Cervical Cancer in India – Burden and the Way Forward

Written By Dr. Sadiya Khan, Resident Medical Officer, Bangalore.

Every year, approximately 1,23,907 women are diagnosed with cervical cancer and about 64 percent of these women die from the disease. It is the second most common cancer among women in India and 25 percent of all global deaths due to cervical cancer occur in India.

The reason for these astounding figures is the lack of effective screening methods and access to timely treatment. Screening for cervical cancer involves Pap smears and HPV tests which require trained personnel and equipment which is scarce in most parts of rural India. However inexpensive tests like visual inspection of cervix with acetic acid and lugol’s iodine is an effective screening method and peripheral health workers can be trained to identify abnormalities and refer women to higher centres. Emerging literature also suggests HPV self sampling kits as an effective strategy to increase delivery and acceptance but its success would depend on health education measures and accessibility.

The WHO has set an ambitious goal to eliminate cervical cancer by setting targets for countries to achieve by 2030. All countries must reach and maintain an incidence of less than 4 new cases per 100000 women per year and meet the 90-70-90 targets –

• Vaccination- 90% of girls to be fully vaccinated with the HPV vaccine by 15 years of age.
• Screening- 70% of women screened by the age of 35 years and again by the age of 45 years
• Treatment- 90% of women with precancer treated and 90% of women with invasive cancer managed.

The introduction of Cervavac, India’s first HPV vaccine that targets HPV 16,18,6 and 11 is a significant milestone in its fight against cervical cancer. The government plans to roll out an immunisation campaign for girls between 9 to 14 years of age in three phases over the next 3 years. It is administered as a 2 dose schedule for people aged 9 to 14 years and a 3 dose series for people at ages 15 through 45.

However, a recent study by the International Agency for Research on Cancer shows that even a single dose of the HPV vaccine offers adequate protection and the WHO recently supported a single dose schedule which would be less expensive and less resource intensive making it easier for us to reach the 2030 targets.

References –

[1] IARC marks Cervical Cancer Awareness Month 2024. Who.int n.d. https://www.iarc.who.int/featured-news/iarc-marks-cervical-cancer-awareness-month- 2024/ (accessed January 25, 2024).

[2] Dutt A. India gears up for HPV vaccine drive against cervical cancer: Who can receive this vaccine? Here’s all you need to know. The Indian Express 2024.

[3] Khedkar S. Easing the cervical cancer disease burden in India. Council on Foreign Relations n.d. https://www.thinkglobalhealth.org/article/easing-cervical-cancer-disease- burden-india (accessed January 25, 2024). Image credits- https://www.emro.who.int/images/stories/ncds/cervical_cancer/ccam_global_12.jpg?ua=1