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

Abstract

Dear Editor,In many regions of the world, a vaccination programagainst the Human Papilloma Virus (HPV), to preventthe cancer of the cervix uteri, has been implemented.This is due to a relatively high prevalence of HumanPapilloma Virus, which is implicated in aetiology ofcervical cancer.As estimated by Globocan, in 2008, per100,000 women, in very high incidence regions as SubSaharan Africa, the annual age-standardised incidencewent up to 56.3 and mortality to 41.7. The incidence ofcancer of the cervix uteri was also reported to be high inSouth America (23.9) and Melanesia (23.0). However,in Pakistan, the estimates for cervical cancer wererelatively low with an incidence of 19.5 (11,688 cases)and mortality of 12.9 (7,311 deaths), per 100,000women.A meta-analysis of 194 studies comprising1,016,719 women with normal cytological findings hasdemonstrated that globally, among women, the cervicalHPV prevalence is around 11.7%; in Sub-SaharanAfrica it is 24%; in Eastern Europe 21.4%; and in LatinAmerica 16%.1 These are considered to be highprevalence areas. The results with type-specific HPVdata (n=215,568) have illustrated that the 5 mostcommon 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 hasshown that in women 15–59 years of age, theprevalence of HPV is 2.8% (n=899) and 92.2% (n=91)in general population and in women with invasivecervical cancer, respectively.2 Also, the same study hasreported that, in general population, the HPV-16prevalence 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 thatthe HPV prevalence is between 18% and 98% (n=50–162).3–5Statistics on the prevalence of HPV infectionin the non-neoplastic samples from the generalpopulation of Pakistan are sparse. So is the informationon distribution of HPV types and costs in terms ofscreening, diagnosis, and treatment of the HPVassociated diseases. Corroborating research that wouldsupport initiating a vaccination program against HumanPapilloma Virus in this type of population is clearlylacking. The research questions that are unansweredneed to be addressed promptly taking into account thesocio-cultural and religious norms of the society.Accordingly, there is a need to conduct morestudies on both the neoplastic and non-neoplasticsamples from our population, and populations similar toours, so as to identify cervical cancer risk factors beforevehemently advocating the adoption of preventivemeasures against HPV infection, including vaccination.Farhana Badar and Natasha Anwar