While in recent years, India has made tremendous economic progress, there is one area where it still lags woefully behind. I refer here to the incidence of cancer of the uterine-cervix or cervical cancer. In fact, we have the dubious distinction of outstripping any other country when it comes to the number of cases of this type of cancer (132,000 new cases are reported every year and around 74,000 women die annually of it).
Is this a glaring example of our failure to address a pressing health issue? Or is it because cervical cancer carries a stigma? Unfortunately, the portrayal of it as a type of cancer that is predominantly found among rural women and those less privileged, and the fact that it is sexually transmitted has not helped matters. Whatever the reason, we cannot escape our moral culpability for inaction especially when cervical cancer is preventable and when detected early curable and the fact that it places young people at a high risk of contracting it.
Thanks to the development of highly accurate tests in the last few years for cervical cancer screening, as well as their availability, it has all but been eliminated from the developed world. Unlike most other types of cancer, scientists have identified the cause of cervical cancer: a common virus known as the human papilloma virus (HPV).
Recently, they have also developed a new vaccine against the most prevalent HPV strains (Types 16 & 18) that increase the risk of cancer of the cervix. First licensed in 2006, these vaccines are now available in North America and Europe and provide protection against about 70 per cent of cervical cancers.
Despite the progress, however, most young women in India don’t have information about or access to these vaccines. It is true they are expensive, but we must ensure that the vaccine reaches those at highest risk, especially as studies suggest that one-half to three-fourths of those who have ever had sex are likely to be infected by the HPV virus during their lifetime. A study done by All India Institute of Medical Science indicates that the distribution of high risk HPV (type 16 and 18) for invasive cancer of the cervix is at 79 per cent.
It is, however, also important to note that while vaccines can save young lives, they will do little to protect women who are already sexually active, because there is a high probability that they are already infected with HPV. For them, cervical cancer screening is a must.
While the good news is that these tests are available in India, the bad news is that most women in India do not have access to quality screening, especially the most vulnerable who live in slums and villages. For the past 60 years, the main test for the disease has been the Pap smear, in which a swab is taken and the cervical cells are visually examined under a microscope for abnormalities. Although this test has saved many lives, it requires trained personnel both to conduct it properly and then to accurately interpret the results. These people are at a premium. Consequently, doctors see women in the prime of their life with advanced, incurable cervical cancer.
Scientists are working on developing a screening test with higher accuracy than the Pap smear for use in remote areas of developing countries, including India. At present, there is another method of screening for cervical cancer that is being used in developing countries. This is known as ‘visual inspection with acetic acid’ test or ‘VIA’. In VIA, vinegar is sprayed on a woman’s cervix and examined with the naked eye to see if any lesions appear. It has the advantage of not requiring trained personnel and can, therefore, be made more widely available at lesser cost than the Pap smear. However, the disadvantage is that it can only diagnose 41 per cent of the HPV cases.
To sum up, it is essential to make available to women in this country tools that can save their lives by preventing cervical cancer. It is time to launch a nation-wide awareness programme regarding the role of HPV in causing this type of cancer not only among the public but also among doctors and public health personnel. It is only after we educate ourselves that we shall be able to educate others.
Harmala Gupta is the founder of CanSupport, which runs a home-based palliative care programme in Delhi and the National Capital Region
The views expressed by the author are personal