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Cervical cancer cases have shown signs of a decline in mortality rates of late with growing awareness, even as India considers rolling out a human papillomavirus (HPV) vaccination for girls aged between 9 and 14 years.
The mortality rate for cervical cancer — the second most common cancer in women after breast cancer — in India declined from 10.9 per 100,000 women in 1990 to 7.38 per 100,000 women in 2019, according to a study published in 2022 by the department of community medicine at Dr Baba Saheb Ambedkar Hospital, Delhi.
The Global Burden of Disease 2019 study also indicated a 21 per cent decrease in cervical cancer incidence in India from 1990 to 2019, accompanied by a 32 percent reduction in mortality.
Ajesh Raj Saksena, senior consultant surgical oncologist at Apollo Hospital, Hyderabad, explains that the mortality drop can be linked to increasing awareness, screening initiatives, and improvements in healthcare access for cervical cancer patients.
The Union health ministry has said that it is yet to take a decision on introducing the HPV vaccination. “The health ministry is yet to take a decision on the roll-out of HPV vaccination in the country. It is closely monitoring the incidences of cervical cancer cases and is in regular touch with states and various health departments,” the Union Health Ministry said on Saturday.
According to Globocan 2020, an online database of statistics and estimates of incidence and mortality in 185 countries for 36 types of cancer, 123,907 cervical cases were diagnosed and 77,348 deaths reported in India that year.
Doctors are expecting an indigenously developed HPV vaccine to be available at lower costs and help reduce cervical cancer incidences.
Yogesh Kulkarni, surgical oncology head at Kokilaben Dhirubhai Ambani Hospital, Mumbai, says, “More than nine in every 10 cases of cervical cancer are caused by HPV. Hence, the majority of cervical cancer cases can be prevented by HPV vaccination. With the expected launch of the new indigenously developed vaccine at a much lower cost (Rs 250-800 per dose) as compared to the imported one (Rs 3,000-4000 per dose), the vaccine is likely to be included in the national immunisation schedule.”
Rama Joshi, principal director of the department of gynae oncology at Fortis Hospital, Gurugram, points out that limited access to regular screening, especially in rural areas, remains a significant barrier. “India sees around 123,000 new cases of cervical cancer each year, resulting in over 77,000 preventable deaths. Alarmingly, 75 per cent of these cases are identified in advanced stages, contributing significantly to the high mortality rates,” says Joshi.
Stressing the need for vaccines, Sarika Gupta, consultant, gynae surgical oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi says: “Universal immunisation in adolescence is 97 per cent effective in preventing cervical cancer. The highest rate of HPV infection occurs in teens and young adults. Also, HPV vaccination creates a high humoral (relating to the humours or body fluids) immunity if given in young adolescents.”
Sampada Dessai, a gynaecological cancer and robotic surgeon at PD Hinduja Hospital in Mumbai, agrees that late-stage detection remains a challenge and screening clinics and vaccination initiatives are crucial in addressing the malaise of cervical cancer.
Speaking on the importance of advanced screening Vani Ravikumar, Senior Consultant and Head of Histopathology, Metropolis Healthcare said "Early screening with advanced techniques like liquid-based cytology and HPV testing has led to a 96 per cent increase in abnormality detection and a 45 per cent decrease in unsatisfactory cases, offering hope for cervical cancer elimination. Screening should be a tailored approach, to begin with, HPV testing in ages 21-25 provides diverse options thereafter optimises impact by aligning with epidemiological patterns and resource considerations. Focusing on the 25 to 30-year age group ensures early intervention, enhancing health outcomes.”
For India, a critical target would be to achieve the World Health Organization’s cervical cancer elimination goal by 2030, which includes ensuring 90 per cent of all girls are fully vaccinated with the HPV vaccine and 70 per cent women undergo high-performance screening by the age of 35 and subsequently by 45 years of age.
While the decline in mortality rates is a positive sign, experts stress the importance of continued efforts in screening, public awareness, and timely vaccination to further curb cervical cancer cases in India.
