MC Explains | Amid rising cases of cervical cancer, an affordable vaccine that can be a game changer

Cancer cells move and divide rapidly. (Image by the US National Cancer Institute via Unsplash)

The indigenous Cervavac, a quadrivalent Human Papilloma Virus (qHPV) vaccine to be manufactured and marketed in the country by the Serum Institute of India (SII), is being seen as a game changer against rising cases of cervical cancer in India.

Leading oncologists say that cervical cancer is the second most frequent form of the disease in Indian women after breast cancer.

“More than a hundred thousand young women in India get cervical cancer every year,” Dr Hemant B. Tongaonkar, senior director, urologic and gynaecologic oncosurgery, Nanavati Max Super Speciality Hospital, told MoneyControl.

Disease development

The cancer develops in a woman's cervix, the entrance to the uterus from the vagina.

According to the World Health Organisation (WHO), almost all cervical cancer cases are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.

Most infections related to HPV often resolve spontaneously and cause no symptoms. It is only when the infection persists due to low immunity of the patient or poor hygienic conditions, and it is left untreated, that cancer can develop.

Symptoms and diagnosis

The cancer can be detected by physical examination of the genital area by a smear test. Early detection is critical in the treatment of cancer.

Dr Pramod Kumar Julka, Senior Director, Medical Oncology, Max Institute of Cancer Care, New Delhi, said that a cervical cancer patient may experience vaginal bleeding after intercourse.

“The patient may also see sudden vaginal discharge, which may be foul-smelling. There can be bleeding post menstruation. If a woman experiences any such symptoms, she must see a doctor because cancer development can be prevented by early detection and management of cervical ulcers or discharge,” he added.

Dr Julka said the cancer is more common in women with multiple sexual partners, repeated abortions, and vaginal deliveries.

Is cervical cancer preventable?

Oncologists say that cervical cancer is preventable and one of the most curable forms of cancer.

“It is preventable because we know the cause of this cancer, which is HPV. There are certain high-risk variants of this virus which can cause cancer. Most women acquire this infection during their reproductive period,” Dr Tangaokar added.

According to Dr Uma Vaidyanathan, senior consultant, obstetrics and genecology, Fortis Hospital, New Delhi, the bivalent and quadrivalent vaccines available for cervical cancer are prophylactic, not therapeutic.

“The vaccination is effective prior to sexual debut, when there has been no baseline exposure to any of the cancer-causing HPV variants. HPV vaccination and regular cervical screening is the most effective way to prevent cervical cancer,” she added.

Also read:  Cervical cancer vaccine to be launched in few months

Efficacy of the vaccine

A study by Falcaro, et al., 2021, published in the journal Lancet, demonstrated that the HPV vaccine helps reduce cervical cancer cases by nearly 90 percent.

“The vaccines offer protection against cervical cancer and precancerous lesions, as per available data,” Dr Vaidyanathan said.

Dr Tongaonkar said that about 80 percent of HPV-related cervical cancers are caused by HPV-16 or HPV-18.

The quadrivalent vaccine has the ability to target high-risk strains like HPV-16 and HPV-18 and has demonstrable efficacy against vaginal and vulvar cancers, and protects against anogenital warts.

Affordability of the vaccine

The available cervical cancer vaccines are costly. This has restricted its widespread access. With a much cheaper vaccine being rolled out by SII, affordability should cease to be an issue in the future.

“The prices of imported vaccines are as high as Rs 8,000 for the two doses required. This is the reason why parents of a girl child in the rural areas desist from taking it,” Dr. Julka said.

CEO Adar Poonawalla has said SII vaccine will be "far cheaper and more affordable" than the imported ones.

"We will announce the price in a few months. It's likely to be between Rs. 200-400. We will discuss this with the government of India," Poonawalla told the media.

Prevalence of cervical cancer

Often termed a lifestyle disease, cervical cancer has been traditionally associated with women residing in rural areas and belonging to the lower socio-economic strata.

“The bulk of cervical cancer cases are reported from the rural areas, but of late the number of urban patients is also rising,” said Dr Pragya Shukla, head of department (clinical oncology), Delhi State Cancer Institute.

Dr Shukla added that almost 90 percent of the cases coming to her institute report a delay in diagnosis.

“Due to lack of awareness and the stigma related to genital hygiene, the majority of patients report for treatment very late, which reduces their chances of survival,” she said.

As per the Indian Council of Medical Research’s (ICMR) cancer registry data, the number of cervical cancer cases and deaths has been increasing since 2015.