Health Forum on HPV Prevention and Cancer Control

As a woman in my 40s, any changes that happen in my body, I take very seriously. When I had heavy menstruation and periods that skip, I immediately reached out to my doctor and had myself checked. I knew that it was just hormonal imbalance. But as part of the prevention of diseases such as cancer, I did my due diligence and underwent tests. On August 31, 2022, a panel of doctors and patient advocates spearheaded a health talk. The forum was entitled #TimeToTalkAboutHPV: A health forum on HPV prevention and cancer control. The panelists appeal to people to stop spreading wrong information about cervical cancer as a death sentence.

The Cervical Cancer Prevention Network of the Philippines (CECAP) together with the Asia & Oceania Federation of Obstetrics & Gynecology (AOFOG), MSD, and the Philippine Obstetrical and Gynecological Society (POGS) organized the event. The forum aims to serve as a reminder that cervical cancer is preventable with regular screening tests and the HPV vaccination.

Cervical cancer is largely preventable through vaccination and screening and with appropriate follow-up and treatment. Women starting at age 30 should have a pap smear every three years and HPV DNA testing. At an early stage, most cases of the disease can be prevented successfully. Having accurate information, preventive services, and routine gynecological care is important.

Cervical cancer is preventable. However, it still ranks as the second most frequent cancer among women in the Philippines. It is also the second most frequent cancer among women between 15 and 44 years of age. Current estimates indicate that every year 7,897 women are diagnosed with cervical cancer, and 4,052 die from the disease.

99 percent of the cases of cervical are linked to HPV or human papillomaviruses. Modes of transmission include sexual contact, skin-to-skin contact, and rarely, through objects exposed to the virus.

It’s a highly-treatable disease if detected at its early stages. The precancerous stage provides ample window for detection and treatment. It could take as long as 30 years before it reaches malignancy. However, it is one of the most common types of cancer and the most common cause of cancer-related deaths worldwide.

Recently, COVID-19 has taken a toll on women’s health. Studies have shown a gap in missed routine preventative exams and screening visits. “I think the world has been focused on Covid for the past 2 ½ years and we have overlooked other health concerns,” said Dr. Anna Lisa Ong-Lim, professor and chief of division of infectious and tropical disease in Pediatrics University of UP Manila College of Medicine. “It is only recently when vulnerabilities to the vaccine-preventable diseases are being noticed once again.”

Things you need to know about HPV

HPV is a virus that causes a wide range of diseases

Dr. Mel Kohn, MSD executive director of medical affairs for vaccines and infectious disease .

“Apart from cervical cancer, the 2nd leading cancer for Filipinas, HPV can give men head and neck cancer, anal cancer for both sexes and a variety of less common but also devastating kinds of cancers,” he enumerated. Examples are vaginal and vulvar cancers and penile cancer.

“Genital warts, while it doesn’t kill you, can be quite devastating,” said Dr. Kohn. “It is quite common and very difficult to eradicate. Imagine the psychological toll on the patient. Again, prevention is the best approach here.”

HPV is common and passed from one person to another during sexual contact. “It’s a quiet epidemic unlike COVID,” he warned. “You don’t immediately see it when you meet somebody but it’s there and has been growing rather insidiously.”

The Philippines has a population of 37.8 million women ages 15 years and older who are at risk of developing cervical cancer. About 2.9% of women in the general population are estimated to harbor cervical HPV-16/18 infection at a given time. While 58.6% of invasive cervical cancers are

attributed to HPVs 16 or 18.

Some of the infections from this commonly occurring virus with more than 100 types usually go away on their own. However, at least 14 types of HPV have been found to be cancer-causing.

The age indication for HPV vaccines is as young as nine years old for both girls and boys. Teens and young adults through the age of 26 years should also have HPV vaccination. Women up to age 45 may be eligible for vaccination after discussing it with their provider.

According to Dr. Ong-Lim, they are targeting the young ones because of their increased susceptibility to infections.

