Preventing cervical cancer, a jab away

Women’s health has for decades been given a lower priority in India. The existing policy attention has been fragmented and reduced to addressing maternal health, by and large. Moving beyond this, there is an urgent need to address other pertinent health issues ailing women in the country, including cervical cancer. This preventable condition with an effective vaccine, caused by the human papilloma virus (HPV), has emerged as the second most common cause of cancer-related deaths among Indian women.

Statistics point out that there are 1,22,000 new cases of cervical cancer annually in the country, with 67,500 women succumbing to the disease, accounting for 11.1% of total deaths related to cancer. Despite these eye-opening figures, the country is yet to put in place an adequate screening programme for the condition.

The irony is that cervical cancer is preventable, has a known cause and mode of spreading, a simple test for screening called Pap Smear — which can help identify it very early — and an effective vaccine which protects against infection by HPV.

However, there is still a lot of hesitation associated with seeing a gynaecologist for a cervical screening, more so in the rural pockets of the country. Many women are uncomfortable undergoing a pelvic examination or getting a pap test done given that the test involves some personal questions. Add to this the acute lack of awareness about the condition, including in schools or colleges. It does not help that family members have no knowledge about it either.

The HPV vaccine is under-utilised due to three reasons: lack of awareness, non-affordability, and debates about its efficacy and side effects. It should ideally be given between the age of 9 to 25 years and works best when administered before a woman has her first sexual intercourse.

The way forward

Sexual ill-health mostly affects women and adolescents. It is important to remove popular misconceptions about sex, contraception, and getting timely checkup done for an underlying sexual infection or disease. Apart from this, in the rural areas, women and adolescent girls have a hard time ensuring that they have protected sex, a major reason for which is the power imbalance between the genders.

There is evidence from other countries to indicate that screening programmes can bring down the rates of cervical cancer and associated mortality. Such screening initiatives need to also be supplemented with quality healthcare infrastructure including trained health workers and availability of gynaecologists. There is a need to also introduce or scale up cost-effective and socially acceptable programmes for prevention, early detection, and treatment of cervical cancer. The Union government’s Ayushman Bharat initiative is a step in the right direction.

Women should be aided in getting a detailed understanding of their partner’s sexual history. In rural areas, counsellors can be appointed for couples before marriage, wherein the man and woman understand how important sexual health and screening is. They should also be educated and made aware of the benefits and use of contraception — especially the barrier methods. Health centres and treatment facilities must bring in policies that enforce Pap Smear in sexually active women (21-65 years) at least every three years. This includes women already vaccinated as well.

In November 2016, New Delhi became the first state to roll out a HPV vaccination programme for government school girls studying in Class 6; Punjab soon followed suit. Tamil Nadu also became the first state to establish a large-scale public health cervical cancer screening and treatment programme, including an awareness drive.

The results have been positive, and more women are opting for a screening. It is time such efforts are rolled out pan-India. Under the National Health Mission, health teams visit all government schools to screen children for several diseases or illnesses. This can be a great channel to mobilise the introduction of the HPV vaccine among adolescent girls.

The health sector in India is undergoing a major transformation, fuelled by government initiatives in this direction. Such a change offers immense potential and opportunities to advance comprehensive prevention approaches for diseases such as cervical cancer through vaccination, screening, and treatment. This is more so for underdeveloped and unreached regions in the country.

Health strategies have, for years, focused on the curative approach. It is perhaps the right time to take the big leap towards a more preventive approach. We are at the cusp of making a major dent in the cervical cancer incidences by adopting the simple and time-tested strategy: vaccination.

(The writer is Medical Director, Portea Medical)