Human Papilloma Virus / Cervical Cancer

Long-term persistence of high-risk human papillomavirus (HPV) is the key factor in the development of 5% of all human cancers, making it the most important known virus related to cancer. Specifically, high-risk HPV are the primary (and necessary) causal agents of cervical cancer. Although Nepal currently suffers from a heavy burden of cervical cancer, there is no official WHO estimate of the distribution of HPV in Nepal. In Nepal, where routine cervical screening is not widely available, cervical cancer is usually only detected when it is at an advanced stage which results in high mortality.

NFCC International, in collaboration with the University of Alabama at Birmingham, is one of the first organizations in Nepal to investigate the prevalence and social determinants of HPV infection and HPV risk behavior in Nepali women in different geographic regions. Previous studies estimate the prevalence of high-risk HPV types in other South Asian countries to be as high as 14% in the general adult population. However, data on high-risk HPV types is not yet available for the general population of Nepal and there is no national cancer registry. In an effort to learn more about the Nepali epidemic of HPV, NFCC Nepal and the University of Alabama at Birmingham are currently investigating the prevalence of HPV in different geographical regions and populations in Nepal. The information gained through this study will help clinicians to better understand the unique risk factors underlying HPV infection in Nepali women, which in turn, will help facilitate the understanding of how HPV is disseminated throughout Nepal’s 29 million citizens.

In Nepal, as in many developing countries, access to screening for cervical cancer and other HPV-related cancers is limited. NFCC is initiating a pilot program for an HPV self-screening test in several districts of Nepal, which will hopefully be utilized as a model for a national screening strategy. NFCC is also involved with training Nepali OB/GYN’s in visual inspectioin with acetic acid (VIA), colposcopy (a procedure for examining the cervix, vagina and vulva for signs of disease) and cryotherapy (a method for treating for cervical tissue damage) in order to improve cervical cancer prevention health services.

Human papilloma virus (HPV) is a group of more than 120 viruses that are extremely common worldwide. At least thirteen types of HPV are known as high-risk or cancer-causing. HPV is mostly transmitted through sexual contact. Two HPV types (16 and 18) cause 70% of cervical cancers and precancerous cervical lesions worldwide. One-third of the world's cervical cancer burden is in India, Bangladesh, Nepal and Sri Lanka. The World Health Organization (WHO) Information Center on HPV and Cervical Cancer states the incidence of cervical cancer in Nepal is 24.2 per 100,000, giving Nepal one of the highest rates of cervical cancer in the world. 9.65 million Nepali women are at risk of developing cervical cancer, with over 2000 people diagnosed annually and over 1000 deaths each year. However, this estimate is most likely an underestimation of the actual cases due to lack of national cancer registry as well as screening and follow-up.