Dr Anthony Pais, Senior Consultant – Oncoplastic Breast Surgery, Co-founder and Clinical Director, Cytecare Cancer Hospitals sheds light on the immediate need for programmes to educate the significance of the HPV vaccination and screening test
Globally, one woman dies from cervical cancer every two minutes. Although easily preventable, today it is the second-most common cancer that affects women in India, and fourth-most common cancer among women worldwide.
The Indian Journal of Medical and Paediatric Oncology found that cervical cancer contributes to approximately 6-29 per cent of all cancers in women. Every year, there are 1,22,844 new cervical cancer cases in India and 74,000 women die of cervical cancer in the country.
For a disease that is preventable and curable, if detected early, a lack of awareness among the public and healthcare professionals is a cause for concern. The alarming statistics makes cervical cancer an important public health challenge in India. The need of the hour is to initiate conversations to create awareness about the disease, particularly among healthcare professionals, public health experts and policymakers.
Back to basics
One of the reasons why cervical cancer is not openly acknowledged and discussed could be its origins and how it is caused. Almost all cases of cervical cancer are caused by repeated infections with certain types of the human papillomavirus (HPV), a sexually transmitted infection.
Cervical cancer is characterised by the growth of abnormal cells in the lining of the cervix. In the initial stages, there are rarely any symptoms. Also, most women who get HPV may not get cervical cancer, as they are caused by only certain types of the virus. Smoking, weakened immune system, multiple childbirths, multiple sexual partners and lack of proper genital hygiene are other risk factors for the disease.
In November 2020, the World Health Organisation (WHO) launched its Global Strategy to Accelerate the Elimination of Cervical Cancer. The campaign has emphasised three major steps to tackle this public health problem – vaccination, screening and treatment. If these steps are successfully implemented, WHO estimates, the world could reduce 40 per cent of new cervical cancer cases and five million deaths by 2050.
In one of the largest studies of its kind in Sweden among 1.5 million women between 2006 and 2017, it was found that HPV vaccination in girls before the age of 17 showed a 90 per cent reduction in the incidence of cervical cancer. Australia is another country that introduced the HPV vaccine as part of its national immunisation programme in 2007. It is projected that by 2028, less than four women in every 100,000 and by 2066, less than one woman in every 100,000 would be diagnosed with cervical cancer in the country.
Given that the early stages of the disease are asymptomatic, HPV screening test or Pap smear test to detect early stage of cervical cell abnormalities can play an important role. These tests can identify lesions, which can be treated to prevent them from becoming cancerous.
Australia’s example once again shows that early detection can reduce the incidence as well as mortality rates associated with cervical cancer. The country introduced the national cervical screening program in 1991, which offered a free Pap smear test to women between the ages of 18 and 70 every two years. Since then the incidence and mortality rates in the country have halved.
WHO guidelines state that women between the ages of 30 and 65 years should be screened for cervical cancer every five years. In India, though, only around 29 per cent of women in that age bracket have been screened through government programmes.
Incidentally, studies show that at least 20 per cent of men have HPV DNA detected in their genital areas, with cases increasing in recent time. Hence, HPV vaccination programmes need to increase their reach to include young boys as well. Concerted efforts and a national programme that looks at early screening for cervical cancer is crucial.
The road ahead
One of the primary reasons why this easily preventable malignant disease has not been tackled effectively is due to the general lack of awareness – even within the medical community. It’s time we address the issue.
A study of 318 healthcare professionals working in tertiary hospitals in Chennai, published in February 2021, found that while around 90 per cent of the participants were aware of cervical cancer, a majority of them lacked knowledge about the role of vaccination in preventing the disease.
What India needs today is a push for vaccination – that is cost-effective in the long run as well as will help in meeting the WHO target of elimination of the disease. Given the incidence of cervical cancer in the younger demographic, it is important for healthcare professionals to talk to parents/caregivers of children about the benefits of HPV vaccination.
In many parts of the world, the COVID-19 pandemic has impacted HPV vaccination programmes as well as early screening tests. For countries like India, it is crucial to win this battle against cervical cancer. Three simple steps can help the country achieve this feat – creating awareness, early screening tests and HPV vaccination.