To protect our girls, the Government must consider launching HPV vaccination under the immunisation programme
A recent tweet by the Union Minister of Health & Family Welfare highlighted a new milestone achieved by India in securing the health of new mothers in the country. Sustained systemic efforts over a decade and targeted health initiatives have helped India bring down the number of maternal deaths per 100,000 live births or the Maternal Mortality Ratio (MMR) from 130 in 2014-2016 to 97 in 2018-2020. With this, India has accomplished the National Health Policy target of an MMR of less than 100 and aspires to achieve the United Nations Sustainable Development Goal target of an MMR of less than 70 per lakh live births by 2030. This achievement bolsters the government’s resolve to create a responsive healthcare system for women, including reducing the burden of cancer of the cervix through timely prevention.
A decade back, deaths due to cancer of the uterine cervix and maternal deaths were both pegged at around 72,000 per year. However, cancer cervix has rapidly surpassed maternal mortality and has become the second most common cause of cancer deaths amongst women in India. This is a distressing sign for a life-threatening disease that is almost entirely preventable but 48.35 crore Indian women above the age of 15 years and older continue to be at risk. In 2020, over 1,20,000 women in India were reported to have cancer of the cervix, resulting in more than 77,000 deaths.
Human Papillomavirus (HPV) has been established as a cause of cancer of the cervix. More than 90% of cancer cervix cases are due to high-risk HPV type. HPV, much like the influenza virus, is a ubiquitous virus and can enter the body through small abrasions in the skin and mucosa. The virus can stay in the cells for extended periods and can either remain dormant or proliferate. While most low-grade infections spontaneously resolve within two years, persistent infection results in cancer of the cervix. Early cancer can be completely asymptomatic. Hence, we may not know when a woman will develop pre-invasive or invasive cancer and a woman could be harboring cancer for several years only discovering it at an advanced stage. Invasive cancer of the cervix can cause a foul-smelling vaginal discharge or pelvic pain and is undeniably the most dreaded form when it invades adjacent organs like the bladder and rectum. Once this happens, the survival rate dramatically decreases and treatment becomes more complex.
In addition to undergoing the harrowing experience of cancer treatment and associated toxicities, cancer survivors also have to battle with long-term issues such as menopausal symptoms, severe leg swelling (lower limb lymphedema), sexual dysfunction, infertility, social judgement and rejection. Unfortunately, this cancer is mostly diagnosed in young women between 35 to 45 years of age when they are in the prime years of their lives.
The only silver line is that the cancer of the cervix is almost entirely preventable. We know that it is caused by a virus and that there are effective vaccines already used globally to help prevent it. Vaccinating young girls long before they are exposed to this virus can aid in primary prevention. Regular screening after the age of 30 and effective treatment through surgery or radiation, can eliminate the second most common cancer in women in India. Advocating the vaccine to every young girl between the age of 9-14, that they see in their practice, and advising screening of women between 30-49 years with a high-precision HPV DNA test will be the two strongest pillars in this fight against cancer cervix. As a member of the World Health Assembly, India committed to WHO’s Global Cervical Cancer Elimination Initiative to accelerate the elimination of cancer of the cervix by 2030. The 90–70–90 target set by the initiative requires 90% of girls to be fully vaccinated with the HPV vaccine before the age of 15, 70% of women to be screened with a high-performance test by the age of 35 and again by the age of 45, and 90% of women identified with cervical cancer (pre-cancer or cancer) to receive treatment. In an endeavour to meet the commitment and protect our girls, the Government of India must consider launching HPV vaccination funded and implemented under the immunization programme.
As we celebrate cervical cancer awareness month this January, each one of us can play a part in helping the country secure the health of its women. So, get informed- find out more about cancer of the cervix and educate the young women around you.
Women represent the cornerstone for a family’s overall health and hence investing in their health and ensuring their access to quality care goes a long way in ensuring the well-being and future of a society. The necessary tools to stop women from suffering and dying from this preventable disease and eliminate it completely are available; thus our girls will live to see a world free of this deadly disease.
(The writer is a Professor and Program Lead of the MCh Gynaecologic Oncology program, Dept. of Obstetrics & Gynaecology, AIIMS Rishikesh)