Govt push puts spotlight on cervical cancer, experts hope it is possible turning point

New Delhi: Cervical cancer is at the centrestage of public health concern with the government’s push for vaccinations in the Union interim budget, a move that is a potential game changer for the disease that kills more than 77,000 women in India each year.

Finance Minister Nirmala Sitharaman last week said in her speech that the government will encourage vaccination against the human papillomavirus (HPV), which leads to cervical cancer, among girls aged 9-14. A day later, model-actor Poonam Pandey grabbed social media attention - and some headlines -- with claims she had died of the disease. It was a hoax, a stunt purportedly attributed to raising awareness about cervical cancer.

The fake claim raised some buzz about cervical cancer. But it is the government’s proactive stance to promote vaccinations that will raise awareness, foster early immunisation practices and marks a significant step towards preventing unnecessary fatalities, said scientists.

The battle is complex and tough, they admitted, but governmental intervention will make a difference.

Vaccinations for cervical cancer, the second most frequent cancer among women in India after breast cancer, have not picked up pace because of the costs involved - approximately Rs 4,000 per jab and two to three doses.

“Another concern has been that infections due to certain strains may not be covered by the vaccine. Screening would still be essential,” Dr Gayatri Gogoi, associate professor of pathology and cancer researcher at Assam Medical College, Dibrugarh, told PTI.

“The vaccines to prevent cervical cancer are likely to become cheaper if the government includes HPV vaccine in the country's immunisation programme,” added Dr Shuchin Bajaj, founder and director of the Ujala Cygnus Group of Hospitals.

The recent announcement is a commendable step towards preventing this deadly disease in young women, Bajaj said.

An estimated 1,23,907 (over 1.2 lakh) women are diagnosed with cervical cancer in India every year and 77,348 of them die from the disease, according to WHO's HPV Information Centre.

India bears a significant portion of the global cervical cancer burden, contributing substantially to the 604,000 (over 6 lakh) new cases reported worldwide in 2020.

Though there is no clarity yet on whether cervical cancer vaccinations will be part of the national immunisation programme or if prices will fall, public health experts said it could well be a turning point.

Dr Atul Mohan Kochhar, CEO of the National Accreditation Board for Hospitals & Healthcare Providers (NABH), agreed with Bajaj, saying the step will encourage vaccination for young girls for prevention of cervical cancer.

“This will be a great step to tackle this disease, which is the fourth most common cancer worldwide, and the second most common cancer among females in India,” Kochhar told PTI.

There will be far fewer cases if the vaccine is made part of the national immunisation programme, added Gogoi.

“This will reduce suffering as well as cost associated, prevent deaths in the long run from cervical cancer,” she said.

According to a report in the US medical centre, NYU Langone Health, of the more than 150 strains of HPV, 40 affect the genital area but most don’t pose a serious health risk. There are at least 12 high-risk strains of HPV, but only two-types 16 and 18-cause the majority of HPV-related cancers, including those involving the cervix.

Two vaccines licenced globally are available in India; a quadrivalent vaccine, Gardasil, marketed by Merck, and a bivalent vaccine Cervarix marketed by Glaxo Smith Kline. While Gardasil covers four strains, including types 16 and 18, Cervarix targets only the main two strains.

A Lancet study last year found the Cervavac vaccine, which covers four strains and is marketed by Pune-based Serum Institute of India (SII), to be as effective as global vaccines. The estimated cost of the vaccine is pegged at around Rs 2,000 for two doses.

About 5 per cent of women in the general population are estimated to harbour cervical HPV 16 and 18 at a given time, and 83.2 per cent of invasive cervical cancers are attributed to these types, the HPV Information Centre said.

Numbers reveal India's alarming contribution to approximately one-third of global cervical cancer fatalities, Kochhar said.

“In addition, over 365 million women above age 15 in India are at risk of developing cervical cancer. This data certainly reflects the alarming stage of cervical cancer becoming one of the most prevalent cancers.” The reasons behind the high incidence of cervical cancer in India are multifaceted.

“Limited knowledge and delayed screenings contribute to the issue, particularly in rural areas with constrained healthcare access. Cultural taboos also affect screening rates, and socioeconomic challenges, including poverty and low education, impede prevention initiatives,” Bajaj said.

“HPV screening test and HPV vaccination are the measures available for the patients to prevent and fight against burgeoning cervical cancer,” Kochhar added.

Gogoi noted that the current status of cancer screening attendance is negligible, regardless of several schemes, programmes, and facilities.

One of the optimistic things about cervical cancer is that both prevention and early detection strategies are well established.

“The screening approaches for uterine cervical cancer such as visual inspection with chemicals such as acetic acid or Lugol’s iodine, pap test, and HPV DNA testing in three to five years interval,” she noted.

A pap smear, also called a pap test, involves collecting cells from the cervix - the lower, narrow end of the uterus. It can detect changes in the cells that suggest cancer may develop in the future.

The HPV DNA test is a laboratory test where the cells of possible infected sites are checked for the genetic material of the virus.

Experts say treatment options for cervical cancer in India include surgery, radiotherapy, chemotherapy and palliative care.

“Vaccines, though considered cost-effective in the long run, may still pose financial challenges for some individuals and governments,” said Dr Chinnababu Sunkavalli, senior consultant, surgical oncology and robotic surgical oncology, at Hyderabad’s Yashoda Hospitals.

He said the cost of cervical cancer treatment can vary significantly, influenced by factors such as the stage of cancer, geographical location, and healthcare infrastructure.