It’s pretty surprising how so little Indonesian people that I have met knows so little about HPV, since it is considered to be the Second Female Killer in the world, responsible for around 300.000 deaths a year in Cervical Cancer alone, and climbing it’s rank to number one in Indonesia. This lack of awareness, although I believe is rising since the introduction of vaccines and HPV testing, is causing the low number of people – Yes! Both male and female – being protected against it.
1. What is HPV-related Cancer?
Human Papillomavirus is a very common virus which is transmitted and spread by sexual activity, that depending on the hundreds of types there are – low or high risk -, may cause warts (condyloma) or cancer to develop. Amongst the cancers caused by HPV, Cervical cancer remains the highest in number. According to the latest report, nearly 21.000 new cases of HPV-positive Cervical Cancer were detected in Indonesia, 2016, ending in 9.500 deaths.
2. We’re All Infected!
Although sexual penetration bears the most risk for infection, however just a simple skin-to-skin, genital-to-genital and genital-to-oral contact is a well-known mode of transmission. At some point in our lives, shortly after being sexually active, everybody is bound to be infected with HPV. However, most infection goes away on its own, some become carriers (not manifesting, but capable of infecting others), and a small percentage (1-3%) develop as cancers. If in the year 2016, in Indonesia alone, 21.000 new cases of just cervical cancers are detected, by the statistics it is safe to estimate the number of HPV infection is around 21 million cases.
3. I’m a Man, I Don’t Have a Cervix, So I Don’t Need To Be Vaccinated.
Well yes, males won’t develop cervical cancer, to emphasize the diagram above (top-left), as common a misconception as it is, HPV is not only causing Cervical Cancer. All mucosa associated with sexual activity are at risk for HPV infection – including the Mouth, the Throat, the Penis, The Anus, and also the Vagina in females – therefore at risk for cancers in the aforementioned body regions. Fun Fact: more mouth and throat cancers are caused by HPV than by smoking tobacco. Not that fun of a fact after all, eh?
4. HPV is a Threat in Our Prime Age.
It takes approximately 15-20 years for cancers to develop after HPV-infection in a person with normal immune system, therefore putting the most cases of Cervical and other HPV-related Cancers to occur at the age of 30-35 years old, much sooner with the rising numbers of underaged sexual activity in Indonesia.
It takes even longer for the cancer to show any symptoms, which is why most (>70%) Cervical Cancers cases are not detected until they are at their late stages in those who do not take regular screening habits. There are currently no known treatment for Cervical Cancer, which means that once you’re diagnosed, death is pretty much imminent. However, it is highly preventable, through vaccination. Vaccination is best done at the age of 11-26 years old or before first sexual contact. However, in the event that certain cases may require additional protection, the vaccine is known to be safe for boys and girls above 9 years of age.
5. No Way, My Daughter/Son Is Not Having Sex Yet. The Vaccine Can Wait!
Social Conservative people are much commonly seen, especially in Indonesia, where it is still rich in its Eastern Traditions to think that their daughters and sons are well-behaved and are not misconducting in any manner – Daddy’s little angel, or so to speak. However, this turning-a-blind-eye attitude is as ignorant as it gets, with more and more news about sexual activities – either voluntary or forced – between boys and girls of school-age. Sex is still considered such a taboo topic in our Eastern Culture to be mentioned, much less taught to our children, and getting them vaccinated for HPV may be thought to lead their children into knowing about sex and leading to curiosity in practicing sex and/or promiscuity.
This is not the time, nor the age to feign ignorance regarding the social exposure our children are experiencing. With nearly every kid nowadays owning smartphones, and other nifty gadgets – and parents unaware of activating parental protection that their smartphones actually offer – , it is in fact much easier for them to acquire such information. What with now, a lot of under-18 boys and girls having accounts to the popular social dating app (eg: T*nd*r; which only until recently rising concerns, have changed their age limitations from previously 13 years old to be above 18 years; not like they can’t lie about it), promoting more match-to-mattress behaviors.
