Since persistent infection raises cervical cancer risks, doctors encourage women to be vaccinated to reduce risk and have regular screening before it’s too late
Of all cancer types, cervical cancer is the second deadliest among Thai women of working age, ranking just behind breast cancer. Every day, 25 Thai women are diagnosed with cervical cancer, bringing the number of confirmed cases to 9,158 a year. On average, cervical cancer kills 13 women on a daily basis. Even more alarming is the fact that more than 80 per cent of sexually active men and women are at risk of contracting HPV at least once without developing any symptoms. As HPV can cause cervical cancer, their infection can be a silent threat. Over time, HPV may transform normal cells into cancerous ones.
Organised with the collaboration of the private and government sectors, the Road to Zero HPV seminar set out to promote public awareness of cervical cancer. Among the speakers were such respected medical experts as Clinical Professor Dr. Vitaya Tithapan, president of the Royal Thai College of Obstetricians & Gynaecologists, Professor Dr. Somsak Lolekha, president of the Royal College of Paediatricians of Thailand, and Dr. Jakkrit Ngowsiri, deputy secretary-general of the National Health Security Office (NHSO). Joining them on the stage was cervical cancer survivor Mrs. Somkuan Sathongkaen, who shared her experience with the audience.
HPV causes cervical cancer: Don’t overlook the risks!
Dr. Vitaya said, “HPV or Human Papillomavirus is a virus that lives on moist body surfaces. It can thus be found in the vagina. HPV can cause various sexually transmitted diseases including cervical cancer, vaginal cancer, vulvar cancer, anal cancer, and genital warts. Even though HPV goes away on its own in most cases, in some people it will stay dormant for 10 to 20 years. The affected skin area will over time turn cancerous. Even during the dormant phase, carriers may spread HPV to their sexual partners too. Moreover, HPV can survive on inanimate surfaces for quite a long while. This means if you share any utensils with others, you may contract HPV from those objects.
Because HPV infections do not present clear symptoms in the beginning, active case finding is of the utmost importance. Early detection will lead to timely treatments. In Thailand, there are two types of HPV tests:
1. PAP smear: Conducted by an obstetrician, this test involves inserting a tool into the vagina to collect cell samples. Lab tests will then determine if cells have any abnormalities.
2. HPV DNA testing: Because it focuses on DNA levels, this test has high accuracy. It also enables early detection of any cancer risks.
Why is HPV important if the virus clears up on its own?
Normally, the human body can eject most of the HPV but this can still leave a 10 percent viral residue. People tend to believe that protection against HPV is not very important as they have confidence in their immune systems. Professor Dr. Somsak told the seminar audience about the availability of HPV vaccines and emphasised their importance. “Presently, we have three types of HPV vaccines – the bivalent HPV vaccine, the quadrivalent HPV vaccine, and the 9-valent HPV vaccine. Each has different efficacy properties. The bivalent type protects against HPV types 16 and 18 with an efficacy rate of 70 per cent. The quadrivalent type protects against HPV types 16 and 18 as well as types 6 and 11, which are responsible for 90 per cent of genital wart cases in men and women. Types 6 and 11 also cause the potentially fatal Recurrent Respiratory Papillomatosis in newborns who have contracted HPV from their mother. The 9-valent HPV vaccine, meanwhile, protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. This type has an efficacy rate of 90 per cent against cervical cancer, genital warts, and Recurrent Respiratory Papillomatosis. HPV vaccination exposes the human body to non-infectious parts of the virus for the purpose of boosting immune system against HPV,” he explained.
Doctors recommend HPV vaccines for boys and girls aged 9 years and above. The best age range for vaccination is from 9 to 15 years old because it will trigger the strongest immunity. Once the full vaccination regimen is complete, protection can last a long time without the need for a booster. Professor Dr. Somsak said children aged younger than 15 years need just two doses of HPV vaccine at an interval ranging between six and 12 months. Vaccinees aged over 15 years of age need three doses. The first and second doses should be given between 1 to 2 months, while the interval between the second and the third doses should be six months. HPV vaccine is recommended for people of all genders. Vaccinated men will face a lower risk of developing HPV-related diseases and also of being HPV carriers.
It is necessary for parents to understand that HPV vaccination is not an indicator that they are preparing their children for sexual relationships. Instead, giving their children HPV vaccine is about disease prevention. Efficacy rate is highest among people who have never caught HPV before. Professor Dr. Somsak said parents should register their children for HPV vaccination when schools schedule vaccination appointments,
People aged over 27 years or who are sexually active should seek further advice from doctors. If they are vaccinated against HPV, they will be protected from reinfection by the old HPV types and also from infection by other HPV types.
Voice of cervical cancer survivor
Several people wonder about the early signs and symptoms of cervical cancer, how the disease can be treated, and how long it takes to achieve full recovery. The seminar therefore featured cervical cancer survivor Mrs. Somkuan Sathongkaen. Talking about her battle against cancer, she said, “I had cervical cancer. It took me more than a year to recover from it. Before I was diagnosed with cancer, I had never undergone a pelvic examination. But I noticed I was bleeding more heavily during menstruation. Later my menstrual cycle became irregular and I also suffered serious stomach pain during menstruation. For a while, I thought these symptoms were appearing because I was getting older and nearing menopause. But as they were getting worse, I decided to see a doctor. That’s when I was diagnosed with cervical cancer. I was really shocked because it was already a Stage 2 cancer. I needed to calm down and think hard about treatment options and the procedures involved. I then began a course of concurrent chemoradiation that continued for well over a year and cost me hundreds of thousands of baht.”
Screening & HPV vaccination
Speaking about free screenings and HPV vaccination for Thais, Dr. Jakkrit said, “Recognising the danger of cervical cancer, the NHSO has closely monitored this threat and allocated a budget for related comprehensive care. We have promoted cervical cancer screening among Thai women aged between 30 and 60 years old by offering a free screening every five years. They can exercise their right at the hospital that has been linked to or assigned to their name. Furthermore, we have provided HPV vaccines to more than 400,000 Pathom 5 schoolgirls across Thailand. HPV vaccination has continued for years with a brief break during COVID-19 pandemic as a result of vaccine shortage. We resumed HPV vaccination for students in 2022. This year, the NHSO has already procured quadrivalent HPV vaccine for all Pathom 5 schoolgirls.”
“In addition, the NHSO has planned to promote cervical cancer screening further by providing free HPV DNA Testing kits. With the kits, women will be able to collect samples for lab tests themselves. HPV DNA Testing kits will likely be available soon. Moreover, the NHSO plans to improve HPV prevention and care further based on the recommendations of a panel of specialists as well as the Public Health Ministry. For example, NHSO may consider giving HPV vaccine to boys too for enhanced healthcare,” he added.
While cervical cancer is a serious disease, its prevention is not difficult. HPV vaccination for people aged 9 years old and up and regular screenings every five years for women aged over 30 years old are crucial tools. Cervical cancer survivors, meanwhile, are recommended to see their doctors on a regular basis to get proper advice and lower the risk of the cancer recurring. Doctors suggest that people who have never had cancer or been vaccinated against HPV go for regular checkups too to determine the state of their health and should any condition be detected, receive timely treatments for sustainable good health.