Seek to achieve cervical cancer elimination through BIAS

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Prof. Dr. dr. Andrijono, Sp.OG(K)-Onk.
Prof. Dr. dr. Andrijono, Sp.OG(K)-Onk. Photo: ESTI/IO

IO – The WHO has set a target for elimination of cervical cancer, at fewer than 4 cases per 100,000 women worldwide by 2030. They are confident enough to do this because experts now know everything about cervical cancer – its causes, how to screen for it and catch it early, how to prevent it, and even the best therapy methods for it. Elimination efforts are three-pronged: vaccinate 90% of girls 15 years and older for HPV, screen 70% of women 35-45 years old for cervical cancer, and provide access to adequate treatment for 90% of patients. 

Sadly, Indonesia is still extremely far from reaching the target of cervical cancer elimination. The incidence of Human Papillomavirus (HPV) infection remains high, at 24.4 per 100,000 women a year. Globocan 2020 data reports that cancer caused by HPV 16, 18, and 52 viruses in Indonesia is second-highest in incidence after breast cancer, at 36,633 new cases (17.2%) occurring a year. This is the highest level in Southeast Asia. 

“We find 89 new cervical cancer cases a day, with a mortality rate of 57 deaths a day. At Cipto Mangunkusumo Hospital Jakarta, 94% of these patients die within two years. Early detection is extremely important, as 80% of patients only come in for a diagnosis during a late stage, while only 10-20% of the people infected by the virus suffer from the cancer within six months of HPV incubation. Therefore, we need to perform primary prevention of HPV vaccination,” said Prof. Dr. dr. Andrijono, Sp.OG(K)-Onk, Chairman of the Indonesian Oncologist-Gynecologist Association (Himpunan Onkologi-Ginekologi Indonesia – “HOGI”) Advisory Council in a webinar themed “Make Indonesia Cervical Cancer Free by 2030” held on Friday (04/02/2022). 

The efficacy of HPV in girls and women 16-23 years of age is 100%. No booster is necessary, because the vaccine will protect them for 16 years. “HPV vaccine is also effective against anal cancer and oropharyngeal cancer. In other words, one vaccine is strong enough to prevent the incidence of three cancers at once. Furthermore, we don’t need to use three doses of vaccine in the Schoolchildren Immunization Month (Bulan Imunisasi Anak Sekolah – “BIAS”) to immunize 11-12 years old girls: twice will do. This will save a third of the cost,” Prof. Andrijono said. 

Pilot HPV Vaccination for 5th and 6th Graders 

At the same event, Ministry of Health’s Head of Legal and PR Affairs of the Directorate General of the Prevention and Control of Disease Secretariat, dr. Iqbal Djakaria, declared that the Ministry scheduled its Introduction to 2022-2024 HPV Immunization Program on 22 December 2021. The Program will be executed in all regencies and municipalities in DKI Jakarta, Special Region of Yogyakarta, Central Java, East Java, Bali, Gorontalo, Southeast Sulawesi, North Sulawesi Utara, and Makassar City in 2022-2023, and will be expanded to include all other regencies and municipalities in Indonesia by 2024. 

BIAS is scheduled for fifth graders in ordinary Elementary Schools, Islamic Elementary Schools (Madrasah Ibtidaiyah – “MI”), or equivalent institutions for the first dose, with the second dose administered when these students enter Sixth Grade. “HPV immunization is also meant to cover children studying in non-formal schools and drop-outs, by providing care for them in Integrated Health Service Posts or Community Clinics. To reach them, we will also hold immunization drives in halfway houses for street children, children’s foundations, orphanages, social organizations, and non-formal schools,” dr. Iqbal said. 

There are multiple challenges surrounding HPV immunization, including a black campaign, rumors, and misperceptions concerning Post-Communication Effects, which result in schools and parents declining to take part in the program. “We need to immediately clarify these negative rumors, so that HPV BIAS can be performed smoothly and achieve a minimum of 95% coverage,” dr. Iqbal said. (est)