Question: Is there any vaccine to protect girls from cervical cancer? I heard from a gynaecologist that it is good for young girls to receive a vaccine to rule out the future possibility of being affected by this cancer. Is it true?
Answer: The short answer to your question is "yes". We now know that cervical cancer is caused by a virus called the human papillomavirus, or HPV for short.
HPV is a very common virus that can be transmitted via skin-to-skin contact, including sexual intercourse. Most infections are harmless and our body's immune system will get rid of them.
A small group of HPVs, however, do cause genital warts. Genital warts do not cause or have any association with cervical cancer, but they are a growing problem, particularly among young adults, as it is the most common manifestation of HPV infection in the community.
Less common effects of genital warts include severe infections that result in difficulty passing urine or giving birth naturally. A much smaller group of HPV infections are categorised as high-risk or oncogenic, as they have been associated with cervical cancer.
Among these oncogenic HPVs, type 16 and type 18 are the most common and cause 70 per cent of cervical cancer cases.
Cervical cancer is a global problem. It is the second-most deadly cancer among women worldwide. The unique thing about the disease is that we can screen for the cells that can change into cancer cells in the future.
These cells are called pre-cancer cells and, when identified, can be removed safely and easily, so as to prevent cervical cancer from developing.
It is now established that an organised cervical screening programme can reduce the number of women getting the cancer. Singapore's cervical screening programme, called CervicalScreen Singapore, invites sexually active women from the age of 25 to 69 to take a Pap smear test every three years to detect pre-cancer cells.
There is no doubt that an organised cervical screening programme is an important initiative that should continue in order for us to eliminate cervical cancer once and for all.
However, this is not enough. Prevention is always better than cure. We also need to prevent oncogenic HPV infections from happening, so that pre-cancer cells are not produced in the first place.
We now have the ability to do that in the form of an HPV vaccine.
This vaccine does not contain a live virus. Instead, a virus-like particle or VLP (an empty shell without virus DNA) is used to trick the body into increasing its immune response to oncogenic HPV infections.
The vaccine protects you from HPV types 16 and 18. It is therefore extremely important, even if you have had HPV vaccination, to continue going for regular Pap smears to check if you are infected with any of the other oncogenic strains.
Given that HPV is transmitted sexually, the risk of being infected before the first sexual encounter is extremely low.
The best time to get the vaccine is before any sexual contact. This allows the vaccine to build up a strong immunity against types 16 and 18 infections that may come in the future.
We also know that women who had been or are currently sexually active, or have had previous treatment for pre-cancer cells, will also benefit from getting the vaccine for prevention of future infections.
Even though the benefit is lower compared with those who receive the vaccine before their first sexual contact, it is still much greater than that for women who did not get the vaccine at all.
In Singapore, HPV vaccination is indicated for females between nine and 26 years old. The vaccine is given in three doses in the span of six months. No additional or booster shots are needed.
The HPV vaccine is safe.
The most common side effects, as expected, would be slight pain at the site of injection.
Some may have slight redness or swelling at the injection site. This will usually go away after a few days.
The vaccine is very closely monitored worldwide and no adverse effects directly associated with the vaccine have been reported.
If you have a daughter who falls within the recommended age group for HPV vaccination, do consider doing so. You may also wish to seek further advice from your doctor regarding the vaccine.
Dr Ida Ismail-Pratt is an associate consultant at the National University Hospital Women's Centre
This article was first published on July 03, 2014.
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