VACCINATION AGAINST HUMAN PAPILLOMAVIRUS FOR PREVENTION OF CERVIX UTERI CANCER IN PAKISTAN —A PUBLIC HEALTH PERSPECTIVE AND DEBATE

Farhana Badar

Abstract


Dear Editor,
In many regions of the world, a vaccination program
against the Human Papilloma Virus (HPV), to prevent
the cancer of the cervix uteri, has been implemented.
This is due to a relatively high prevalence of Human
Papilloma Virus, which is implicated in aetiology of
cervical cancer.
As estimated by Globocan, in 2008, per
100,000 women, in very high incidence regions as SubSaharan Africa, the annual age-standardised incidence
went up to 56.3 and mortality to 41.7. The incidence of
cancer of the cervix uteri was also reported to be high in
South America (23.9) and Melanesia (23.0). However,
in Pakistan, the estimates for cervical cancer were
relatively low with an incidence of 19.5 (11,688 cases)
and mortality of 12.9 (7,311 deaths), per 100,000
women.
A meta-analysis of 194 studies comprising
1,016,719 women with normal cytological findings has
demonstrated that globally, among women, the cervical
HPV prevalence is around 11.7%; in Sub-Saharan
Africa it is 24%; in Eastern Europe 21.4%; and in Latin
America 16%.1 These are considered to be highprevalence areas. The results with type-specific HPV
data (n=215,568) have illustrated that the 5 most
common types worldwide are HPV-16 (3.2%), HPV-18
(1.4%), HPV-52 (0.9%), HPV-31 (0.8%), and HPV-58
(0.7%).1 In contrast, a recent study from Pakistan has
shown that in women 15–59 years of age, the
prevalence of HPV is 2.8% (n=899) and 92.2% (n=91)
in general population and in women with invasive
cervical cancer, respectively.2 Also, the same study has
reported that, in general population, the HPV-16
prevalence is 0.7%; and in those with cervical cancer,
the HPV-16 prevalence is 75.8% and HPV-18 is 6.6%.
Some other studies from the country have revealed that
the HPV prevalence is between 18% and 98% (n=50–
162).3–5
Statistics on the prevalence of HPV infection
in the non-neoplastic samples from the general
population of Pakistan are sparse. So is the information
on distribution of HPV types and costs in terms of
screening, diagnosis, and treatment of the HPVassociated diseases. Corroborating research that would
support initiating a vaccination program against Human
Papilloma Virus in this type of population is clearly
lacking. The research questions that are unanswered
need to be addressed promptly taking into account the
socio-cultural and religious norms of the society.
Accordingly, there is a need to conduct more
studies on both the neoplastic and non-neoplastic
samples from our population, and populations similar to
ours, so as to identify cervical cancer risk factors before
vehemently advocating the adoption of preventive
measures against HPV infection, including vaccination.
Farhana Badar and Natasha Anwar

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References


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