Cars, Cancer, Condos & Condoms

Can you blame people for thinking the road to a cervical cancer-free existence is via a preventive vaccine?

WrittenBy:Chitra Subramaniam Duella
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With inputs from Anand Ranganathan

If you, as me, didn’t know what is common between cars, cancer, condoms and condominiums in that order, here’s a crash-course.

It is helpful to watch the entire link before reading further. Inattention to detail – people, comments, visuals and running commentary – is injurious to health.

Now, you drive, I navigate, at your own risk and peril.

You heard words like awareness, cancer, fourth monkey, amazing technology, public health, empowerment, seat belts, high five, women’s genetic mix, breast cancer, rape, curves, education, girl child, police, fashion, famous, prevention. Surely you caught the camera angles focusing on car brands and wannabes.  My favourite is the use of the words genetic mix, like porridge or muesli. Let’s leave that for a bit.

You also heard words like cervical cancer, Tata Memorial, preventive vaccine, three shots, so easy, every woman in India should have the vaccine – that anti-cervical cancer thing, you know.  I am sure you noticed, as I did, that all talking heads had the same eye-wear.

Isn’t it odd that there were no epidemiologists, oncologists, virologists, surgeons, gynaecologists and public health experts flagging off the cars?

Now read this and see if you can you spot the hair pin bend.

Click on ‘prevention’ if you missed it.  It says a Pap smear is a highly effective test for screening cervical cancer. The Tata Memorial does not talk about vaccines to prevent cervical cancer, much less three shots, because the public health jury on the two vaccines in circulation is out.  For example, polio vaccine prevents polio – the public health verdict on it has been in for several decades.

Next stop, read what the World Health Organisation (WHO) has to say about vaccines for cervical cancer, especially about their role in preventing it. There is no single vaccine capable of preventing an HPV-induced cervical cancer, just as there is no single vaccine to prevent all sub-types of flu, although as of now, the two HPV vaccines seem to cross-protect against a few HPV strains tested.

Happy women’s day from Bastar.

A group of women driving to Lavasa from Mumbai and Pune to raise awareness about cancer including cervical cancer is a very worthy effort, regardless of the destination. Pharmaceutical majors Merck and GlaxoSmithKline have recently launched preventive vaccines in India and some of the drivers speak about them.

Attention – approaching ghat section.

Life is tough in the fast lane. The human papillomavirus (HPV) is a joint family of more than 150 viruses of which only four are associated with cervical cancer for now.  The vaccines address these four types and they have to be taken three times over a six-month period, preferably between 9 and 12 years of age. The assumption being that children and young adults are sexually active by then.

HPV is one of the most easily and highly transmissible infection. That said, only a tiny fraction of those infected with HPV get cancer. The HPV vaccine is a sub-unit vaccine, i.e. it is not a heat-killed or a live-attenuated vaccine (like polio vaccine is) and so there is no risk of the vaccine itself causing an HPV infection. However, it has been found that the antibody levels in those vaccinated with HPV vaccine are inversely proportional to age. The vaccine efficacy is stated to be 5 years.

In other words, these are early days. As the WHO says: “Screening programmes will still be needed to prevent cervical cancer, even after HPV vaccines are introduced…Target group for HPV vaccines is likely to be pre-adolescent girls (aged 9–12 years), but the cost-effectiveness of vaccinating other groups needs to be evaluated. The overall population benefit from vaccinating women aged 15–26 years would depend on the epidemiology of HPV in the population (including age-specific rates of infection, and the proportion of infections and clinical endpoints due to the vaccine-related HPV genotypes). The benefit cannot be directly extrapolated from the efficacy results of current vaccine trials.”

For parents in the developed world, HPV vaccination and cervical cancer is a school project in itself. It is discussed in schools and between parents and teachers because they also discuss teenage sexuality. Doctors in Switzerland, for example, tell you the importance of understanding that the vaccine only protects against a small set of HPV viruses that can lead to cell abnormalities that in some instances can cause cervical cancer if the abnormalities are not identified and treated. The road is full of ifs and bumps. Calling the vaccine a one-time-only anti-cancer shot is misleading to say the least. It is recommended and insurance pays for it because the shots can cost up to $500.

Attention – roadwork suspended indefinitely. Make your own way.

Cervical cancer rates in India are high and there is no national survey to get at any real numbers. This is because most Indian women do not go to gynaecologists. In 2010, seven Indian girls died after being vaccinated with the Merck and Glaxo HPV vaccines. The clinical trials came to a halt.

The vaccines are still available in India. The WHO estimates that in India 15-30 females per 100,000 females show incidence of cervical cancer, a percentage higher than US and most European countries.

Dead End. No U-turn.

830 million of us live on Rs 20 a day, and 830 million of us don’t know what a cervix is. It is not those women drivers on their way to Lavasa who are at fault. It is our nation, and her government, and her priorities, and her ministries, and her health minister, and her hospitals. Her, her, her, but when it comes to her – 60 crore hers, Pipli hers, Chakradharpur hers, Mughalsarai hers, Teensukhiya hers – no one cares, not him especially.

Public health advocacy requires serious work and some of the best examples (tobacco control, cancer, seat belts) come from America. Advocacy – whether it is for policy change, fund raising or awareness – requires science, economics and legislation to speak together. Advocacy is about clearing space not crowding it. If the organisers of the drive want to promote real estate with vaccines, it is their right and their prerogative. Hopefully the next edition will have responsible talking heads on cervical cancer.

Cars run over sleeping pavement dwellers in our country. They don’t know what killed them. Pavement dwellers also die of cancer without ever knowing that it was cancer that killed them. Unless the Health Minister takes the crab by its claws, there is no drive, no corporate, no NGO, no media, no academia, no hospital, no city that can address the distress of millions of cancer-suffering women in this country. And for those whose suffering comes to an end on International Women’s Day, cervix remains as perplexing a word as cancer.

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