AABIDA KHAN
Have you heard about human papillomavirus (HPV)? Do you know that HPV can cause cancer and that it can be prevented? Read on to learn more about HPV.
Scientists have discovered more than 200 human papillomavirus (HPV) types that can infect the skin and mucosal tissue, which is the internal lining of the body cavities such as in the mouth or genital tract (vagina, cervix, penis). HPV infections are common worldwide in all age groups affecting both males and females. Most HPV infections are mild or do not cause any symptoms, and the majority resolve completely.
HPV is transmitted by direct contact (skin or mucosal) to infected individuals. There are some HPV types that have a preference to infect the skin, while other types prefer the skin and the mucosa. The stigma associated with HPV derives from the sexual transmission of some of the HPV types and its association as a sexually transmitted disease.
Depending on the HPV type, it can cause an array of clinical manifestations such as warts on the skin, genital warts, and various cancers. High-risk HPV types have been designated as carcinogens by the World Health Organization International Agency for Research on Cancer since 1995. High-risk HPV16 is the most common HPV type causing HPV-related cancers globally. HPV-related cancers contribute to substantial morbidity and mortality.
Cancer of the cervix in women has the strongest association with being caused by HPV. In 2020, there was an estimated >604 000 cases of cervical cancer and >300 000 deaths due to cervical cancer globally. In South Africa, cervical cancer is the second most common cancer and the main cause of cancer deaths in women. According to the South African national cancer registry report for 2019, there were 6 945 confirmed cases of cervical cancer reported. HPV also causes a significant proportion of other cancers of the anus, penis, vulva, vagina and oropharynx (throat), therefore also affecting males.
HPV-related cancers are entirely preventable by several strategies. A great advance in the field is the availability of a safe and highly effective HPV vaccine. The HPV vaccine provides protection primarily against the high-risk HPV types 16 and 18 that are responsible for most of the HPV-related cancers. Some HPV vaccines also cover the low-risk HPV types 6 and 11, which cause genital warts and laryngeal papillomas (warty growths in the airway). The newest vaccine on the market covers nine HPV types.
There are also effective strategies for cervical cancer screening that can pick up pre-cancerous conditions in the cervix, and treat before it develops into cancer. This is done by a Pap smear test in women, which is a procedure to collect cells from the cervix for laboratory evaluation.
Developments in technology have facilitated the introduction of HPV testing on Pap smear samples which has several advantages over the traditional method of cytology (assessing the cells for abnormalities and changes). This will allow for more cases to be picked up and treated earlier before cancer development.
The South African national cervical cancer prevention and control policy recommends Pap smear testing in all women aged from 30 to 50 years old, with a minimum of three Pap smears in a lifetime in women deemed to be low risk without any symptoms or Pap smear abnormalities.
In South Africa, the HPV vaccine which covers the high-risk HPV types 16 and 18 has been implemented since 2014 as a school-based vaccination programme in public schools for girls in Grade 4, aged 9 to 10 years. Cervical cancer screening by Pap smear is also available in South Africa in most health-care facilities, although the uptake and follow-up for both preventive strategies are not optimal especially since the Covid-19 pandemic impact, and can be considerably improved.
Many women are afraid to go for a Pap smear; although it may be uncomfortable, it does not cause any pain and can be lifesaving by detecting pre-cancerous abnormalities that can be treated. There is also a lot of misinformation in general, surrounding vaccines. HPV vaccines have undergone rigorous clinical trials showing that they are safe and effective in preventing cervical cancer.
World Cancer Day is commemorated on February 4 annually with the theme of “Close the care gap” and for 2023 the campaign is “Uniting our voices and taking action”. We are now on the eve of International HPV Awareness Day, which is on March 4 every year. It is an opportunity to raise awareness on an important health issue that impacts society.
Let us educate ourselves about HPV and take ownership of our health and well-being. Let us debunk the myths and the stigma surrounding HPV and vaccine hesitancy. Let us spread the word to others and advocate for prevention by screening and vaccination so as to protect our mothers, grandmothers, daughters, sisters, aunts and cousins from a preventable cancer. Let me conclude with an African proverb that I found apt in this context: “If you want to go fast, you go alone. If you want to go far, go together.”
Aabida Khan is Pathologist in the Department of Virology, National Health Laboratory Service and School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal
References:
National Department of Health Republic of South Africa. Cervical cancer prevention and control policy 2017. Available from: https://www.knowledgehub.org.za/e-library.
World Health Organization. Factsheet. Cervical cancer. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer.
Cancer Association of South Africa (CANSA). Cervical cancer. Available from: https://cansa.org.za/cervical-cancer/.
International Papillomavirus Society. International HPV Awareness Day Campaign. Available from: https://ipvsoc.org/hpv-day/.
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