The dramatic drop in cervical cancer numbers in India was at the centre of the debate on whether or not India needs to have an HPV vaccine programme to prevent this cancer. Doctors of the premier cancer facility, Tata Memorial Centre, reasoned with oncologists and health experts from other parts of the world on why the HPV vaccine to prevent cervical cancer was not needed in India.
The discussions were part of the events of the second day of the ongoing oncology conclave to mark the platinum jubilee of Tata Memorial Centre.
Dr Freddie Bray, who heads the section of cancer surveillance at WHO, said India accounts for one-fourth of the cervical cancer deaths globally and has to do something to reduce the number. The introduction of the vaccine in other parts of the world such as France, Denmark and Australia have only shown positive results.
Dr Daniel Hayes, who will be taking over the American Society of Clinical Oncology president, said he was all for a vaccination programme, but he pointed out that in the United States it was an affordable vaccine. He acknowledged that screenings too have shown to be effective in bringing down cervical cancer numbers.
Oncologists from India, however, pointed at the dramatic drop in the number of cervical cancer cases without any medical intervention, but with simple measures of creating awareness of personal hygiene.
“The death rates and the incidence of cervical cancer in India have already reduced dramatically. The incidence in the United States is 7 per 100,000 and it is 8 per 100,000 in Mumbai. This reduction is uniform in Mumbai, Bangalore, Chennai, Kolkata and Delhi. We have four cancer registries in four rural pockets where the incidence has remained constant at 30 per 100,000 over the last 20 years. In cities it has gone down,” said Dr Rajendra Badwe, director, Tata Memorial Centre. He attributed the drop to better awareness of personal hygiene, availability of running water, and privacy of bathrooms for men. He said the incidence recorded in cancer registries, located barely 50 km from the registries in rural parts, in small towns that had the availability of running water, the privacy of a washroom for men, was 17 per 100,000. “Obviously, there is something that is happening and there is no screening, nothing anywhere,” he said.
The drop in numbers is further reflected in the registrations at Tata Memorial Hospital. Dr Badwe said the incidence of penile and cervical cancer is reducing at breakneck speed. “At Tata, the annual registrations for new cervical cancer cases were about 2,000 to 2,200 two decades ago; today it is 800,” Dr Badwe said.
Another reason contributing to the drop in cervical cancer numbers is possibly screening programmes being undertaken in rural India. The trend in rural India is changing. The National Family Health Survey in its latest data released in January recorded the number of women who have undergone examinations of the cervix and breast and the figures for urban and rural parts were much the same. In fact, in States such as Bihar, Haryana, Karnataka and Telangana, the number of women who underwent the examination in rural parts was higher than in urban parts.
A paper on trends in breast, ovarian and cervical cancer incidence in Mumbai published in British Journal of Cancer in 2011 had noted that the significant decline in cervical cancer, once the most common cancer of Mumbai women, is likely due to changes in marriage and family planning, supported by underlying improvements in education and socioeconomic status.