Toilet ki ek aur katha- Personal hygiene and Prevention of Cervical cancer

I am so glad that ‘toilets’ are receiving the importance thanks to the movie ‘toilet ki ek prem katha’. Here ‘s the reason why toilets should be demanded by every lady !

Cervical Cancer incidence and mortality is decreasing steadily.

However most of the reduction happened in the developed countries as this graph shows.(GLOBOCAN)

All this happened even before HPV vaccine was introduced . Even pap smear screening was not total in some countries.

How did this happen?

Its clear that improved personal hygiene due to access to toilets with privacy was an important factor . Personal genital hygiene in both men and women can reduce cervical cancer.

Just compare with the countries with least number of toilets per capita ( WHO/UNICEF)

20150708_Toilets_FoGLOBOCAN_BSC_87648723

All  in the areas with high cervical cancer.

Of course there are other factors like unprotected sexual activity and HPV does spread due to poor habits. There was a nice study way back in 1999 from Kerala, in a survey based in Trivandrum centre,  that highlighted the correlation of cervical dysplasia to  lack of access to hygiene with toilets, sanitary napkins etc .

Expensive vaccines and even more expensive population screening are not suitable for large rural populations like India and Africa.

The fact however is that the rural and urban poor ARE AWARE of the ill effects of poor hygiene but have no access to clean toilets

That’s a preventable tragedy!

Its time for action !! It’s time this basic need is ensured in every household

Conflict of interest:

I know Akshay Kumar but was neither influenced or approached to write. The  thought developed for sometime in discussion with Dr Anita Borges.

Should I take HPV vaccine for preventing Cervical Cancer?

Cynthia, my secretary, said that her aunt aged 54 was advised by a gynaecologist to take the HPV vaccine for preventing Cervical Cancer.  It is quite tempting to opt for any technique to prevent cancer and rightly so.

Yes, Cervical Cancer is caused by six strains of the Human Papilloma Virus (HPV). This has won Nobel prize for Prof . Zur Hausen.

zur hausen

The vaccine contains recombinant DNA of 2 or 4 of such virus strains.  The IMPORTANT FACT is  the vaccine is recommended to be given before the sexually active age i.e preteens aged 11-12. Certainly not after 25.  This also created a lot of controversy in India as this was actually tested in rural population where none had knowledge of Cervical Cancer nor did they benefit from the vaccine.

What are the basic facts of Cervical Cancer

Cervical Cancer, worldwide, even before the advent of the vaccine, started falling and this was evident as in most of the developed world.  Cervical Cancer has gone down significantly from No.2-3 position in many countries and is mainly the problem of eastern and northern Africa and parts of developing world. .

Why did this happen when they were not even vaccinated?  Even a pap smear screening was not implemented in many countries like India.  But in the urban population, even in India, Cervical Cancer started coming down.  The simple reason is that Cervical cancer is largely related to a number of children, early marriage and most importantly the personal hygiene of women.  As the lifestyle has changed, personal hygiene improved. Number of children are limited to 1 or 2 and the age at marriage has progressively increased.  So, social dynamics and personal hygiene  reduced the incidence of Cervical Cancer.

More facts on HPV vaccination

  • Some side effects of headache and fever are reported. In Japan more serious effects like persistent body aches, joint pains made the government suspend promotion of vaccine. India also has adopted a cautious approach.
  • The vaccine would not protect once there is infection and so has to be given early.
  • The cost is around 300 USD for 3 doses and in those highrisk populations, it would never be affordable.
  • The risk of cervical cancer is reduced by 43% and screening by pap smear is still recommended.
  • Highrisk individuals include homosexuals, HIV positive and immuno compromised patients

Summary

Readers of this blog are NOT at risk.

They are healthy, mostly over 15 and definitely conscious about hygiene.

So don’t panic if some one advises HPV vaccination for you.

You can carefully consider for young girls.

References:

http://www.cdc.gov/hpv/vaccine.html

http://globocan.iarc.fr/factsheets/cancers/cervix.asp