Cervical cancer vaccine: It's too early to cheer

Cervical cancer is the second most common cancer of women in India. While it may sound grim, the cancer is largely preventable. It has a well-defined and long pre-malignant phase—it takes 15 to 20 years for cervical cancer to develop in women with a normal immune system. Regular screening tests and follow-ups can help detect it in its early stages. Unfortunately, most women in India are not aware of screening. This leads to malignancy and resultant deaths.

The recent news of India’s first indigenously developed quadrivalent Human Papilloma Virus (HPV) vaccine for the prevention of cervical cancer being launched in a few months is welcome news in such a scenario. The vaccine, developed by the Serum Institute of India (SII), will be made available in a price range of ₹200-400. The vaccine would be made available through the government channel and from next year onwards some private partners would be involved too.

In November 2020, the World Health Organization launched a Global Strategy to accelerate the elimination of cervical cancer as a public health problem. If this Strategy is implemented globally, a total of 74 million cervical cancer cases could be prevented and 62 million women’s lives could be saved over the next century.

Cervical cancer develops in the cells of the cervix. In more than 95 percent of the cases, the disease is caused by HPV, which is a sexually transmitted infection. Usually, the virus is cleared up by the body’s immune system. But there are times the virus manages to survive, leading to cancer. Early detection is the key to treating the cancer and so screening is of utmost importance. Cervical cancer can be detected through the Pap smear, the LBC test, and the HPV test.

The larger question here is: Will the vaccine reach the rural populace in India where the prevalence of the disease is highest?

As per Globocan 2020, 6,04,100 new cases of cervical cancer were detected globally in 2020 and 3,41,831 deaths were attributed to this malignancy. In India, cervical cancer accounted for 9.4 percent of all cancers and 18.3 percent (1,23,907) of new cases in 2020. Globocan is an online database providing global cancer statistics and estimates of incidence and mortality.

According to the findings, cervical cancer is still amongst the commoner cancers in India and a leading cause of cancer-related deaths in women in low- and middle-income countries. It is the second leading cause of cancer deaths for females in 12 Indian states. Cervical cancer has become a public health threat in India.

“Cervical cancer is most often diagnosed in women between the ages of 35 and 44. Two in three women between the age of 30-49 years have never been screened for cervical cancer. It is estimated that in developing countries like India, around 1 in 53 Indian women will suffer from cervical cancer during their lifetime,” says Delhi gynaecologist Ruchi Tandon.

The situation is more alarming in the rural areas of the country. The majority of women from rural areas and semi-urban areas—Tier III cities—are illiterate and ignorant about the hazards of cervical cancer. Nor do they have the needed access to healthcare resources.

“A woman faces different problems from puberty till menopause but rarely addresses the issues to a health expert. Not sharing the problem of irregular bleeding or post-coital bleeding can be a symptom of cervical or endometrial cancer. Diseases which are easily treatable are often diagnosed at an advanced stage where either the treatment is impossible or is very expensive,” says Dr Ila Gupta, Senior IVF Consultant and Clinical Director at Ferticity Fertility Clinics, Delhi.

ASHA (which means hope in Hindi) is the network of more than one million accredited women health workers, who are at the forefront of healthcare delivery in India, especially in villages. They are among the six recipients of the World Health Organisation (WHO) Director-General’s Global Health Leaders Award and have been recognised for their outstanding contribution to protecting and promoting health this year.

Despite this positive view, there is little to cheer about. Let’s look at the profile of an ASHA worker. ASHA is primarily a woman resident of the village, preferably in the age group of 25 to 45 years. She should be a literate woman, qualified up to Class 10. The chosen ASHA workers are imparted basic healthcare training so that they can disseminate information and awareness among the women in the villages. But with village clinics being mostly ill-equipped and poorly staffed—if at all—these ASHA workers have little help to fall back on.

Also, the decision-makers in such areas are largely men, who are routinely left out of women’s healthcare discussions. When it comes to a woman’s health, the men in the family are mostly ignorant, and willingly so. This more often than not robs the women of access to medical care at the relevant time.

Poor prognosis due to late diagnosis is a death knell for any disease, especially cancer. Also, the other factors that weigh in in a rural set-up are factors such as age at the time of marriage, number of pregnancies, genital hygiene, use of oral contraceptives, nutritional status, smoking, etc. Inaccessibility, social stigma, non-availability of affordable tests and poor infrastructure further aggravate the situation. In such a scenario whether the women have half a chance of early diagnosis and treatment of cervical cancer—vaccine or not—is anybody’s guess. Maybe a woman-first approach on the part of the central and state governments will help address the lacunae and be the much-needed game-changer.