Health
Across the world, the incidence of cancer is 25% higher in men, but in India, women shoulder the burden more.
Image for representation

As I sat down to discuss cervical cancer with a veteran radiologist who specialised in women’s cancers, I asked her if she thought there is enough awareness about the HPV vaccine as one of the ways to reduce incidence of cervical cancer in women. “I tell all my patients not to give it to their daughters,” she said without a pause, and continued, “I ask the mothers a simple question - ‘nee un ponna ozhunga valathirikiya? Appidina, poda vendam.’” (Have you raised your daughter well? If yes, you don’t have to give it to her.)

“Such statements really rile me up,” said Sudha Sundar, professor of Gynecological Oncology at the University of Birmingham and president of the British Gynaecological Cancer Society, after I narrated the incident to her on the sidelines of the 15th Prof. Arcot Gajaraj Memorial Oration held recently in Chennai. “Which mother will ever accept that she has not raised her daughter properly? And what does that have to do with the sex lives of their daughters, and the risk of exposure to HPV?” she asked.

HPV, human papillomavirus, is one of the most common sexually transmitted diseases. While it doesn’t cause any major immediate harm to the body and goes away with medication, certain types of HPV cause cervical cancer. A woman who has been exposed to infection by high-risk HPV types is considered to be at risk of cervical cancer, and research has shown that vaccination against HPV in young girls significantly reduces the risk of cervical cancer. But due to the stigma attached to the vaccine – HPV gets transmitted only via sexual contact, so the thinking is that if a woman doesn’t “sleep around” then she will not be exposed to the viral infection – many parents, and even doctors, wrongly discourage the use of the vaccine.

Research in the US has also found that the low vaccination rates against HPV arise from concerns that giving the vaccine leads to sexual promiscuity. In India, too, similar findings have been seen, as the study notes, “Many are of the opinion that HPV vaccines would make sex safe, leading to promiscuity and change in sexual behaviour in younger generation, which would cause social stigma, and may tarnish family prestige.”

“But, as clinicians, what we can and should do is educate and equip our patients to protect themselves from acquiring sexually transmitted diseases that could affect them for the rest of their lives. A theoretical risk that a patient will be somewhat more likely to engage in sex because he or she is more protected from adverse health consequences should not supersede a clinician’s duty to offer counseling, education, and interventions to prevent infection with preventable diseases. Parents and patients need to be educated on the burden of HPV infection and the benefits of vaccination,” argues Jennifer Emberger in the AMA Journal of Ethics.

At the memorial event in Chennai, organised by gynecological oncologist Dr Jaishree Gajaraj who runs the Mangai Women’s Health Clinic in the city, Professor Sudha focussed her oration on the various cancers among women and the scientific advancements in their treatment. But her speech also recognised, at several instances, how misinformation, personal beliefs and social taboos impact our battle against cancer. The stigma around the HPV vaccine, she says, is among the most visible illustrations of it.

Across the world, the incidence of cancer is 25% higher in men, but in India, women shoulder the burden more. Cumulatively, Professor Sudha said, breast, cervical, ovarian and uterine cancer account for more than 50% of cancers in women in India. Cervical cancer is the second most common cancer among women in India, and one Indian woman dies of it every eight minutes. With cervical cancer being preventable, just the HPV vaccine could reduce the overall cancer burden among women significantly, she said. “It is important to stress that HPV vaccination protects against 70-75% of cervical cancer,” she said in an email later, “But vaccinated women must also continue with screening (regular pap-smears).”

The battle against cervical cancer, she said in her speech, is simple: encourage young girls to take the HPV vaccine, and continue screening among women once they cross 30 years in age. “I have a young daughter, and when she gets older, I will ensure that she gets the HPV vaccine. As doctors, we must create awareness among mothers and young women that the vaccine prevents HPV,” she said emphatically during the talk.

“My analogy is that of an insurance policy,” she said, “Most of us have health insurance and accident cover. But does that mean we drive rashly? Indeed, the types of people who take out insurance policies are people who drive safely. The insurance policy gives us some peace of mind, in the event that another driver on the road drives rashly.”

HPV vaccines are recommended by the WHO. “Clinical trials and post-marketing surveillance have shown that HPV vaccines are very safe and very effective in preventing infections with HPV infections,” WHO has said.

The HPV vaccine can also be given to boys to reduce transmission of the virus. “The HPV vaccine is routinely recommended for girls and boys ages 11 or 12, although it can be given as early as age 9. It is ideal for girls and boys to receive the vaccine before they have sexual contact and are exposed to HPV. Research has shown that receiving the vaccine at a young age isn't linked to an earlier start of sexual activity,” the Mayo Clinic said. 

Read: Here is WHO’s fact-sheet on HPV and cervical cancer for more information. 

All data provided by Professor Sudha Sundar.