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Prescription for prevention

There is something about medical product launches. You may/may not have the merchandise in your medical bill; but you leave the event wiser, medically. MSD India introduced Gardasil to presspersons last week and had the audience totally involved. In her presentation, gynaecologist and fertility expert Dr. Kamala Selvaraj said, “Cervical Cancer (CC), caused by the human papilloma virus (HPV) is the most common cancer among women in India. Every year 1.5 lakh women are handed a report with two disquieting words — cervical cancer — printed on it. Nearly 74,000 women in India succumb to CC annually. India adds 27 per cent new cases every year to the global incidence of this not-too-well reported disease. “

HPV is a common virus. At least 50 per cent of sexually active women and men play host to genital HPV infection at some point in their lives. Most of the infection shows no signs or symptoms and gets cleared in a couple of years, thanks to natural body immunity.

The risk factors include very early sexual activity, sex with multiple partners, poor immunity, smoking, sexually transmitted diseases like HIV, socio-cultural restrictions that forbid check-ups, poverty. Age? Watch out, those between 18 and 26 years and those over 40.

There are more than 100 types of HPV and the high-risk ones are 16, 18, 31, 45 (6, 11 are low-risk). These are responsible for 76 per cent of cancer cases in India.

HPV-related disease develops over five years. How will a woman know? “Any abnormal bleeding, especially if you get it after intercourse,” Dr. Selvaraj said. “Also from foul-smelling discharge, pain around the hips, sudden weight loss, hair loss, a general feeling of ill health.” Treatment is similar to that followed in other types of cancer.

MSD Pharmaceuticals, has come up with Gardasil, a vaccine (costs around Rs. 10,000) that will help prevent CC. “Education, screening and vaccine,” said Jyotsna Ghoshal of MSD, in her launch speech, play a vital preventive role.

“Three doses of Gardasil — three injections over six months — immunises a girl if given before she becomes sexually active,” Ghoshal said.

“Immunity may last beyond the stipulated five years.”

Some 23,000 girls have enrolled for the vaccine programme, she claimed. If effectiveness of the vaccine is one concern, safety is another. “India already has a robust cold chain system used in the polio programme,” said Ghoshal. “This vaccine comes in a pre-filled form. Implementation studies are being done, public/private partnership is possible.”

She pegged prevention as women’s empowerment, having control over their health.

A couple of angry-looking listeners asked: “What about a vaccine for men? They transmit HPV.” Ghoshal said the firm was working on it, “but the trauma is on the cervix.”

In a country where 85 per cent of women don’t go for regular screening, immunisation was the best control tool, the doctors said. Large-scale immunisation, he asserted, would dramatically bring down the number of CC caseBut the point is: The vaccine is administered before the start of sexual activity. And prevents the 76 per cent of CC occurring through HPV 16 and 18.

That still leaves a sizeable number of women without protection. The vaccine may help, but what women need is regular PAP smear test that is cheap and effective. And once a lesion is detected, an immediate course of treatment.

ABOUT THE VACCINE

Cost: Around Rs. 10,000

PAP smear is a must even after immunisation.

Gardasil is the only FDA-approved vaccine for CC.

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