Cervical cancer is one of the most frequent cancer in women in India and second across the world. India has a population of 365.71 million women above 15 years of age, who are at risk of developing cervical cancer. Annually approximately 132,000 new cases are diagnosed with cervical cancer and 74,000 deaths are recorded annually in India, accounting nearly 1/3rd of the global cervical cancer deaths. About 6.6% of the women in the general population are estimated to harbor cervical HPV infection.
Human Papillomavirus (HPV) transmission is influenced by age and sexual activity. Approximately 75% of all sexually active adults are infected with at least one HPV type. However, the majority of the infections resolve spontaneously and only <1% of the HPV infections progress to cancer. In women who undergo routine screening, the risk of having an abnormal Papanicolaou (Pap) smear is 35%, CIN 20%, and ICC is <1% approximately. The Pap test is used to find cellular abnormalities in cervical tissue, aiding early diagnosis.HPV is a necessary cause of cervical cancer, but it is not the only cause. Other cofactors are necessary for progression from cervical HPV infection to cancer. Long-term use of hormonal contraceptives, high parity, early initiation of sexual activity, multiple sex partners, tobacco smoking and co-infection with HIV have been identified as established cofactors. Poor hygiene and a diet low in antioxidants are other probable cofactors.
Currently, all genital HPV infections cannot be prevented except by abstinence and lifetime mutual monogamy. There is no clear evidence that barrier methods of contraception, most notably use of condoms, confer protection against HPV infection. Secondly, except for genital warts, the infection is asymptomatic. Adherence to routine screening by the susceptible female population through periodic Pap smears even in developed countries has been unsatisfactory, whereas, in developing countries like India, large-scale routine screening is difficult to achieve.
The HPV vaccination is for primary prevention of carcinoma cervix. A cost-effective second-generation HPV vaccine is needed for developing countries like India to address various issues specific to the region. However, till such time, secondary prevention through periodic cervical cancer screening should be in place to use the existing infrastructure and cost-effective screening methods such as Pap smear and HPV DNA tests. HPV vaccination and regular cervical screening is the most effective way to prevent cervical cancer.