It’s #TimeToTalkAboutHPV and lead the way to a cervical cancer-free Philippines
“Stop spreading fake news. We should stop spreading false information that cervical cancer immediately means a death sentence – it’s not!”
That’s the call from the panel of physicians and patient advocates who led the all-new cervical cancer health talk titled #TimeToTalkAboutHPV: a health forum on HPV prevention and fight against cancer.
Organized by the Cervical Cancer Prevention Network of the Philippines (CECAP), in collaboration with the Federation of Obstetrics and Gynecology of Asia and Oceania (AOFOG), the Philippine Society of Obstetrics and Gynecology (POGS) and MSD in the Philippines, the media forum aims to remind people that cervical cancer can be prevented with regular screening tests and HPV vaccination.
Cervical cancer is largely preventable through vaccination and screening for precursor lesions (vaginal smear at least every three years and HPV DNA testing for women over 30), with follow-up and treatment appropriate. With access to accurate information, preventive services and routine gynecological care, most cases of the disease can be prevented and successfully treated at an early stage.
Despite this, cervical cancer is the 2nd most common cancer among women in the Philippines and the 2nd most common cancer among women aged 15-44. Current estimates indicate that each year 7,897 women are diagnosed with cervical cancer and 4,052 die from it.
Cervical cancer develops at the entrance to the uterus from the vagina and approximately 99% of cases are related to HPV or human papillomaviruses. Modes of transmission include sexual contact, skin-to-skin contact and, rarely, through objects exposed to the virus.
It is a highly treatable disease if detected in its early stages. The precancerous stage offers a wide window for detection and treatment, and it can take up to 30 years before it reaches malignancy. However, it is one of the most common types of cancer and a common cause of cancer-related death worldwide, mainly affecting uneducated young women in poor countries.
But more recently, COVID-19 has taken a toll on women’s health, as studies have shown a gap in missed routine preventative checkups and screening visits. “I think the world has been focused on Covid for 2 1/2 years and we have neglected other health issues,” said Dr Anna Lisa Ong-Lim, professor and head of the division of infectious and tropical diseases at the University of Pediatrics at UP. Manila College of Medicine. “It’s only recently that vulnerabilities to vaccine-preventable diseases are being noticed again.”
What you need to know about HPV
A life-altering issue that deserves attention is the vast burden that continues to threaten women and men, including adolescents around the world, caused by the human papillomavirus (HPV). “HPV is a virus that causes a wide range of diseases,” said MSD’s Executive Director of Medical Affairs for Vaccines and Infectious Diseases, Dr. Mel Kohn.
“In addition to cervical cancer, the 2n/a The first cancer for Filipinos, HPV can give men head and neck cancer, anal cancer for both sexes, and a variety of less common but equally devastating types of cancer,” he listed. Examples are cancers of the vagina and vulva and cancer of the penis.
“Genital warts, although they don’t kill you, can be quite devastating,” Dr. Kohn said. “It’s quite common and very difficult to eradicate. Imagine the psychological toll of the patient. Again, prevention is the best approach here.
HPV is common. It is passed from person to person through sexual contact. “It’s a silent epidemic unlike COVID,” he warned. Unlike measles which has an obvious expression, “you don’t see it immediately when you meet someone, but it is there and has developed rather insidiously”.
The Philippines has a population of 37.8 million women aged 15 and above who are at risk of developing cervical cancer. It is estimated that approximately 2.9% of women in the general population are carriers of cervical HPV-16/18 infection at any given time, and 58.6% of invasive cervical cancers are attributed to HPV 16 or 18.
Although some of the infections caused by this common virus with over 100 types usually clear up on their own, at least 14 types of HPV have been shown to cause cancer.
The age indication for HPV vaccines is as young as nine for girls and boys. Teenagers and young adults up to age 26 who have not started or completed the HPV vaccine series should also be vaccinated against HPV. Women up to age 45 may be eligible for vaccination after discussing this with their provider.
According to Dr. Ong-Lim, they target young people because of their increased susceptibility to infections.
“This particular age group demonstrates an optimal immune response. Additionally, only two doses are needed to achieve protection,” she explained.