“That particular age group demonstrates optimal immune response. Also, only two doses are needed to achieve protection,” she shared. Giving the vaccine at a younger age ensures that they are already protected before they become sexually active.

HPV vaccines work best when given before exposure to the virus. We must try to catch that window when the immune system really responds very well to it.

Dr. Anna Lisa Ong-Lim, professor and chief of division of infectious and tropical disease in Pediatrics University of UP Manila College of Medicine

Call to Action Against Cervical Cancer chair and practicing OB-Gynecologist Dr. Jean Anne Toral mentioned that the young and adult fertility study done recently indicates that the average age Filipina women become sexually active is 18.2 years old. “Giving the vaccine at age 9-15 would be beneficial as there is no life event that exactly pinpoints exposure to HPV apart from age of sexual debut,” she said.

There will be seven to eight out of 10 women who would be exposed to HPV at one point in their life, “But not all women will develop cervical cancer,” Dr. Toral assured. The probability of HPV exposure developing into cancer increases if a patient smokes or is exposed to other sexually-transmitted diseases, and HIV.

School-based HPV vaccination

The Department of Health together with partner agencies rolls out the School-Based Immunization (SBI) Program.

The SBI Program includes measles, rubella, tetanus, diphtheria (MR-TD), and human papillomavirus (HPV) vaccines that are administered to eligible students in public elementary schools. The inclusion of HPV vaccination in the SBI Program aims to protect young women from cervical cancer later in life, among other diseases associated with HPV.

Under the DOH’s SBI Program, HPV vaccination is given to grade 4 based on DOH’s recommended age group to receive the two doses of HPV vaccine, six months apart, for protection against cervical cancer.

The consent of parents was obtained first by school officials prior to the administration of a vaccine. Hence vaccination education campaigns usually highlight the role of parents in fortifying the health shield of their children through timely vaccination against diseases.

Due to the COVID-19 pandemic, the HPV vaccination, which was formerly delivered through the SBI Program is now being shifted as part of the Community-based Immunization to be able to still deliver HPV vaccination to young girls amidst the pandemic to protect them against cervical
cancer and other HPV-related diseases and cancers.

Towards a cervical cancer-free future

The elimination of cervical cancer has been defined as achieving an incidence rate low enough for the disease to be considered controlled as a public-health problem. This threshold has been defined by the WHO as fewer than 4 cases per 100,000 women per year.

To reach this, every country must reach and maintain three key targets, within the lifetime of today’s young generation:

1. 90 percent of girls are fully vaccinated against the human papillomavirus (HPV) by the age of 15.
2. Ensure that 70 percent of women are screened using a high-performance test by the age of 35. And again by age​ 45.
3. 90 percent of women with pre-cancer receive treatment and 90
   percent of women with invasive cancer to have their condition properly managed.

Achieving this vision will require a whole-of-society and multisectoral approach to ensure health systems prioritize women and girls.

Carmen Auste, Chief Executive Officer of Cancer Warriors Foundation Inc. said that the Philippines is among the countries that declared commitment together with WHO to finally eradicate cervical cancer in the country by 2040, and by 2030 worldwide. “There is already one type of cancer that we can delete or ‘block’ like social media,” she humored. “To attain that goal, we must augment HPV vaccine uptake and educate the Filipinos on HPV, vaccines, and cancers caused by HPV,” she said.

Auste mentioned the SUCCESS (‘Scale-up Cervical Cancer Elimination with Secondary prevention Strategy’) project as one of the advocacies recently launched in selected barangays. Led by Expertise France and delivered in collaboration with Jhpiego and the Union for International Cancer Control (UICC) in support of WHO, the project aims to deploy innovative solutions to fight cervical cancer in four countries, including the Philippines.

At this critical juncture, we must empower women and rally our neighbors, community leaders, and governments to take action and save thousands of lives. If widespread, high coverage of these interventions can be achieved by 2030 and maintained, research predicts cervical cancer can be eliminated in most countries globally by 2120—avoiding over 63 million deaths of women globally.