Prevention is better than treatment

"Health is wealth" -- maybe is the most widely used proverb in the world and maybe the one proverb we all, irrespective of geographical and social background grew up hearing from a very early age. Unfortunately we take this proverb lightly and take health for granted and put health including preventative healthcare in the backseat and our other activities gets much more priority. This negligence may lead to unwanted and unwarranted health tragedy at a time when it is least expected. Interestingly amongst most of us the inertia to go for preventative action/s is alarmingly high. The awareness of few preventable diseases are  at such a lower level, that even victims, let alone the general people do not consult their doctors and take protection against the diseases. If we look into the disease burden specially in developing countries like Bangladesh and other neighbouring countries we will see that many of the diseases can be prevented. According to World Health Organisation (WHO), after clean and safe drinking water, vaccination is the best medical intervention to prevent a disease if such vaccine is available. Vaccination has played remarkable results in eradicating some major fatal diseases from world, amongst which is the recent eradication of Polio, a disease which is not fatal but causes permanent physical disability to its victims.  The good news is that recently the Polio vaccination programme has reached its desired goal and WHO has announced that most countries of the developing world including Bangladesh, Myanmar and India are now Polio-free. In Bangladesh, we are now combating Hepatitis-B through Hepatitis B vaccination under the extended immunisation programme (EPI) for under 5 children and private vaccination facility for the adults.
Let us now look at another vaccine-preventable disease called cervical cancer. Today, the prevalence of cancer in Bangladesh is high and one of the common cancers is cervical cancer. It is the second common cause of death of women in Bangladesh. According to ICO Information Centre on HPV and Cancer (HPV Information Centre) 2014, Bangladesh has a population of 54.38 million women aged 15 years and more who are at risk of developing cervical cancer. Cervical cancer, caused by human papillomavirus (HPV) is the second most deadly cancer among women worldwide. Current estimates indicate that every year 11,956 women in Bangladesh are diagnosed with cervical cancer and 6,582 of them die. Cervical cancer ranks as the second most common cancer among women in Bangladesh and women between 15 and 44 years of age are the major victims. However, in South Asia, the regions Bangladesh belongs to, about 7.9 per cent of women in the general population are estimated to harbour cervical HPV infection at a given time and 82.8 per cent of invasive cervical cancers are attributed to HPVs 16 or 18 (*different types of HPV virus). Worldwide, in every 2 minutes a woman dies of cervical cancer.
Women are the major victim for this deadly disease -- 'cervical cancer' in Bangladesh, where social boundaries or hesitation do not trigger one woman to discuss their very private issues with doctors and also with their husbands until and unless it reaches to severe level. On this very important World Health Day, I would like to share the good news that cervical cancer is a preventable disease for which effective vaccines are   available in the world market. Another good news is that, this vaccine is also available in Bangladesh since 2009.
The Human Pappiloma Virus (HPV), its genome and its causal association with cervical cancer was innovated by a German Medical Scientist Dr. Harald Zur Hausen for which he was awarded Nobel prize in Physiology and Medicine in December, 2008. He exclusively established the necessity of HPV for the development of cervical cancer. This basic study of Zur Haussen on HPV was ultimately brought into clinical development of HPV vaccine, a ground breaking innovation and contribution in the field of immunology and vaccinology.
When HPV gets into the lining epithelium of a woman's cervix during its transmission through sexual route, it may stay there for several years without doing any harm. Initial infection usually does not produce cancer. But if the virus persists there, it then may produce a damage to the cells in the basal layers and finally, transform these cells first into precancerous and then into cancerous stage. As already mentioned that to produce cancer of the cervix by HPV,    several years (10 to 15 yrs) may be required.
Since HPV vaccine is available at our hand, therefore, we should take the advantages of such vaccine for the prevention of a deadly cancer -- cervical cancer; that kills millions of women in the world. This vaccine is applicable for women from 9 years of age and onwards with three doses. Along with vaccination, women must take the advantages of HPV screening test (pap's smear test)   in consultation with their doctors. This is a gold standard test for the detection of early cellular changes of the cervix. It is to be remembered that pap's test is not the diagnostic test for cervical cancer, rather it is the test which examines the 'health' of the cervix. Since presence of unhealthy cervix as evidenced by the presence of abnormal cells is likely to indicate   the presence of HPV infection. In such cases, it would be easier to take appropriate preventive measure. Screening should be done once every year for 3 years.  If the result is negative, it should be done once every 3 years. Research suggests that even if women in developing countries have access to just one screening in their life time, it could reduce their risk of cervical cancer by a third.
Medical professionals had a long dream of beating cancers by vaccine.  With the discovery of HPV and subsequently, with the introduction of prophylactic HPV vaccines in the prevention of cervical cancer, the dream has now come into a reality. In fact, the first vaccine to prevent cancer is hepatitis B vaccine which has been introduced long ago in the prevention of hepatitis B infection.  Following its introduction in the prevention of hepatitis B infection,     it was recognised that this vaccine in addition to prevention of hepatitis B infection, has also been found to prevent hepatocellular cancer -- a complication of hepatitis B infection. Thus, HPV vaccine in this regard   can be called a second vaccine   against cancer.
On the World Health Day, my message to the readers is that, 'know your health, care for the health of your family & know all the possible prevention to shield yourself and your loved ones from all possible diseases.'
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The author of the article is former professor and chairman of the department of pharmacology, Bangabandhu Sheikh Mujib Medical University (BSMMU)