Cervical cancer is one of the most common cancers seen in Indian women; the other is breast cancer. It is a type of cancer that occurs in the cells of the cervix—the lower part of the uterus that connects to the vagina—mostly due to the Human Papilloma Virus (HPV). According to a recent Lancet study on the disease, India accounts for the highest number of cervical cancer cases, followed by China. The research revealed that out of 40% of the total deaths from cervical cancer, 23% occurred in India, and 17% in China.
In 2020, there were around 6,04,127 new cases of cervical cancer and 3,41,831 deaths globally. Statistics show cervical cancer continues to affect women in India at an alarming rate. The disease ranks as the second most frequent cancer among women in India. According to research, about 8 out of 10 women in India will contract HPV (human papillomavirus), the most common sexually transmitted infection and the virus that can cause cervical cancer at some time in their lives.
Grim situation in rural India
Despite a whopping number of deaths from the disease in India, there is a lack of awareness of the availability of vaccines for cervical cancer, besides a lack of proper and structured screening programs. “The situation is more alarming in rural areas where most women are illiterate and ignorant about the hazards of cervical cancer. Apart from that, access to quality screening and diagnosis, and the cost remains a major issue. On top of that, several myths and misconceptions associated with the disease have contributed to the higher incidence,” says Dr. Sunita Kapoor, Director and Consultant Pathologist at CIty Xray & Scan Clinic Pvt. Ltd.
In rural India, the acceptance of cervical cancer screening has not been encouraging due to a lack of awareness and fear of undergoing a procedure. Also, there is hesitation, ignorance, and fear around HPV vaccines, besides lack of access and the cost factor.
HPV and the role of vaccination
In India, there is a lack of awareness and lack of acceptance that a simple HPV virus can cause devastating cancer. In the early 1980s, a link between HPV infection and cervical cancers was established and now it is proven that HPV infection is the cause of cervical cancer. “There are numerous types of the HPV virus. Among them, HPV types 16 and 18 are responsible for 70% of cervical cancer worldwide. They are hence designated as high-risk types of HPV virus and known to be carcinogenic, meaning virus-causing cancer,” adds Dr Kapoor.
According to doctors, you can reduce your risk of developing cervical cancer by receiving a vaccine that protects against HPV infection.
The good news is that the World Health Organization (WHO) had said recently that India is soon going to receive HPV vaccination to eliminate cervical cancer as a public health problem. Meanwhile, India’s first indigenous cervical cancer vaccine is likely to be priced at a more affordable Rs 200–400, making it a viable alternative for the masses in India.
Delays in screening a major problem: How timely diagnosis can save lives
Delays in cervical cancer screening are largely linked to increased mortality due to the disease among Indian women. The Federation of Obstetric and Gynecological Societies of India (FOGSI) recommends the use of co-testing with combined cytology and HPV testing every 5 years, as the best method for cervical cancer screening. “In addition to this, co-testing leads to an earlier diagnosis of CIN3 and cancer. Cervical intraepithelial neoplasia 3 (CIN3), associated with human papillomavirus (HPV) infection, is a premalignant state of cervical cancer,” explains Dr Kapoor.
Experts have also noted that incorporating HPV with cytology helps in finding more AIS (Adenocarcinoma in situ) than cytology alone and negative co-test allows spacing screening every five years. AIS of the cervix is a premalignant precursor to cervical adenocarcinoma.
The usual interval between clinically detectable AIS and early invasion appears to be at least five years, suggesting ample opportunity for screening and intervention. In fact, co-testing has been successfully implemented in developed countries like the United States and recent data show a continued decline in cervical cancer rates.
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“Regular screening is crucial to ward off or combat the second-most common cancer among women. While the lack of access to quality diagnosis remains a major concern in Indian villages, smaller towns, and cities, there has been a significant amount of lack of awareness in metros as well,” opines Dr Kapoor. Doctors recommend that sexually active women over 21 years of age must undergo a pap smear once in three years or more often, if possible. In rural areas, where access to this test may be limited, women can undergo a simple visual examination of the cervix.
Access to quality diagnosis, structured screening, and follow-up care is the key to combating cervical cancer, which is the fourth leading cause of cancer mortality in females globally. “Fortunately, today we have some state-of-the-art diagnosis facilities for cervical cancer which can minimize false-positive results and help clinicians target the right patients for advanced tests like colposcopy. This can minimize difficult patient conversations, minimize the potential for unnecessary colposcopies and biopsies, and minimize unnecessary cost(s) to the patient,” signs off Dr Kapoor.
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