Cervical cancer is currently a public health problem in Peru and represents the second most frequent cancer nationwide after breast cancer, and in 2018 4103 new cases of cervical cancer were diagnosed, and it also produced a high mortality rate in in Peru, with 1836 deaths in 2018. This cancer is of infectious origin since the Human Papilloma virus has been identified as its causative agent and this recognition constitutes one of the great advances in medical knowledge in recent decades.
Human papillomavirus infection is one of the most common sexually transmitted infections in the world, it causes dysplasia or abnormality in the development of tissues located mainly in the anogenital area and also in the aero-digestive tract in both women. like men. Among women, it produces the most common sexually transmitted infection; More than 300 million women worldwide are carriers of the virus, of which a third are infected by types 16 and 18, which are oncogenic, which will lead to cervical cancer in the course of 10 to 20 years. 70% of cervical cancers are linked to types 16 and 18; But if we include the other 5 most common types such as 31, 33, 45, 52, 58, we will have included 90% of the causative agents of cervical cancer.
Since the identification of this virus, strategies have been undertaken for the early diagnosis of cervical cancer through the implementation of the papanicolaou smear, and at present this measure is complemented by viral detection tests. But as of this millennium, primary prevention measures have been implemented such as vaccination, which have been introduced worldwide since 2006 and in Peru since 2015, which have been authorized by the Food and Drug Administration (FDA ), recommended by the Centers for Disease Control and Prevention (CDC), the American College of Obstetrics and Gynecology, and the American Cancer Society. This vaccination constitutes a public health strategy that is based on the ability to stimulate an immune response that is 50 to 80 times greater than that of natural infection.
The first vaccine against human papilloma emerged in 2006 and was called tetravalent (Gardasil 4) because it protected against types 16, 18, 6 and 11; showing 99% efficacy against high grade cervical lesions. The bivalent vaccine (Cervarix) was presented in 2007 against types 16 and 18 with an efficacy of 100%. None of these vaccines contain viral DNA, so its application cannot cause infection, much less disease. In 2015, the Gardasil 9 vaccine, known as the nonavalent vaccine, was authorized, which adds to the 4 old genotypes, genotypes 31,35,41,52 and 58; conferring more efficacy in immunogenicity reducing the incidence of cervical cancer and its premalignant lesions. In the nonavalent vaccine, the application of two doses separated by 6 months is authorized, in children under 14 years of age and of 3 doses (0.2.6 months) from 15 years of age. This vaccine has been shown to be effective in women up to 45 years of age, although it is known that the immune response decreases after the age of 26; and if it is administered at a younger age there will be a greater production of neutralizing antibodies; For this reason, it is advisable to use the vaccine before being exposed to the pathogen, that is, before the start of sexual activity.
At present, the efficacy of vaccination against the human papilloma virus in preventing cancer and its premalignant lesions in the cervix, vulva and vagina has been demonstrated; but its safety is also guaranteed, so it is imperative that its use be included in a vaccination schedule in our country permanently and not occasionally as has been happening in public health establishments. And perhaps in the near future vaccination can be extended to men, as some studies report a prevalence of human papilloma infection of up to 50% in men; and it may even be beneficial to vaccinate men in places where there is low vaccination coverage in women.
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