An ounce of prevention, a pound of cure

Given the robust immunisation programme, the swift introduction of HPV vaccines will save thousands of women

Non-communicable diseases including cancer are on the rise and some like cervical cancer adversely affects half the Indian population — its women. Every year, over 120,000 women are diagnosed with cervical cancer and more than 67,000 die from the disease. This leaves India in the unenviable position of accounting for onefourth of the global burden.

The major cause of cervical cancer is infection with the human papillomavirus (HPV), making this one of the few preventable cancers. However, the disadvantaged position women face in various settings often exposes them to greater risk. Factors such as marriage at early age, multiple pregnancies, multiple sexual partners, repeated infections and poor hygiene exacerbate the incidence of disease.

Data from the Indian Council of Medical Research’s national cancer registry programme shows that between 2012 and 2014, Arunachal Pradesh’s Papumpare district had the highest levels of cervical cancer. Although there has been a rapid decline of this cancer in urban areas, it is much slower in rural areas.

Given India’s scale, the management of cancers requires a comprehensive approach. Simple measures like regular screening can help detect pre-cancerous lesions and even get treated during the same visit to the health facility.

The ministry of health and family welfare recently developed and disseminated guidelines for screening of common cancers. Although cervical cancer is almost entirely preventable, the majority of cases are diagnosed at advanced stages of the disease. For this, the government is working to enhance tertiary care cancer facilities while providing treatment through central government hospitals/institutions in different parts of the country.

Nonetheless, treatment for cancer is expensive and imposes a huge financial burden on families and the health system, affirming again that an ounce of prevention is worth a pound of cure.

Vaccines exist against HPV infections and the WHO recommends them as part of the basket of comprehensive interventions for cervical cancer control worldwide. The vaccines can prevent 70% of all cervical cancer and are given to pre-pubertal girls in the age group of 9 to 13 years. These are included in the immunisation programmes of over 65 countries.

A decline in costs and contributions from donors have enabled governments to procure the vaccines at affordable prices. Several low- and middle-income countries now use the HPV vaccine nationally. There is enough evidence on HPV vaccine safety and efficacy globally. Lessons from countries like Malaysia demonstrate successful HPV programmes where a schoolbased approach covers more than 90% of eligible girls.

Given India’s robust immunisation programme, a swift introduction of HPV vaccines could give a further push to the natural reduction in cervical cancer rates.