Non-communicable diseases including cancer are on the rise and some like cervical cancer adversely affects half the Indian population — its women. Every year, over 120,000 women are diagnosed with cervical cancer and more than 67,000 die from the disease. This leaves India in the unenviable position of accounting for one-fourth of the global burden.
The major cause of cervical cancer is infection with the human papillomavirus, making this one of the few preventable cancers. However, the already disadvantaged position women face in various settings often exposes them to greater risk. Factors such as marriage at early age, multiple pregnancies, multiple sexual partners, repeated infections and poor hygiene exacerbate the incidence of disease.
Recent data from the Indian Council of Medical Research’s national cancer registry programme shows that between 2012 and 2014, Arunachal Pradesh’s Papumpare district had the highest levels of cervical cancer. Although there has been a rapid decline in the cervical cancer in urban areas, the decline is much slower in rural areas.
Given India’s scale, the management of cancers requires a comprehensive approach. Simple measures like regular screening can help detect pre-cancerous lesions and even get treated during the same visit to the health facility.
The ministry of health and family welfare recently developed and disseminated guidelines for screening of common cancers. Although cervical cancer is almost entirely preventable, the majority of cases in India are diagnosed at advanced stages of the disease. For this, the government is simultaneously working to enhance tertiary care cancer facilities while ensuring treatment is provided through central government hospitals/institutions in different parts of the country.
Nonetheless, treatment for cancer is expensive and imposes a huge financial burden on families and the health system, affirming again that an ounce of prevention is worth a pound of cure.
Vaccines exist against HPV infections and the World Health Organization recommends them as part of the basket of comprehensive interventions for cervical cancer control worldwide. The vaccines can prevent 70% of all cervical cancer and are given to pre-pubertal girls in the age group of 9 to 13 years — in either two or three doses. These are included in the immunisation programmes of over 65 countries around the world.
While the cost of the vaccine had been a major challenge, a decline in costs and contributions from donors have enabled governments to procure at affordable prices. Several low- and middle-income countries now use the HPV vaccine nationally. There is enough evidence on HPV vaccine safety and efficacy globally. Lessons from countries like Malaysia demonstrate successful HPV programmes where a school-based approach covers more than 90% of eligible girls.
Given India’s robust immunisation programme, a swift introduction of HPV vaccines could give a further push to the natural reduction in cervical cancer rates.
Soumya Swaminathan is director-general, Indian Council of Medical Research
The views expressed are personal