Introduction:
The belief that women do not indulge in any sort of sexual activity at a young age is a myth. Every passing year has seen an exponential increase in the number of teenagers becoming sexually active at a very young age. According to the National Health and Family Welfare data, the average age for first sexual activity in India is 19 years. Though there is no national body that collects data on premarital sexual activity among Indians, various surveys conducted by some independent bodies suggest that as high as six to 15 percent of adolescents are involved in sexual activity. Almost one in three women admit to having been involved in sexual activity before reaching the age of 18. One in ten girls have had a sexual experience of some kind before even turning 15.
With no proper sexual education in the school curriculum, easy and early access to pornography, rampant illegal child marriages, and in general, the taboo associated with sex in the culture, the situation seems to be only worsening. Other than being of deep moral and ethical concern, the dangers are nothing less than an epidemic. Sexual activity at this tender age brings with it loads of psychological and health-related burdens. This is seen in the form of rising sexually transmitted diseases among adolescents, teenage pregnancies, and illegal abortions. Most sexually transmitted diseases are amenable to cure, but unfortunately, many are lifelong afflictions. One of the most disastrous consequences of early sexual activity, coupled with multiple sexual partners, is cervical cancer.
What Causes Cervical Cancer?
Many people are unaware that 90 percent of cervical cancer cases are caused by sexually transmitted Human papillomavirus (HPV). Although the majority of HPV infections do not cause symptoms or disease and resolve spontaneously, persistent infection with high-risk HPV strains may result in cervical cancer. Cervical cancer is responsible for the death of almost 60 to 70 thousand women every year in India. There are 12 high-risk HPV types recognized by the International Agency for Research that can cause cancers in humans, which include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59.
In addition to cervical cancer, HPV infection is also implicated in the causation of genital warts, and cancer of the anus, oropharynx, vulva, vagina, and penis. It is estimated HPV-16 and 18 are the main cause of almost 40 percent of vulvar cancers and all anal cancers.
Can HPV Infections Be Prevented?
Fortunately, HPV infection and consequently, cervical cancer can be prevented. HPV infections decrease through abstinence, older age at first sexual activity, lifetime mutual monogamy, and barrier contraception methods like condoms. None of these methods, however, is guaranteed protection.
After years of research, in 2006 and 2007, two vaccines were introduced in the market against HPV infection:
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A quadrivalent vaccine, HPV-9 was directed against HPV-16,18, 6, and 11.
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A bivalent vaccine was directed against HPV-16 and 18.
This started a new chapter in the primary prevention of cervical cancer. A new vaccine Gardasil 9 is also approved by the United States FDA (Food and Drug Administration), which protects against nine strains of HPV. This is not available in India yet.
When and How to Vaccinate?
It is recommended that cervical cancer vaccines should be administered mainly before the beginning of sexual activity, that is before the initial exposure to HPV infection. Given the decreasing age at first sexual activity, the CDC (Centre for Disease Control and Prevention) and WHO (World Health Organization) recommend vaccination between the ages of 9 and 12.
People may think that 11 years of age is too early to vaccinate as many children do not become sexually active for several more years, but vaccinating preteens helps to take the guesswork out of figuring out when a child will become sexually active. The vaccine also is more effective in immunizing against HPV when it is given to younger girls. Girls who are vaccinated before the age of 15 may need only two vaccine shots in contrast to older girls who need a standard three-shot vaccination.
The Indian Academy of Pediatrics Committee on Immunization (IAPCOI) recommends offering the HPV vaccine to all females who can afford the vaccine. Australia has been one of the leading countries in implementing public health programs for the prevention of HPV, being among the first to introduce a National HPV Vaccination Programme for girls and young women. More than 50 countries already have it in their national immunization schedule. The vaccine is given as a deep intramuscular injection, generally three shots at 0, 2, and 6 months. The vaccine is so far not recommended for boys in India.
Girls aged 13 to 26 who have not received it earlier can also take the vaccination. The vaccination can also be beneficial for sexually active females to a certain extent because some of the sexually active young women are usually infected with all the HPV types that can be prevented by the vaccines. Therefore, most young women could still get protection by getting vaccinated. For women aged more than 26 years, screening and early detection by PAP test or PAP smear is the key to prevention, though some studies do suggest the benefit of vaccination even up to the age of 40 years.
What Are the Safety Concerns of Vaccination?
There have been no serious safety concerns associated with this vaccine while studying thousands of individuals around the globe. However, mild pain at the site of injection, fever, dizziness, fainting, and nausea may occur rarely.
Conclusion:
As care providers, doctors must emphasize that the primary goal of vaccination is to help prevent cervical cancer. It should not give a false sense of security against all sexually transmitted infections. It is also not a replacement for periodic screening with a PAP smear. Hence, screening programs should continue as per recommendations to detect non-HPV-related cervical cancers, which are around 10 percent.
Safe sex should be taught to adolescents, and sex education made mandatory in schools. Laws against child marriage should be more strict, and cervical cancer screening by PAP smear should be made widespread by government programs and available in all hospitals at a very low cost. These practices will help in decreasing the disease burden in the country.
Everyone loves their daughters, mothers, and sisters; give them the gift of a cervical cancer-free life. Also, pledge to vaccinate all the daughters before their 13th birthday.
