A few weeks ago in Uttar Pradesh, I was delighted to see mobile vans bringing cancer screening services within the reach of rural communities. Simple pap smears were being performed to test for the early signs of cervical cancer, a disease which affects around 1.3 lakh women in India every year. Yet, despite these numbers, discussion about this disease is often in hushed tones.
A woman loses her life to cervical cancer every eight minutes, with a a fourth of the total number of cervical cancer deaths worldwide being from India — more than any other country. These figures are appalling, especially as cervical cancer is one of the few cancers that can be prevented.
Awareness in India is so negligible that many women are not only unaware but also ignorant of the preventive options available. If pre-cancer is detected early it can be treated, and full-blown cervical cancer avoided. Barely 5% of women in India have been screened for cervical cancer. Further, the human papillomavirus (HPV) vaccine, which can prevent cervical cancer to a large extent, is currently not included in the national immunisation programme Thus, very few girls have been offered the benefit of its protection.
An unwillingness to speak about cervical cancer is perhaps influenced by our cultural predisposition to stigmatise discussions on the sexual and reproductive health of women, in turn perpetuating a culture of silence around the disease.
Cervical cancer affects the cervix, an important part of the female reproductive system, located at the lower end of the uterus. While there are over 100 types of HPV, two high-risk types (16 and 18) are responsible for over 80% of cervical cancers in India. Persistent infection with high-risk HPV can lead to pre-cancerous lesions of the cervix, which can eventually develop into cervical cancer.
However, as cervical cancer has a long pre-cancerous phase, successful treatment is possible if it is detected early. There are several methods of determining cervical pre-cancer such as HPV testing, pap smears, colposcopy (visually examining the cervix with a magnifying glass) and visually inspecting the cervix with acetic acid or iodine. HPV testing, which tests for the presence of HPV DNA, is the most accurate but not widely available in India. The Ministry of Health and Family Welfare recommends regular screening for women over 30, at least once every five years.
Vaccinating adolescents
HPV vaccination of adolescent girls is another effective and essential way to prevent cervical cancer. An expert group constituted by the Indian Council of Medical Research last year, recommended HPV vaccination for girls between 9 to 13, in line with the World Health Organization’s recommendation. However, recent discussion around the vaccine has largely ignored the abundance of global evidence affirming its efficacy and safety.
To date, 270 million doses of the vaccine have been distributed worldwide; more than 70 countries have added it to their national immunisation programmes. They include the United States, Australia and Canada, as well as India’s neighbours such as Bhutan, Bangladesh and Malaysia. In India, there is an urgent need to change the narrative around this disease.
India has made immense progress in saving the lives of women and children in recent years. Maternal mortality is lower than it has ever been while immunisation interventions are saving lakhs of children from vaccine-preventable diseases. But access to interventions to address cervical cancer, a disease which affects the same women and children remains scarce.
From policymakers and health professionals to women and girls who are at risk for cervical cancer, it is imperative that everyone recognises the opportunity that the latest health interventions provide us, and that we act on this opportunity. It is only when the risks and prevention prospects are accepted and understood widely that we stand a chance of beating the disease.
Dr. Navin Dang is a specialist in microbiology and Founder and Director of Dr. Dang’s Lab, New Delhi. He is a member of the Medical Council of India and a former member of the Delhi Medical Council
