How to reduce the burden of cervical cancer in India

In the context of India, 96,922 new cases of cervical cancer are diagnosed every year (2018). It is the second-most common cancer in women in the age group of 15-44 years. However, HPV can be prevented by timely vaccination and screening. Prevention is more effective when the person receives a series of doses before becoming sexually active. However, regardless of sexual activity and orientation, women aged 26 and under should get the HPV vaccination series.

Despite the availability of HPV vaccination and cervical cancer screening preventive tools, HPV infection and cervical cancer are widespread. In low- and middle-income countries, this is primarily due to a lack of awareness of the benefits of the vaccines and difficulty in access, since many countries do not have it included as a part of their national immunisation strategy.

According to the World Health Organization, the global strategy to eliminate cervical cancer has set targets to accelerate the elimination: Maintaining an incidence rate of less than four per 100,000 women a year will require a 90-70-90 strategy that needs to be met by 2030. This means that 90% of girls are fully vaccinated with the HPV vaccine by 15, 70% of women are screened with a high performance test by 35, and again by 45, and 90% of women identified with cervical cancer receive treatment (90% of women with pre-cancer treated; 90% of women with invasive cancer managed).

India is yet to adopt HPV vaccination in its national programme. Though some states have begun the work, it is a long road ahead before the 90-70-90 targets can be met. Meanwhile, around 60,000 women in India die every year due to cervical cancer.

A lack of awareness of the relationship between HPV and cancers in males is connected with lower readiness to vaccinate boys and to promote vaccination of boys within the family. Due to beliefs that early or premarital sexual behaviour and HPV transmission are related, some religious communities may have lower rates of adolescent girl vaccination and parental acceptance of the HPV vaccine. All males, regardless of sexual orientation, suffer a major burden of HPV-related diseases, which is growing in developed countries, but can be significantly decreased if boys are vaccinated.

Raising public awareness and minimising the stigma associated with HPV are critical components of the worldwide campaign to eradicate HPV and decrease the global burden of cancer. Elimination of cervical cancer can be done by empowering the public and communities and implementing cost-effective, evidence-based interventions, such as vaccinating girls against HPV, screening for and treating pre-cancerous lesions, and improving access to diagnosis and treatment of invasive cancers.

Improving vaccine uptake among adolescents of both sexes is a critical public health concern. Vaccinated males will benefit from the prevention of HPV-related infection as men are more likely than women to get oropharyngeal cancer, which can be caused by HPV. India has a public national cancer screening programme in place but lacks a quality assured structure to monitor and supervise the cervical cancer screening programmes.

A good screening programme at regular intervals, supported by a good vaccination programme, will bring down the burden of cervical cancer in India and save many lives in the bargain. HPV vaccination has been mired in a lot of myths and misconceptions and building trust through awareness will set the momentum in the right direction.

Ratna Devi is CEO, Dakshayani and Amaravati Health and Education. Ankit Dabra is manager project, Patient Academy for Innovation and Research

The views expressed are personal