HPV Vaccination: Who Needs It and What It Prevents

Please write in with any questions, over WhatsApp or text, at any time. Many patients cannot travel to India, so the goal is to help diagnose and treat them on time wherever they are. Prepare a doctor's note with the relevant clinical details and share it; if the picture is clear, specific pointers on managing the case can be given from that.

Self-examination should be done by the woman herself, using the opposite hand on the opposite breast with three fingers held flat, including the axilla and neck. Clinical breast examination should be done by anyone properly trained, which can include nurse practitioners, physician assistants, internal medicine doctors, general surgeons, gynaecologists and oncologists. Training, not job title, is what matters, since missing lesions is common when the examiner has not been trained. GPs and internal medicine doctors should learn the technique and offer it to every woman who comes to the clinic.

Once the diagnosis is confirmed by biopsy, a staging scan, often a PET scan, establishes the exact stage, including whether the bladder, rectum, parametrium or lymph nodes are involved. Fitness for treatment is then assessed with kidney function testing (GFR) and audiometry, since some chemotherapy agents can affect hearing. Weekly chemotherapy is then given alongside radiation, with the potential radiation side effects explained to the patient beforehand.

MRI of the pelvis is excellent for local pelvic structures, but the upper abdomen and chest still need to be assessed, which is better done on CT. The recommendation is CT of the thorax combined with CT of the abdomen and pelvis with contrast, or alternatively MRI of the abdomen and pelvis with contrast combined with a CT of the chest. The chest is generally better seen on CT, and the pelvis is generally better seen on MRI.

Treatment depends on the patient's oestrogen receptor, progesterone receptor and HER2 status, and on whether she is receiving neoadjuvant chemotherapy followed by surgery, or surgery followed by adjuvant chemotherapy. Filgrastim is supportive care only, a white blood cell growth factor given to prevent a drop in counts after chemotherapy; it is not the primary cancer treatment. Its use depends on which chemotherapy protocol is being followed, but the treatment plan for the cancer itself is a separate, biology-driven decision.

Children of both sexes from age 9 to 14 receive two doses given six months apart. From age 15 to 45, the schedule shifts to three doses given at 0, 2, and 6 months.

The nine-valent, or nonavalent, vaccine covers the widest range of HPV strains but costs the most. The quadrivalent vaccine is the most commonly used and effective formulation. The bivalent vaccine, the simplest option, still protects against HPV 16 and 18, the two most important cancer-causing strains.

No. Vaccination reduces the risk from the strains it covers, but cervical cancer screening must continue on the same schedule as for any other patient.

An indigenously developed HPV vaccine in India has meaningfully lowered the cost of vaccination, making it more accessible without changing the recommended dosing schedule.