Article Text


Epidemiology and policy
SP3-28 Is vaccination against the human papillomavirus for prevention of the cervix uteri cancer indicated in Pakistan where there is no Pap smear cervical cancer screening program-a public health perspective?
  1. F Badar,
  2. N Anwar
  1. Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab, Pakistan


Introduction As reported by Globocan, in 2008, per 100 000 females: (I) in Pakistan, the estimates for cervical cancer were: (i) incidence 19.5 (11 688 cases) and (ii) mortality 12.9 (7311 deaths); and (II) in very high incidence regions as sub-saharan Africa, the annual age-standardised incidence rate was up to 56 and mortality was 41. Pakistan does not have a Pap smear cervical cancer screening program. The cervical Human Papilloma Virus (HPV) prevalence in women with normal cytology has been reported to be as follows: globally 11.7%; sub-saharan Africa 24%; Eastern Europe 21.4%; and Latin America 16%. Worldwide, the five most common HPV types were: 16, 18, 52, 31, and 58.

Method A review was conducted to estimate the prevalence of HPV in cervical tissues obtained from neoplastic and non-neoplastic samples and indications for vaccination of females against HPV infection in Pakistan.

Results Recent studies from Pakistan have shown the HPV 16/18 prevalence in the general population to be about 2.8% (N=899 married women, 15–59 years); few other studies have shown the HPV prevalence in cervical cancer to be 18%–98% (N=50–91).

Conclusion Information about the prevalence of HPV infection in neoplastic and non-neoplastic samples is sparse. Pakistan does not have a cervical cancer screening program either. More epidemiologic studies are needed to determine if ours is a low- vs a high-HPV- prevalence setting and to identify cervical cancer risk factors, before vehemently advocating the adoption of preventive measures against HPV infection using the HPV vaccine, as has been initiated in the country.

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