A silent killer – cervical cancer is one of the leading causes of morbidity and mortality among women in Montenegro when it comes to malignant diseases. According to data from the World Health Organization for 2020, Montenegro has the highest age-standardized incidence rate (26.2 per 100,000 women) and mortality (10.5 per 100,000 women) from cervical cancer in Europe. This malignant disease ranks fourth among women in Montenegro in terms of the number of new cases and deaths. Globally, cervical cancer is the fourth most common cancer in women worldwide, and the fifth most common in Europe. Of particular concern is the fact that it is a highly preventable disease, if effective prevention programs are implemented, such as vaccination against the HPV virus. Despite the availability of a “cure” for this problem, the situation in Montenegro is still worrying because an insufficient number of the population is vaccinated, despite the availability of the vaccine.
What is an HPV virus?
HPV stands for human papillomavirus. This is a group of viruses that infect the skin or various mucous membranes (such as in the mouth or cervix). Most infections are not dangerous, but certain types of HPV can cause genital warts and several types of cancer, the most important of which is cervical cancer. During their lifetime, more than 80% of people will be infected with one or more types of this virus. In a part of the infected, HPV infections become long-term and can cause genital warts, as well as cancer in six locations.
Despite the availability of the HPV vaccine, which provides high protection against cervical cancer, the response of young people to vaccination in Montenegro is still worryingly low. According to the data, so far only 6,505 children between the ages of nine and 15 have received the vaccine, while as many as 49,935 children in that age group remain unvaccinated. These numbers represent a serious problem because vaccination coverage is far behind the recommendations of the World Health Organization, according to which at least 90% of the target population should be vaccinated in order to eliminate cervical cancer as a public health problem.
The data recorded in Australia, which stands out as a global leader in the fight against cervical cancer thanks to a successful vaccination program, speaks of how important it is to be vaccinated. Back in 2007, a national HPV vaccination program was started there, which includes free vaccines for girls and boys of school age. The result is that vaccination coverage among young people has reached an impressive 80%, while the rate of developing cervical cancer has been significantly reduced. It is expected that by 2035, Australia will be the first country in the world to completely eliminate cervical cancer as a public health problem, because mass immunization during 10 years (2005-2015) reduced the occurrence of HPV to 1.1 percent, which puts it in first place in terms of success in the fight against cervical cancer.
How to Boost the Immunization?
This example indicates the enormous potential of vaccination, but also the necessity of providing conditions in which greater information would be provided, social stigmas would be removed, because although the vaccine is available and free in Montenegro, the response rate is only 11.5%.
One of the reasons of why this vaccine is not so commonly used among people is that they became much more sensitive to topics like this since COVID 19 happened. During the pandemic, health systems around the world were forced to focus on the fight against that virus, which largely overshadowed all other health initiatives. All resources, attention and energy were directed towards the new, then unknown threat, leaving vaccines that prevent diseases like cervical cancer in the background.
Also, this number is affected by the stigmas mentioned by parents, because many often associate this vaccine with the idea that it is intended only for “sexually active” people, and for this reason they believe that their children are not exposed to risk. This perception leads to resistance to vaccination, as parents do not want to lay the groundwork for discussing sexual health at an early age, even though the vaccine provides protection before any sexual activity occurs. Social prejudice and lack of information only make the situation worse, because the vaccine is not seen as preventing cervical cancer, but as something associated with “something inappropriate”. Although it is proven to be safe and effective, the stigma attached to it remains an obstacle that slows down its widespread use, thereby missing the opportunity to save lives and reduce the number of patients.
Which Vaccine is Available in Montenegro?
The vaccine that is available and free in Montenegro is nine-valent – Gardasil 9®, the use of which was approved in 2014. The term “valent” refers to the number of virus types that the vaccine targets. In this case, “nine-valent” means that the vaccine provides immunity against nine specific strains of HPV: 6, 11, 16, 18, 31, 33, 45, 52, and 58. Types 6 and 11 are responsible for about 90% of genital warts. Types 16 and 18 are high-risk strains that cause approximately 70% of cervical cancers, as well as other types of cancer, such as cancer of the anus, vulva, vagina and throat. An additional five high-risk types 31, 33, 45, 52, and 58 also contribute to cervical and other cancers, making the nine-valent vaccine a more effective option for preventing HPV-related disease. This is also the most expensive vaccine covered by the national health system.
In two years, since the beginning of vaccination against human papillomavirus (HPV), the causative agent of cervical cancer, 9,367 of 162,986 (the total number for all groups that can receive the vaccine) have been vaccinated.
Montenegro is now facing a serious challenge when it comes to the fight against HPV and cervical cancer, a disease that can be effectively prevented by timely vaccination and regular screening examinations. If the vaccination were carried out according to plan, although it sounds far away, in 15 years we, like other countries, would see a shift in the number of people infected with the virus and deaths caused by cervical cancer, so every vaccinated young person is one step closer to a society that defeats cervical cancer and ensures the long-term health of women in that country.