that are most commonly responsible for cervical cancer, and is indicated for use in girls from the age of 9 years. The quadrivalent vaccine covers four strains of the virus, including those commonly responsible for cervical cancer and genital warts, and is indicated for use in girls and women from age 9 to 45 years and boys and men from 9 to 26 years of age.2,6
  3. The ideal time to vaccinate is before the first sexual experience, so that adolescents are protected long before they start to engage in sexual activity.2
  4. The safety of the bivalent and quadrivalent vaccines has been well established in clinical trials and in clinical practice worldwide. There is no truth to the myths that vaccines are associated with infertility, or lead to promiscuity or sexual activity at an earlier age.2,7
  5. By the end of 2014, the HPV vaccine was already introduced in 63 countries.8
  6. In South Africa, in conjunction with the World Health Organisation (WHO), the bivalent vaccine has been administered to girls in grade 4 at government schools since the year 2014.9,10
  7. Vaccination has been extremely successful. For example, in Australia, in comparison to before a vaccine was routinely available, the proportion of women between the ages of 18 and 24 infected with the virus has decreased by 77 %.11
  8. Parents who are able to afford to vaccinate their children who are not currently included in the school-based programme (i.e. girls at private schools and boys) can obtain the quadrivalent vaccine in the private health sector. Both the bivalent and quadrivalent vaccines are available at pharmacies, private clinics, general practitioners and gynaecologists.

References

  1. Weaver BA. Epidemiology and natural history of genital human papillomavirus infection. JAOA 2006; 106(3 Suppl 1): S1-S8.
  2. World Health Organization. Human Papillomavirus vaccines: WHO position paper. Weekly epidemiological record 2014: 89 (43): 465-492.
  3. Bruni L, Barrionuevo-Rosas L, Albero G, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in South Africa. Summary Report 2015-03-20.
    Available at: http://www.hpvcentre.net. Accessed 5 July 2016.
  4. American cancer Society (ACS). Cervical cancer prevention and early detection (2014).
    Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003167-pdf.pdf. Accessed 24 June 2016.
  5. De Vincenzo R, Conte C, Ricci C, et al. Long-term efficacy and safety of human papillomavirus vaccination. Int J Women’s Health 2014; 6: 999-1010.
  6. Gardasil package insert. MSD, South Africa; 2014.
  7. Centers for Disease Control and Prevention (CDC). Tips and time-savers for talking with parents about HPV vaccine 2016.
    http://www.cdc.gov/vaccines/who/teens/for-hcp-tipsheet-hpv.html. Accessed 3 June 2016.
  8. World Health Organisation. Immunization coverage. Available at http://www.who.int/mediacentre/factsheets/fs378/en/#. Accessed 5 July 2016.
  9. World Health Organisation regional office for Africa. WHO HPV readiness assessment picture story.
    http://www.afro.who.int/en/south-africa/press-materials/item/6395-who-hpv-vaccination-readiness-assessment-picture-story.html. Accessed 5 July 2016.
  10. South African Government News Agency. HPV vaccination campaign to be rolled out in schools; 12 http://www.sanews.gov.za/south-africa/hpv-vaccination-campaign-be-rolled-out-schools. Accessed 5 July 2016.
  11. Bonanni P, Bechini A, Donato R, et al. Human papilloma virus vaccination: impact and recommendations across the world. Ther Adv Vaccines 2015; 3(1): 3-12.