6. So How Can I Be Protected Against Human Papillomavirus?
For non-sexually active youngsters, not only vaccination, but also proper sexual education is the way to go. There are currently two kinds of vaccine worldwide, including the bivalent (2-types of HPV-like protein) vaccine giving protection against only high-risk (type 16, 18) cancer-causing HPV type, and quadrivalent (4-types of HPV-like protein) vaccine protecting against both the low-risk (type 6, 11) and high-risk HPV type. The CDC (Centre for Disease Control, United States) recommends the quadrivalent vaccine for both boys and girls above 11 years old – safe above 9 years old (if really necessary).
Comparatively, sexually-active young female with no history of abnormal Pap Smear result is recommended to take the test every three years. Important to realize, because the HPV vaccine does not cover all types of the virus (type 16 and 18 HPV are accountable to only 80-90% cancer cases). Other preventive measures includes using condoms during intercourse, and to avoid multiple partner sexual habits in general – the more partners you have, the higher your risks are.
Additionally, sexually-active young male should learn that vaccination, condoms, and avoiding multiple partner habits is the way to go.
7. How Many Times In Life Do I Need To Vaccinate?
Another key point to ensure optimal protection, is that the vaccine should be given in a 3-dose series, scheduled in the months 0 (first shot), 2 (2 months after the first shot), and 6 (4 months after the first shot). If however, you do miss a shot, you should pick up where you left off, instead of repeating the vaccine from dose-1.
VaxCorp Indonesia, June 2016.
- Vet JNI, deBoer MA, Van den Akker BEWM, Siregar B, Lisnawati, et al. Prevalence of Human Papillomavirus in Indonesia: a population-based study in three regions. BrJ Cancer; 2008, Jul 8, 99(1): 214-218.
- Jaspers L, Budiningsih S, Wolterbeek R, Peters AAW. Parental Acceptance of Human Papillomavirus Vaccine in Indonesia; A Cross-Sectional Study. Vaccine 29(44); 7785-93, August 2011.
- Cervical Cancer. http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf
- Andriani R. Penderita Kanker Serviks di Indonesia Tertinggi di Dunia. Antara. Suara.com. April, 2015.
- Haddad RI. Human Papillomavirus Infection and Oropharyngeal Cancer. http://oralcancerfoundation.org/hpv/pdf/hpv_Infection.pdf. 2008.
- Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B. Human Papilloma and Related Diseases Report. htpp://www.hpvcentre.net. February, 2016.
- Fact Sheet 2016. Indonesia: Human Papillomavirus and Related Cancers. ICO Information Centre on HPV and Cancer. http://www.hpvcentre.net/statistics/reports/IDN_FS.pdf. February, 2016.
- Fact Sheet 2016. Human Papillomavirus and Cervical Cancer. World Health Organization. http://www.who.int/mediacentre/factsheets/fs380/en/. June, 2016.
- Bruni L, Diaz M, Castellsague M, Ferrer E, Bosch FX, et al. Cervical Human Papillomavirus Prevalence in 5 Continents: Meta-Analysis of 1 Million Women With Normal Cytological Findings. J Infect Dis. Oxford Journals. (2010) 202 (12):1789-1799.
- Jegtvig S. HPV Test Awareness, Knowledge Still Low. http://www.reuters.com/article/us-hpv-test-awareness-idUSBREA0N1J420140124. Reuters. January, 2014.
- Dodd RH, McCaffery KJ, Marlow LAV, Ostini Remo, Zimet GD, et al. Knowledge of Human Papillomavirus (HPV) Testing in the USA, the UK, and Australia: an International Survey. Sex Transm Infect doi:10.1136/sextrans-2013-051402.
- Bogart N. T*nder Bans Users Under 18 After Concerns About Underage Teens Using The App. http://globalnews.ca/news/2754141/tinder-bans-users-under-18-after-concerns-about-underage-teens-using-the-app/. June, 2016.
- Indonesia Demographic and Health Survey 2012. Ministry of Health Indonesia. August, 2013.
- Rettner R. HPV Vaccine: What If You Miss A Dose? http://www.livescience.com/36951-hpv-vaccine-series-miss-dose.html. April, 2013