HPV: The Puzzling Virus

The Human Papillomavirus (HPV) is considered as a major health threat for women worldwide. The majority of cervical cancer cases, by far, are thought to result from chronic infection with certain strains of HPV. The virus can be hidden for years from a woman's immune system with no apparent symptoms — then awaken and create the deadly disease. This is called shy virus that puzzled scientists for many years. In 1983, Dr Harald zur Hausen of Germany discovered the association of HPV with cervical cancer for which he was awarded the Nobel Prize in Medicine in 2008.

HPV infects predominantly the cervix (lower part of uterus) and also can affect vagina and anus. Although it causes cancer in women, it can lead cancers of the anus and penis in men. It can also infect the mouth and throat. Over 100 different types of HPV have been identified so far. Some HPV types cause warts, but do not cause cancer; whereas, other types cause cancer, but do not cause warts. However, the majorities of viruses are considered harmless and have no symptoms. Most infected individuals do not know that they are infected and are passing the virus on to their sex partner. Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery.

About 40 types of HPV are typically transmitted through sexual contact. Persistent infection with high-risk HPV types (HPV-16,18,31,33 etc.) different from the ones that cause warts — may progress to pre-cancerous lesions and invasive cancer.

Most HPV infections in young females are temporary, 70 per cent of infections are gone in one year and 90 per cent in two years. But when infection persists, 5-10 percent of infected women develop pre-cancer, which can eventually progress to invasive cervical cancer. This process usually takes 15–20 years, providing opportunities for detection and potential treatment with high cure rates. There are several ways that one can lower the chances of getting HPV — practice of safer sex, faithful relationship and vaccines.

Visual Inspection using Acetic Acid (VIA) and Pap test are used to detect abnormal cells which may develop into cancer. A cervical examination also detects warts and other abnormal growths. Abnormal and cancerous areas can be removed with a simple procedure, typically with a cauterising loop or cryotherapy. New HPV DNA tests are now available that is more sensitive than Pap or visual inspection.

Cervical cancer screening has reduced the incidence and fatalities in the developed world, whereas, substantial death tolls are still associated with HVP infections in the developing countries like Bangladesh where the cancer ranked number one among cancers that affect females.

Published in The Daily Star on 20 Feb, 2010

Chain Up For Cervical Cancer Awareness

Although cervical cancer is the leading cancer in women of Bangladesh, it is still a less spoken issue. The ironical thing about cervical cancer is that many women cannot access the free service to screen cervical cancer simply because of not knowing about the service. Many women detected at end stage of cervical cancer when apparently physicians have nothing to do. Unlike many cancers, we have vaccine and chap cancer test called VIA (Visual Inspection using Acetic Acid) to prevent and detect the disease at early stage. Still it remains one of the top ranked killers. There is an urgent need to promote these services throughout Bangladesh.

Cervical cancer is caused by genital infection with Human Papillomavirus (HPV), a common virus that can be passed from one person to another during sex. Among 100 different strains of HPV, type 16 and 18 are responsible for about 70 percent of cervical cancer worldwide. HPV is so common that most women get it at some time in their lives. HPV usually causes no symptoms and go away in course of time. However, if it does not, there is a chance that, over time, it may cause cervical cancer.

According to World Health Organisation, 12,931 women are diagnosed with cervical cancer every year and 6,561 die of this disease. This number will be more than double by 2025. Unfortunately, no study has been done yet to determine the prevalence of HPV infection in the population of Bangladesh. To reduce the death toll, nationwide cervical cancer screening programme should get strengthen to reach the hard to reach women.

In order to screen more women in our resource-poor settings, the government of Bangladesh offers most cost effective VIA test as free of cost in any government setting. It offers a real-time advantage over other screening methods with the distinct improvement of diagnosis at early stage to provide rapid treatment.

Another test called Pap test (or Pap smear) is also used to screen cervical cancer. It looks for pre-cancers cell changes on the cervix that might become cervical cancer, if it is not treated appropriately.

Women should start getting regular screening at the age 21 or within three years of the first time they have sex — which ever happens first. Cervical cancer is a preventable disease; unfortunately many women are still unaware about it. In order to raise cervical cancer awareness four key messages need to be developed for dissemination among the general population.

1. Cervical cancer is preventable
2. VIA test is easy and given free of cost
3. Screening saves lives
4. HPV vaccines are available for prevention who can afford it

To achieve these goals, Bangladesh should designate January as “Cervical Cancer Awareness Month” along with the international communities. During the campaign Ministry of Women and Children Affairs, Ministry of Health and Family Welfare, Obstetrics and Gynecology Society, Cancer Society, popular women celebrities, Media, NGOs, Universities, Colleges, High Schools, Army, BRD, Girls Scout, Women’s club, Rotary Club, Lions Club etc. can act as a chain to organise special programmes to raise much awareness about cervical cancer.

Women are generally considered as the heart of our family. Family falls apart when they get sick. To sustain tranquility and prosperity should not we strive to keep them happy and healthy?

Published in The Daily Star on 01 Jan, 2010