The Irony of Cervical Cancer Amid Vaccine and Screening Adva
In commemoration of World Cancer Day today, the entire community is again reminded of the dangers of cancer, including cervical cancer. Globocan data in 2020 showed that there were 36,633 new cases of cervical cancer with around 21,003 deaths.
In Indonesia, cervical cancer is the second most common cancer experienced by women after breast cancer. In Southeast Asia, Indonesia is the country with the highest incidence and mortality from cervical cancer, namely, 24.4 per 100 thousand population with 14.4 deaths per 100 thousand population.
Andrijono, consultant gynecological oncology and Chairman of the Advisory Board of the Indonesian Gynecological Oncology Association (HOGI) said the latest data showed there were 89 new cases of cervical cancer and 57 deaths per day. Most of the patients present in the late stage condition. He added, RSCM noted that 94 percent of cervical cancer patients died within 2 years.
"The cause of cervical cancer is known, the method is known, the vaccine has been obtained, the screening method is available, the therapy is also there, but how come in Indonesia [the cases] are still high? This is our irony," Andrijono said in a joint press conference with KICKS and MSD Indonesia, Friday ( 4/2).
If seen, he said, infection with Human Papilloma Virus (HPV) or the virus that causes cervical cancer is regression. Only 10-25 percent of infections become persistent and only a few lead to cancer.
The World Health Assembly adopted a global strategy to accelerate the elimination of cervical cancer by 2030. The World Health Organization (WHO) has also launched 3 elimination strategies, namely, prevention by vaccination, screening and management of precancerous lesions and treatment and palliative care for cervical cancer patients. .
Looking at these three strategies, Andrijono highlighted two challenges in efforts to reduce cervical cancer in Indonesia, namely, vaccination coverage and screening.
In the HOGI team's research in collaboration with R&D involving 20 thousand samples, it was found that most cervical cancers were caused by the HPV types 16, 18 and 52. The HPV vaccines for type 16 and type 18 were able to reach 70-80 percent. However, this coverage is still far from the WHO target of 90 percent (vaccination for girls under 15 years of age).
"This vaccine is very effective, almost 100 percent. [According to research] up to 16 years there is no need for a booster. In men, the HPV vaccine can prevent anal cancer, in women as well. So in men it can be used for cancer of the anus, penis and oropharynx, while in women, for the cervix, anus and oropharynx," he added.
Then for screening, the numbers are more concerning. Cervical cancer screening methods include Visual Acetate Inspection (IVA or Visual Inspection with acetic acid/VIA), pap smears and HPV DNA tests. Adrijono said the screening coverage was still 10 percent. In fact, if we look at the WHO strategy, the screening coverage is at least 70 percent.
In screening, problems often occur in hospitals with inadequate facilities, especially hospitals in remote areas. Diagnosis usually uses an HPV DNA test followed by VIA to determine abnormal lesions and a biopsy to prove the presence of cancer.
"In fact, if there are abnormal lesions and the results of the HPV DNA test are positive, a colposcopy is performed (a close examination of the condition of the cervix). But sometimes hospitals don't provide them, only a few have them, especially in rural areas," said Andrijono.
Iqbal Dzakaria, representing Maxi Rein Rondonuwu, Director General of Disease Prevention and Control at the Ministry of Health, said that the program targets 5th grade SD/MI/Equivalent girls for the first dose, followed by 6th grade elementary school girls for the second dose.
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