Cervical cancer: ‘India lacks a nationwide screening program’

Cervical cancer is the fifth most common cancer in humans, the second most common cancer in women worldwide and the common cause of death in the developing countries. Large majority (around 85 per cent) of the global burden occurs in the less developed regions, where it accounts for almost 12 per cent of all female cancers. However, in India women continue to be afflicted by a disease that is potentially preventable and treatable when detected early

Cervical cancer: ‘India lacks a nationwide screening program’

  • Cervical cancer is the commonest cancer cause of death among women in India. It is the second most common cancer in women aged 15 to 44 years.
  • An estimated 122,844 new cases and 67,477 deaths due to cervical cancer occurred in India in 2014, contributing 26 per cent and 27 per cent to the global cervical cancer incidence and mortality respectively.
  • The peak age of incidence of cervical cancer is 55 to 59 years, and a considerable proportion of women report in the late stages of disease.

Most factors related to cervical cancer are associated with sexual behaviour and it is well-established that Human Papillomavirus (HPV) infections play a critical role in the development of cervical cancer. HPV prevalence among cervical cancer patients in India has varied from 87.8 per cent to 96.67 per cent.

The prevalence was higher among high-risk categories such as commercial sex workers at 25 per cent, urban slum in Mumbai at 32.3 per cent and HIV-positive women from 41.7 per cent to 56 per cent. HPV-16 and 18 has been found most commonly.

Cervical cancer: ‘India lacks a nationwide screening program’
Dr Niranjan Chavan

India lacks a nationwide screening program leading to area wise disparities in screening, treatment, and survival. Opportunistic screening in various regions of India varies from 6.9 per cent in Kerala to 0.006 per cent and 0.002 per cent in the western state of Maharashtra and southern state of Tamil Nadu, respectively. Most of the cases present in advanced and late stages, and more than half (63 per cent to 89 per cent) have locally advanced stage at the time of presentation.

Where do we stand?

Cervical cancer is the 2nd most common cancer in women worldwide but most common cause of cancer related death in India. All over the world, including India, there is decreasing trend of cervical cancer.

However, where countries like USA are celebrating a substantial decrease in HPV infection owing to their immunisation programme, in India women continue to be afflicted by a disease that is potentially preventable and treatable when detected early.

Those who are lost to screening or who do not receive screening at all are most susceptible to the development of cervical cancer.

The Federation of Obstetric and Gynaecological Societies of India (FOGSI) had started “Connecting the Dots” 15 centres in INDIA recognised by FOGSI for compiling the data of cervical cancer and training in PAP smear and  colposcopy so that it may help in reducing the incidence of cervical cancer.

The author is a Professor, Gynaecology Department at LTMG (Sion) Hospital and chairperson, FOGSI oncology committee (2012 to 2014)