Cervical cancer is the second leading cause of cancer death among women in the Philippines. The Department of Health (DoH) estimates that almost 7,300 new cases of cervical cancer and 3,800 deaths due to the disease occur in the country every year. This May, the country is putting focus on the disease with the observance of the Cervical Cancer Awareness Month.
The main cause of cervical cancer is persistent infection with high-risk types of human papillomavirus (HPV) that are transmitted through sexual contact or intimate skin-to-skin contact. Regular cervical cancer screening is important because infection with high-risk HPV does not usually cause symptoms. The UK National Cancer Institute said that if an HPV infection develops into cancer, it may cause symptoms such as bleeding, pain or swollen glands.
According to the US Centers for Disease Control and Prevention (CDC), HPV is estimated to cause nearly 36,500 cases of cancer in men and women every year in the United States. HPV vaccination can prevent 33,700 of these cancers by preventing the infections that cause them. The number of HPV infections and cervical precancers (abnormal cells on the cervix that can lead to cancer) have dropped since HPV vaccines were first used in the US. Among teen girls, infections with HPV types that cause most HPV cancers and genital warts have dropped 88%. Among young adult women, infections with HPV types that cause most HPV cancers and genital warts have also dropped by 81%. Among vaccinated women, the percentage of cervical precancers caused by the HPV types most often linked to cervical cancer has dropped by 40%.
The Pediatric Infectious Disease Society of the Philippines (PIDSP) and Philippine Foundation for Vaccination (PFV) recommend a two-dose HPV vaccine series for females ages nine to 14 years, and a three-dose series for females ages 15 years and older. They recommend HPV vaccine for males nine to 18 years of age for the prevention of anal and genital warts and anal cancer.
The Philippine Society for Microbiology and Infectious Diseases (PSMID) recommends HPV vaccination for females until the age of 26 years for the prevention of cervical cancer and anogenital warts. They also recommend HPV vaccine for males 16 to 26 years of age for the prevention of genital warts and anal cancer.
In 2015, the DoH partially introduced the national HPV immunization program, initially as a community-based immunization program and later shifting to a school-based immunization program targeting young girls aged nine to 14 years to ensure high coverage and minimal dropout rate. Although the program provided free HPV vaccination, the Philippines still ranked last among low- to middle-income countries in terms of HPV vaccination coverage, according to a study by Lintao et. al. published last year in the journal Frontiers in Medicine.
As of 2020, 23% of the female target population received the first dose of the HPV vaccine, virtually unchanged from 2019. Meanwhile 5% received the last dose, up from 3% during the same year.
With the suspension of in-person classes due to the COVID-19 pandemic, strategies such as putting up vaccination stations at permanent health facilities or temporary posts at multi-purpose town halls and door-to-door approach were employed to provide continuous immunization. With the significant improvement in the country’s COVID-19 situation, in-person classes have resumed and the program is expected to revert to school-based immunization.
Meanwhile, low utilization of available cervical cancer screening tests such as Pap smear and visual inspection with acetic acid (VIA) hampered HPV infection and cervical cancer control and prevention in the country. Among those diagnosed with cervical cancer in the Philippines, only an estimated 50% to 60% receive some form of treatment, the study noted.
The authors acknowledged government efforts to provide financial risk protection to Filipino patients. The PhilHealth Z Benefit Packages for Cancer covers a substantial portion of the cost of cancer treatment. The Cancer, Supportive Care and Palliative Care Medicines Access Program (CSPMAP) provides free medicines for gynecologic cancers including cervical cancer not covered by PhilHealth. This program is funded by the Cancer Assistance Fund, established under the National Integrated Cancer Control Act (NICCA). Indigent and financially incapacitated patients can avail of medical and financial assistance in accordance with the Malasakit Centers Act.
Making cervical cancer one of the public health priorities — starting with its prevention — can help save lives and stave off the suffering of women and girls in the family and the community.
Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.
