Health experts call for making HPV vaccine available in Pakistan immediately

Senior health experts have emphasized the need to take cervical cancer seriously and consider dealing with it as our top priority, suggesting that the vaccine for human papillomavirus (HPV) should be available in Pakistan at subsidised rates and a mass vaccination drive should be carried out as soon as possible.

Screening should also be initiated in the community, they said while speaking at a health awareness seminar titled ‘Close The Care Gap’ held in Karachi on Saturday in connection with World Cancer Day 2023. The seminar focused on cervical cancer, one of the rapidly growing and most ignored cancers in Pakistan.

Experts also suggested that girls’ schools and colleges must be engaged in cervical cancer awareness programmes; otherwise, this cancer will strike as a catastrophic epidemic like oral and breast cancers that are already hitting our society.

Guest speaker Dr Sonia Naqvi, consultant gynaecologist and IVF expert at SCH and Australian Concept, Karachi, said around 20 women die of cervical cancer daily in Pakistan, which ranks seventh among countries having the highest number of cervical cancer deaths worldwide, also making it the second most common malignancy in Pakistani women aged 15-44 years. An estimated 604,000 women were diagnosed with cervical cancer worldwide and about 342,000 women died from the disease last year, she added.

She further said that the risk factors that increase the development of this deadliest cancer include early coitarche, having a full-term pregnancy at a young age, multiple full-term pregnancies (three or more), having a condition that alters the body’s immunity, sexually transmitted diseases, smoking (in all forms) and the use of birth control pills for more than five consecutive years.

Dr Sonia Naqvi said cervical cancer usually has no symptoms in the early stages. The most common symptom is abnormal vaginal bleeding, which can occur after sexual contact, in between periods or bleeding after menopause. There could also be abnormal discharge or pelvic pain seen as other symptoms.

She suggested that women should simply talk to their gynaecologist, who will be able to address all their queries as well as inform them, how often they need to go for screening—depending on their initial test results. The screening is commonly known as pap-smear tests, and the main benefit of this screening is that it actually detects pre-cancerous abnormalities at an early stage. Without this test, these changes might go undetected, as women may not have noticeable symptoms, especially in the pre-cancerous phase. If untreated, it may lead to cervical cancer.

“Screening is recommended between 25 and 65 years of age. The gynaecologist takes a small sample of cells from the cervix and sends it to the laboratory where the cells are checked for any abnormal changes. A pap test takes only 5 to 10 minutes in the clinic but its protective impact is on life time,” said another guest speaker, Dr Muhammad Afzal, who is a consultant medical oncologist and assistant professor at the South City Hospital.

“The causes of delay in diagnosis of gynecological cancers including cervical cancer in Pakistan range from patients ignoring the symptoms, delay in seeking professional help, lack of access to specialised facilities, stigma attached to the situation and of course financial constraints are the biggest challenges for our community,” he explained.

He also highlighted the role of immunotherapy drugs including monoclonal antibodies that work in more than one way to control cancer cells and may also be considered targeted therapy because they block a specific protein on the cancer cell to keep it from growing.

Dr Afzal explained the role of the latest chemotherapeutic agents in patients with persistent, recurrent or metastatic cervical cancer. “Most early-stage cervical cancers are treated with a radical hysterectomy operation, which involves removing the cervix, uterus, part of the vagina and nearby lymph nodes. A hysterectomy can cure early-stage cervical cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant,” he said.

“Cervical cancer is one of the most preventable and highly treatable forms of cancer if caught in the premalignant or early stages. The good news is that a simple vaccine can prevent the cancer for lifetime. Ideally both girls and boys should have the vaccine for cervical cancer in the teenage years starting from 13 years. The vaccine protects against 4 types of HPV: 6, 11, 16 and 18. Out of them 16 and 18 are the causes of most cervical cancers,” said Dr Farhan Essa Abdullah, CEO of the prestigious DELD and an infectious disease specialist.

He gave the reference of Sindh Minister for Health and Population Welfare Dr Azra Fazal Pechuho, who recently said research in cervical cancer in women is imperative, as HPV immunization of adolescent girls can substantially reduce the risk of cervical cancer in the country. The minister firmly believed that only a healthy mother could raise a healthy family.

Dr Farhan Essa Abdullah quoted a recent landmark study published in the New England Journal of Medicine by Dr Pär Sparén, which showed that of nearly 1.7 million girls and women, those who had been vaccinated before the age of 17, had their risk of developing cervical cancer reduced by 88 per cent, while the risk for those vaccinated between the ages of 17 and 30 dropped by 53 per cent.

He urged the government of Pakistan to include cervical cancer vaccination in the national mass vaccination programme and ensure that all women and girls had equitable access to the HPV vaccine. He stressed that multinational pharmaceutical companies and NGOs should make available the HPV vaccine in Pakistan as it has gone short from market in the past 2-3 years.