HPV vaccine, testing imminent
- Landmark initiative offers hope in fight against Cervical Cancer
By Melanie Allicock
Kaieteur News
February 11, 2007

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A vaccination to prevent Human Papilloma Virus (HPV) which causes Cervical Cancer is to be introduced during the first half of this year among pre-sexually active girls.

According to Health Minister Dr. Leslie Ramsammy, the vaccination will be given to girls between the ages of 9-11.

Guyana is also to soon break new ground in the Caribbean with the introduction of testing for the HPV virus.

The Health Minister told Kaieteur News that this landmark initiative should begin in the public health sector early in the year.

With this test in place women will now be advised if they are at risk of developing cancer or already have the disease. Early diagnosis also means that they can be treated earlier, the Minister noted.

The testing will first be introduced into the ante natal population, according to the Minister.

At the outset, only women involved in the Prevention of Mother to Child Transmission Programme (PMTCT) will have access to the HPV testing free of cost, because of the high cost attached to programme.

“Other women will have access to the test too, but they will have to pay. Initially the government will not provide HPV testing free for all women, only those in the ante natal clinics and since most young women will go through a period of ante natal service at some time or another, they will all have access at some time or another”.

He noted that in the past, cervical cancer was thought of as a non- communicable chronic disease, but today it is understood that it is communicable and therefore preventable.

It is in this regard that the HPV testing is being introduced to avert the incidences of its prevalence.

The Minister noted that previously cervical cancer was considered as a disease for which only older women should be tested, but now women at all ages are being affected.

“If a woman has cervical cancer at 40 or 50 years old it means that she probably got it since she was infected at around 15-20 years old and so prevention efforts must start from early for any female.

My goal is that in 2007 every woman who joins the anti natal clinic will have the HPV testing done.

Since cervical cancer is one of the sexually transmitted diseases, the same education and awareness activities being undertaken in the fight against HIV/AIDS will be used in this programme,” the Minister said.

He added that the introduction of the HPV vaccines for pregnant women will follow this initiative.

Recently, a United States medical team visited Guyana to conduct research on the specific strains of Human Papilloma Virus that are prevalent here.

This exercise was deemed important since various strains of the virus exist and as such it is critical for the specific genotype of the virus present in Guyana to be established before any move is made towards providing diagnosis or treatment.

This is especially so since the HPV vaccines projected to be offered by Guyana will only target a specific strain.

“It makes no sense for us to invest in vaccines that will not target the specific HPV type that is available here.”

The overseas team worked closely with a local medical group in their research activities.

In excess of one thousand women have been screened in the public sector for cervical cancer in the last year.

In an effort to enhance the accessibility to the procedure, the sector has deployed mobile teams around the country.

The Health Minister said this new venture is part of an overall programme aimed at early detection and identification of women with precancerous conditions.

“We are working towards making all the interventions in cancer available to the public. Radiotherapy and Chemotherapy are already in place.”

The Minister also divulged plans of introducing the VIA (visual inspection with ascetic acid) method of screening for cervical cancer on a large scale here. At the moment only a few women have benefited from this type of intervention.

The VIA method which is presently only being used in a few countries, involves the use of the acid on a spate to detect precancerous conditions.

Once the conditions apply, an electro-surgical intervention is performed shortly after on the affected area.

Ramsammy noted that this technique is cheap and has proven 100% effective on the few women on which it has been performed.

He explained that unlike Pap smear testing, this procedure is direct, less complicated and quicker.

Noting that prevention is now the challenge for Guyana , the Minister said it is in this regard that the HPV testing is being introduced to avert the incidences of its prevalence.

Pap smear tests being done in Guyana at the moment only identify the presence of cervical cancer and do not test specifically for the presence of the HPV since this requires specialised equipment.

However, any abnormalities identified in the cells of the cervix, which in many cases are the symptoms of cancer caused by the undetected HPV virus, are treated.

Just recently Director of the Pan American Health Organisation (PAHO), Dr. Mirta Roses, noting that 80 percent of cervical deaths occur in the developing countries where some 600 women die per day from cervical cancer, urged countries to increase their efforts at early detection.

The doctor advanced the view that in developing countries, in most cases, the cancer is already in its advanced stages when detected.

She posited that it is especially critical to improve poor women's access to detection services to control this disease and save thousands of lives each year.

The incidence of cervical cancer in Latin America and the Caribbean is said to double that of the developed countries, while the mortality rate triples.

Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection.

The types of HPV that infect the genital area are spread primarily through genital contact. Most HPV infections have no signs or symptoms; therefore, most infected persons are unaware they are infected, yet they can transmit the virus to a sex partner.

Rarely, can a pregnant woman pass HPV to her baby during vaginal delivery. A baby that is exposed to HPV very rarely develops warts in the throat or voice box.

The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. Very rarely, HPV infection results in anal or genital cancers.

Genital warts usually appear as soft, moist, pink, or flesh-coloured swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.

Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV.

No HPV tests are available for men.

There is no “cure” for HPV infection, although in most women the infection goes away on its own. The treatments provided are directed to the changes in the skin or mucous membrane caused by HPV infection, such as warts and pre-cancerous changes in the cervix.

Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with “high-risk” types of HPV is the main risk factor for cervical cancer.

A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer.

The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another individual.

HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.