11 March 2024 – The Hindu

How to prevent Cervical Cancer in the Future

• In India, cervical cancer remains a serious health danger, underscoring the importance of taking preventative action. To reduce the risk of cervical cancer, the Indian government plans to launch a three-phase HPV vaccination campaign for girls between the ages of 9 and 14.
• But in order to effectively fight this avoidable disease, it is essential to understand the risk factors, immunisation alternatives, screening procedures, and care of precancerous situations.

Cervical cancer: What is it?

• The cervix of a woman is where cervical cancer develops. In the world, it is the fourth most prevalent type of cancer among women.
• A high-risk Human Papillomavirus (HPV) infection is associated with nearly all occurrences of cervical cancer (99%). HPV is a very prevalent virus that is spread through sexual contact.

Different Strain Types:

• Approximately 85 percent of cervical cancer cases are caused by persistent infections with specific high-risk HPV strains.
• At least 14 varieties of HPV have been found to be oncogenic, or having the ability to cause cancer.
• Of these, HPV types 16 and 18, which are thought to be the most carcinogenic, have been linked to over 70% of cervical cancer occurrences worldwide.

Why it is so important for India to combat cervical cancer?

• High Mortality and Prevalence Rates: With 1.27 lakh cases reported annually and an estimated 80,000 deaths annually, cervical cancer is the second most frequent malignancy among women in India.
• Comorbidities and Risk Factors: One of the main causes of cervical cancer in India is human papillomavirus (HPV) infection, which is mainly spread through sexual contact.
• Efforts to eradicate cervical cancer are made more difficult by the high prevalence of comorbidities like HIV/AIDS and risk factors like early marriage, multiple sexual partners, and non-use of contraception.
• Disproportionate Impact on Underserved areas: Because of socioeconomic circumstances, lack of awareness, and restricted access to healthcare facilities, women in underserved and marginalised areas are disproportionately affected by cervical cancer.
• Economic Burden: Cervical cancer has a substantial financial impact on affected individuals and their families, as the expenses of diagnosis, treatment, and care put a strain on healthcare resources.
• Effect on Women’s Well-Being: Women in their prime years are primarily affected by cervical cancer, which causes early deaths that have an adverse effect on the socioeconomic stability of families and the wellbeing of their children.
• Human Rights Issue: Women’s right to health and well-being depends on having access to inexpensive, high-quality healthcare services, such as HPV vaccination and cervical cancer screening.
• Long-Term Benefits: Funding initiatives to prevent and control cervical cancer has a positive long-term impact on public health and sustainable development. It raises life expectancy, improves maternal and child health outcomes, and advances the Sustainable Development Goals (SDGs).

What Barriers Prevent India from Eradicating Cervical Cancer?

• Limited Knowledge: Many people are unaware of the risk factors for cervical cancer, the prevention strategies that include HPV vaccine and routine screening, and the disease itself. This is especially true in rural and underserved areas.
• Inadequate Screening Programmes: In India, there are insufficient, widely available programmes for screening women for cervical cancer, which results in late-stage diagnosis and unsatisfactory treatment outcomes.
• Lack of Access to Formal Health Care: Early cervical cancer detection, diagnosis, and treatment are hampered by a lack of adequate healthcare infrastructure, especially in rural areas.
• According to an Andhra Pradesh study, 68% of patients went to traditional healers first, and only 3% had been vaccinated against HPV.
• Lack of Skilled Personnel: There is a deficiency in the number of medical specialists with training in the prevention, detection, and treatment of cervical cancer, such as gynaecologists and oncologists.
• Stigma and Cultural Barriers: Women may be discouraged from participating in screening programmes or seeking prompt medical attention due to sociocultural taboos surrounding women’s health issues, particularly cervical cancer.
• Vaccine Hesitancy: Inaccurate information and false beliefs regarding HPV vaccinations cause parents and other carers to be reluctant to vaccinate, which lowers vaccination rates.
• Accessibility and Affordability: Many people, especially those from low-income families, may find the expense of HPV vaccinations, screening tests, and treatment choices to be prohibitive.
• Geographic Disparities: Incidence and mortality rates of cervical cancer fluctuate markedly between Indian regions, with rural areas frequently facing greater rates of disease and fewer access to healthcare.
• Limited Government Funding: The implementation of comprehensive plans and interventions is hampered by the lack of funding for programmes aimed at preventing and controlling cervical cancer.
• Limited Research and Innovation: To provide accessible and efficient screening methods, diagnostic approaches, and treatment modalities suited to the Indian setting, more research and innovation are required.

Which government initiatives are involved in the treatment of cancer?

• The National Programme for Diabetes, Stroke, Cardiovascular Diseases, and Cancer Prevention and Control
• The National Cancer Database
• National Day to Prevent Cancer
• HPV vaccination
• Government Initiatives for Cancer Screening: In primary health facilities, the Indian government conducts cancer screenings, which include visual and HPV tests.

How Can India Fight the Threat of Cervical Cancer?

Vaccination against HPV:

• Cervical cancer is caused by a high-risk persistent HPV infection, low socioeconomic status, and smoking.
• HPV can be prevented and cured by vaccination, screening, and prompt treatment.

Possibility of Early Identification and Management:

• The pre-invasive phase of cervical cancer lasts between 10 and 15 years, providing a window for early detection and outpatient therapy.
• A cure rate of more than 93% is achieved with early-stage care, underscoring the significance of prompt interventions.

Development of Indigenous Vaccines:

• Cervavac, an indigenous quadrivalent vaccination developed in India, promises accessibility and cost.
• The CERVAVAC vaccine is the first to be produced in India and is intended to protect against four strains of the quadrivalent human papillomavirus (qHPV): Type 6, Type 11, Type 16, and Type 18.
• Cervavac, which costs ₹2,000 each dose, has great potential in the battle against HPV infections and cervical cancer.

Take A Hint from the HPV Vaccination’s Worldwide Success:

• Cervical cancer cases have significantly decreased as a result of the successful implementation of HPV vaccination programmes in more than 100 countries worldwide.
• Research from Australia and Scotland show how HPV vaccinations have a real-world impact by significantly lowering the incidence of cervical cancer.
• The efficacious HPV vaccination programme in Rwanda highlights the criticality of vaccination as the first line of defence against cervical cancer.
• “90-70-90” Targets by WHO: The World Health Organisation has set aggressive goals, including 90% of girls receiving the full HPV vaccine by the age of 15, 70% of women getting screening tests for cervical cancer by the ages of 35 and 45, and 90% of women receiving treatment for cervical cancer by 2030.

The function of technological progress:

• Cervical cancer prevention is improved by innovations such as single-dose HPV vaccination, self-sampling for HPV testing, and Artificial Intelligence (AI) technology.
• These advancements, in conjunction with rising HPV vaccination rates, are encouraging for environments with limited resources.

Strategies and Awareness at the Population Level:

• Increasing awareness, encouraging HPV vaccination uptake, overcoming reluctance, putting age-appropriate screening into place, and fortifying pre-cancer treatment procedures are all necessary to combat cervical cancer.
• Adding information about HPV to health curricula in schools can help create demand among teenagers.

• The startling numbers of newly diagnosed illnesses and fatalities underscore the critical need for preventative actions. When treated at an early stage, early detection with screening and HPV vaccination offers a significant opportunity with a high cure rate. To successfully eradicate cervical cancer, there must be persistent and coordinated efforts for precise diagnosis, improved cancer registries, less financial burden, and strong health systems.