But more importantly, giving the vaccine at a younger age ensures they are already protected before they become sexually active. “HPV vaccines work best when given before exposure to the virus. We have to try to catch that window when the immune system responds to it really really well,” Dr Ong-Lim explained.
The Chair of the Manila Declaration: Call to Action Against Cervical Cancer and obstetrician-gynecologist, Dr. Jean Anne Toral, mentioned that the recent study on fertility in young people and adults indicates that the average age of Filipina women who have become sexually active is 18.2 years. “Giving the vaccine between ages 9 and 15 would be beneficial because there is no life event that exactly identifies HPV exposure outside of the age of sexual debut,” she said.
Seven to eight out of 10 women will be exposed to HPV at some point in their lives, “but not all women will develop cervical cancer,” Dr. Toral said. The likelihood of HPV exposure turning into cancer increases if a patient smokes or is exposed to other sexually transmitted diseases and is HIV positive.
School-Based HPV Vaccination
As part of the government’s efforts to protect children and adolescents against vaccine-preventable diseases, the Ministry of Health, in collaboration with partner agencies, has launched the School-Based Immunization (SBI) program.
The SBI program includes measles, rubella, tetanus, diphtheria (MR-TD), and human papillomavirus (HPV) vaccines that are given to eligible students in public elementary schools. The inclusion of HPV vaccination in the SBI program aims to protect young women against cervical cancer later in life, among other HPV-associated diseases.
Under the DOH’s SBI program, the HPV vaccination is given through 4th grade based on the age group recommended by the DOH to receive the two doses of the HPV vaccine, six months apart, for protection against cervical cancer.
Prior to administering the vaccine, parental consent must first be obtained by school officials. This is why vaccination education campaigns usually emphasize the role of parents in strengthening their children’s health shield through prompt vaccination against diseases.
Due to the COVID-19 pandemic, HPV vaccination, which was previously administered through the SBI program, is now being moved under community-based vaccination to still be able to administer HPV vaccination to young people girls amid the pandemic to protect them from cervical cancer and other HPV-related diseases and cancers.
Towards a future without cervical cancer
Elimination of cervical cancer was defined as reaching an incidence rate low enough for the disease to be considered under control as a public health problem; this threshold has been defined by the WHO as being less than 4 cases per 100,000 women per year.
To achieve this, each country must achieve and maintain three key goals, in the lifetime of today’s young generation. The first is that 90% of girls are fully vaccinated against the human papillomavirus (HPV) before the age of 15. The second is to ensure that 70% of women are screened with a high performance test before the age of 35, and again at the age of 45. The ultimate goal is for 90% of women with pre-cancer to receive treatment and for 90% of women with invasive cancer to have their condition properly managed.
Achieving this vision and each of the elimination goals will require a whole-of-society and multi-sectoral approach to ensure that health systems prioritize women and girls. Individuals, families, communities, civil society and government agencies at all levels have a role to play in promoting greater awareness, education and social support.
Carmen Auste, chief executive of Cancer Warriors Foundation Inc., said the Philippines was among the countries that have pledged with the WHO to finally eradicate cervical cancer in the country by 2040 and by 2030 worldwide. “There’s already a type of cancer that we can suppress or ‘block’ like social media,” she joked. “To achieve this goal, we need to increase the use of the HPV vaccine and educate Filipinos about HPV, vaccines, and cancers caused by HPV,” she said.
Auste mentioned the SUCCESS project (“Scale-up Cervical Cancer Elimination with Secondary prevention Strategy”) as one of the recent advocacy initiatives in some barangays. Led by Expertise France and carried out in collaboration with Jhpiego and the International Union Against Cancer (UICC) in support of the WHO, the project aims to deploy innovative solutions to fight cervical cancer in four countries. , including the Philippines.
At this critical juncture, we must empower women and rally our neighbours, community leaders and governments to take action and save thousands of lives. If widespread and high coverage of these interventions can be achieved by 2030 and sustained, research predicts that cervical cancer can be eliminated in most countries of the world by 2120, preventing more 63 million female deaths worldwide.
Together, let’s engage with women around the world to end cervical cancer.