Covid-19 has shown us the most shocking face of a global health crisis: an acute infection, with easy respiratory transmission, which collapses emergencies and generates a large volume of hospital admissions, ICU care and deaths in populations fragile.
Regardless of where the phenomenon originated, the first waves registered mainly affected Europe and other developed countries, with which the economic and media repercussions were spectacular. For months, all the media have been opening their editions with news about the pandemic. At the same time, experts have come out in all corners, and we have lived through moments of considerable confusion about the decisions to be taken, individually and collectively.
We have all been and are attentive to covid-19, that is indisputable. However, there are other ongoing pandemics whose social and health perception is very different, such as that of the human papillomavirus (HPV). And this despite the fact that globally we estimate the number of cancer cases caused by HPV infections at about 600,000 per year and the number of deaths at about 300,000 per year.
One in ten women at cancer risk from HPV
Let us choose a representative sample of the female population between 30 and 60 years old in good health in a developed European country. If we take routine cervical samples from gynecological controls and use current technology to look for the presence of HPV infections (similar to the well-known nasal PCR for COVID 19), we will find that between 8% and 10% of women in this The sample will have a normal cervical cytology, but analytically they will be carriers of an HPV infection, in general of a viral type of high oncological risk.
This prevalence is highest among young women and decreases progressively with age. The prevalences in the male population are generally higher and do not decrease significantly with age.
People who become infected with HPV and clear the infection spontaneously will never know they have passed it. However, in a small proportion of cases, infections do not resolve and can lead to a serious, life-threatening illness if not treated well and on time. The interval between infection and disease usually lasts for years, during which there are also no clinical signs that motivate medical consultations.
A virus that causes cancer
As mentioned above, globally we estimate the number of cancer cases caused by HPV infections at about 600,000 per year and the number of deaths at about 300,000 per year. Without a doubt, the most important cancer caused by HPV is that of the cervix (also called the cervix). But HPV is also attributed important fractions of tumors of the vulva (50%) and vagina (80%), of the penis and scrotum (40%), of the anal canal (80%) and of the tonsil and oropharynx (40%) in both sexes.
It is, therefore, a significant problem of public health and social inequity. Because, indeed, the majority of cases and associated deaths occur in low-development countries in Africa, Latin America and Asia.
An inadvertent infection
How is it possible that this infection has spread worldwide in these proportions, going unnoticed except for the victims and for health care? There are several reasons:
Because there is no acute disease phase.
Except for genital warts, which are the florid clinical expression of a low-risk HPV infection (HPV 6 and 11), cancer-risk infections (represented by HPV 16, 18, 45, 31, 33, 52 and 58 and others less frequent) are acquired and are resolved or remain persistent for years, without presenting any clinical manifestation. In these circumstances there is no medical consultation, there is no follow-up, there is no treatment, and transmission between couples multiplies silently.
If the screening system is very poor or non-existent (as is the case in most developing countries), preneoplastic lesions will progress to invasive cancers and the diagnosis will be made in more advanced stages, with more aggressive treatments and with a lower probability of survival. .
Because there are prevention alternatives in populations with access to screening.
Developed countries have incorporated cervical cancer preventive check-ups based on frequent and repeated visits in which exfoliated cells from the cervix and vaginal fundus are examined into their care routines. This strategy, started in the 1950s with cytology, managed to reduce the incidence and mortality from neck cancer in countries where long-term systematic programs were organized, including most of the population. This type of screening has improved its effectiveness with the new viral detection technologies that are more widely used in developed countries.
For years, the health consideration in rich countries was that this was a “resolved” tumor for which we already had early diagnostic methods and that the cases that escaped detection were few and acceptable. The reality is that in Spain there are an estimated 2,000 new cases and about 800 deaths each year from cervical cancer.
The other side of the coin is that most countries have only partial programs, based on urban populations and offered at high socioeconomic levels, with limited or anecdotal preventive impact on entire continents: Africa, Latin America and Asia.
Because the most violent pathology primarily affects poor women from poor countries.
The dramatic example of covid-19 in late 2021 once again reflects the socioeconomic gap in access to vaccines. The WHO repeatedly claims that equal access to vaccination is a priority on international agendas, which maintain discussions on third doses and booster doses in Europe while the poorest countries have not yet had access to the first doses in significant percentages of its most fragile population.
The complex interactions between politics, economics and health have their crudest expression here.
Francesc Xavier Bosch José, Associate Professor of Health Sciences Studies, UOC – Open University of Catalonia and Assumpta Company Serrat, Researcher in Health Sciences, UOC – Open University of Catalonia
This article was originally published on The Conversation. Read the original.