Cervical cancer is a preventable disease and if it is detected early then can be cured with better treatment. (Source: Getty Images/Thinkstock) Delays in diagnosis and treatment of cervical cancer are likely to lead to more cervical cancer deaths compared to Covid-19 deaths averted among patients with cervical cancer, Dr R Shankarnarayanan, Senior Scientific Advisor at the International Agency for Research on Cancer (IARC), a specialised cancer agency of the WHO told The Indian Express. January is observed as cervical cancer awareness month.
What is the burden of cervical cancer in India?
According to IARC projections, cervical cancer accounted for 124,000 new cases and 77,000 deaths in 2020 in India. Cervical cancer is preventable and curable if detected early and managed effectively. Yet it is the fourth most common form of cancer among women worldwide, with the disease claiming the lives of more than 300,000 women in 2018. Nearly 90% of these deaths occurred in low- and middle-income countries.
National Family Health Survey (NFHS-5) shows not many states are promoting the vaccine due to a lack of awareness or directive from the government. Why is there hesitancy to take the vaccine?
Vaccine misinformation, particularly on its safety, unfounded fears on both short and long-term side effects, vaccine costs and unaffordability for most people, and the long latent period for its efficacy to become obvious seems to be the main factors responsible for vaccine hesitancy.
So how do we achieve the target of eliminating cervical cancer?
We aim to reach and maintain an incidence rate of four per 100,000 women or less by vaccinating 90% of the girls with two doses of human papillomavirus (HPV) vaccination separated by a 6-12-month interval before they reach 15 years and screening 70% of adult women aged 30 years and above using a highly accurate test such as testing for HPV infection and treating adequately screen-positive women found with precancerous lesions (stage 0). In addition, early diagnosis, and adequate treatment of cervical cancer with surgery or chemoradiotherapy can cure a large proportion of early stage (stages 1 and 2) cervical cancer patients. It is critical that more than 90% of women detected with cervical precancerous lesions or cancer should receive adequate treatment well in time. For maximum impact, the 90%-70%-90% (vaccinate-screen-treat) targets must be implemented simultaneously.
With the ongoing pandemic, how do you see this global strategy of eliminating cervical cancer work?
With the ongoing Covid-19 pandemic, there is an inevitable impact in terms of low coverage of HPV vaccination and screening as well as challenges in accessing diagnostic and treatment services. The low coverage of HPV vaccination and screening can delay the elimination of cervical cancer, possibly by several years. Deaths from cervical cancer will increase due to inadequate access to diagnosis and treatment. The unprecedented reallocation of healthcare services necessitated by the pandemic across high-, middle-, and low-income countries, coupled with staff shortages and capacity constraints, is likely to hamper cervical cancer elimination efforts globally
How long will it take to witness a cervical cancer-free society?
In countries such as Australia, which has made substantial progress in implementing the 90%-70%-90% strategy, cervical cancer is estimated to be eliminated between 2028 and 2035. With remarkable results for two of the targets – 70% of women screened and 90% of women identified with cervical cancer treated – Slovenia could very well become one of the first European countries to reach all 3 targets well in the pathway to elimination. On the other hand, the evolution of a cervical cancer-free society will take several years in those countries which might not comprehensively implement the targeted interventions by 2030.
What is the way forward?
In an effort to support the cervical cancer elimination strategy, the Conquering Cancer campaign and documentary were developed to showcase the urgent need to have a cohesive strategy towards cervical cancer elimination. By improving awareness of the general population on cervical cancer prevention; by providing tools to health care providers to better address vaccine misinformation; alleviating fears on vaccine safety; by making HPV vaccines more affordable and accessible; and by reinforcing messaging to empower and remind parents of the importance of HPV vaccination, vaccine hesitancy can be fought to enable reaching goals for HPV vaccination.
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