Dr Vishal Sehgal, President, Portea Medical emphasises that while an affordable and accessible vaccine can address the burden of cervical cancer in India provided the other barriers are also addressed alongside. This can be done through mass awareness campaigns to remove vaccine-related myths and strengthening screening programmes
There is a rise in the incidence of gynaecological cancers in India and among these, cervical cancer continues to remain the second most common cancer in women. It accounted for 9.4 per cent of all cancers and 18.3 per cent (123,907) of new cases in 2020 in India. Worldwide, cervical cancer is the fourth most common cancer in women with an estimated 604,000 new cases in 2020. About 90 per cent of the estimated 342,000 deaths from cervical cancer occurred in low- and middle-income countries in 2020.
About 95 per cent of the cervical cancer cases occur due to the human papillomavirus (HPV), a common sexually transmitted infection (STI). Some major factors responsible for the rising number of cases include low literacy and awareness, poor screening, social inequality, stigma, and poverty.
Cervical cancer is detected through a pap test which helps determine any kind of changes in the cells of the cervix. Once this is done, it is possible to start treatment early and prevent the cancer from developing further.
Treatment and prevention in India: how far have we come?
There are two proven strategies to reduce cervical cancer: HPV vaccination and screening. Vaccination helps in offering protection against the disease and screening enables in the timely diagnosis for better prognosis. The WHO introduced a global strategy to accelerate the elimination of cervical cancer. It proposed the vaccination of 90 per cent of girls with the HPV vaccine by the age of 15, 70 per cent of women to be screened twice in their lifetime, and 90 per cent of women diagnosed with cervical cancer to get appropriate treatment. The situation in India is starkly different with only opportunistic screening advised in the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS).
Given the resource constraints, HPV testing mandatory screening and vaccination are far from feasible. Despite being introduced in 2008, the HPV vaccine is still not included in the National Immunization Programme. Recently, a vaccine that costs at least 10 times lesser than the previous ones was introduced. It is hoped that apart from addressing the challenge of affordability, it will also increase the number of women who get vaccinated. But this is just one part of the problem. There are several other barriers before we reach the vaccination stage. The awareness levels among the Indian community about cervical cancer are very low. Add to this the stigma surrounding the condition which acts as a barrier to vaccination. This is because cervical cancer is related to sexual activity which further reduces the willingness to speak about it or act.
The role of home healthcare
Vaccination and screening have been identified as two important ways to prevent the incidence of cervical cancer. However, according to various studies, there is a wide variation in facility readiness across India for cervical cancer screening. This is further exacerbated by the deficits in infrastructure and staffing at the primary and secondary care levels, which is a major barrier to the process of screening and vaccination. Studies also suggest that health policies and quality of the healthcare system influence cervical cancer screening behaviours. This is where public-private partnerships become important. By strengthening primary care in the form of home-based screening and vaccination at home, it is possible to reach out to more women across all the age groups. There are several leading out-of-hospital care providers in India today who can take a lead in this regard.
The way forward
While an affordable and accessible vaccine can address the burden of cervical cancer in India provided the other barriers are also addressed alongside. This can be done through mass awareness campaigns to remove vaccine-related myths and strengthening screening programmes. The role of home healthcare becomes essential in this regard. This is the only way forward in terms of a long-term, sustainable solution to the increasing cervical cancer burden of India.