HPV-avertable cancer risks in India: A pooled analysis of 9 observational studies

Abstract

Dear Sir, We read with great interest the article by Michaud et al. 1 "Highrisk HPV types and head and neck cancer." Their research presents the associations between infections with high-risk HPV subtypes and head and neck cancer risk in the US. In addition to HPV16, HPV18/33, and HPV52 emerged as important risk factors for oropharyngeal and oral cancers, respectively.Oral cancer is the most common form of malignant cancers in the Indian subcontinent; it accounts for one-third of the global burden of oral cancer incidence and mortality. 2,3 Despite extensive improvements in diagnosis and therapy in recent decades, the prognosis of oral cancers remains poorly understood. 4 In the Indian sub-populations, oral cancer is primarily associated with commonly known risk factors such as tobacco chewing and bidi or cigarette smoking. However, additional risk factors may be at play, as suggested by the incidence of oral cancer in approximately 20% of the patients, who develop this malignancy without a definite etiology of risk factors. 5 Similarly, cervical cancer in India constitutes a quarter of the global burden with 132,000 new cases and 74,000 deaths every year. 3 It is the leading malignancy in our region with age standardized rates of 14.3 and 7.7 per 100,000 individuals from urban and rural areas, respectively. 6 Mixed claims have been made regarding the association of HPV infection with the development of both cervical and oral cancers in different regions of India. 7,8 In addition, limited information is available on the distribution of HPV types in the country. This makes it important to further explore the association between HPV types, and cervical and oral cancers.Based on the existing literature from the Indian context, we conducted a meta-analysis on the association of HPV and high-risk HPV types on head and neck, and cervical cancer Figure 1. Meta-analysis of the association between HPV subtypes and cervical and head and neck cancers in India.

Human Papilloma Virus Vaccine in Indian Settings: Need of the Hour

“…Alternative strategies such as naked eye visual inspection of cervix (down staging), visual inspection with acetic acid (VIA), magnified VIA (VIAM), visual inspection with lugol's iodine (VIAL), cervicography and HPV DNA testing in detecting cervical cancer and its precursors have to be adopted [33]. Regular screening through VIA has along with further referral for treatment has been suggested in a pooled analysis [34]. As the age affected by cervical cancer is decreasing thus a study has suggested that screening should be initiated at 25 years of age [19].…”