Cervical cancer is the second-most frequent cancer among women in India. Cancer develops in the cervix, located at the bottom of the uterus. Doctors stress two preventive measures — vaccination and regular HPV screening for early diagnosis and treatment.
On International Day of Action for Women's Health 2022, we take a look at the situation in India. In 2020, the country accounted for an estimated 1,23,907 cervical cancer cases, which contributed to 20.5 percent of the estimated 6,04,127 cases worldwide, according to the International Agency for Research on Cancer data.
“Across the world, we get half a million cases globally per year, so it is common cancer. It is the fourth most common cancer in women across the world, but in India, it is the second-most common cancer in urban women and the most common cancer in rural women. So it is heavily prevalent,” said Dr Tanaya Narendra, aka Dr Cuterus on the social media platform Instagram (@dr_cuterus), where she shares information regarding reproductive health and sex ed.
India also has a high burden of deaths from cervical cancer, mainly from late diagnosis, she said. According to the World Health Organization (WHO), India reported 45,300 deaths in 2019, second to China’s 51,600 fatalities.
Almost 90 percent of cervical cancers have a human papillomavirus (HPV) implication.
What is human papillomavirus (HPV)?
HPV is a big group of viruses that has close to 200 strains. Of them, around 10 viruses are related to cervical cancer. The two very-commonly associated HPV strains with cervical cancer are — 16 and 18. “Getting the HPV infection doesn’t directly mean one will get cancer, but it can cause changes into your body that can lead to cancer,” Dr Narendra said.
The other HPV strains can be associated with other cancers as well, such as cancer of the throat, anus or vulva.
“A lot of different cancers, especially genital cancers are associated with HPV. This is because HPV is essentially a sexually transmitted infection and it is extremely common. Estimates say that 80 percent of anybody who has been sexually active will have had HPV at some point in their lives. It’s like the common cold. Everybody has had HPV in some way or some form in their life and that is because HPV doesn’t necessarily spread through sexual intercourse. It can also spread through skin-to-skin contact,” she said.
Recommendations to check HPV
As most cervical cancer cases are diagnosed in the later stages, doctors have the following recommendations:
HPV screening
Doctors advise getting the pap-smear test done regularly for early diagnosis. "There is also another test, which is the HPV DNA test," said Dr Yogesh Kulkarni, Head of the Gynecological Oncology Department at Kokilaben Dhirubhai Ambani Hospital.
While conducting the pap smear test, the doctor touches the surface of the cervix with a brush to get some cells on it, which is then sent for examination. "The pap smear test has to be done every three years, while the HPV DNA testing, has to be done every five years," Dr Kulkarni added.
Dr Narendra said that screening can be helpful in making sure there are no pre-cancerous changes in the cervix.
The screening should start from age 25 and can be done till the age of 65 years. "If your previous three screenings are normal then you can stop screening for cervical cancer at the age of 65 years," she said.
HPV vaccines
At present, HPV shots, Cervarix, Gardasil 4 and Gardasil 9, are available in India. The cost of Cervarix and Gardasil 4 is around Rs 2,000 to Rs 3,500 per dose, while Gardasil 9 is more expensive.
Cervarix promises immunity against strains 16 and 18, whereas Gardasil 4 guards against four strains — 16, 18, 6 and 11. “Strains 6 and 11 are associated with genital warts. So it offers a little more protection in terms of the strains it is protecting you against,” said Dr Narendra.
Gardasil 9, which came to India in September 2021, guards against 9 strains, she added.
When to take the shot?
In India, women up to the age of 45 years can take the HPV vaccine. However, doctors strongly recommend the vaccine be taken before one turns sexually active. For the same reason, the ideal age for taking the vaccine is 9-13 years, when the person has most likely not been exposed to the HPV yet, Dr Narendra said.
The number of doses — two or three — depends on the age. For the 9-14 age group, two doses are given, while for the 15-45 age group, three doses are given, Dr Kulkarni says.
Earlier this month, it was reported that the Serum Institute had also sought the government's nod to manufacture and stockpile the Quadrivalent Human Papillomavirus (qHPV) vaccine against cervical cancer after completing the phase 2/3 clinical trials to ensure its early availability in the country.
"We are making the cervical cancer vaccine for women, the HPV vaccine, and we are hoping to launch in November-December this year itself, with a small volume and then picking it up next year," Serum Institute of India's CEO Adar Poonawalla told CNBCTV-18 on May 23 on the sidelines of the World Economic Forum Annual Meeting 2022 in Davos.
Symptoms
“Some people come to us with weight loss, backache, experiencing bleeding while urinating. These are very common symptoms of gynaecological cancers essentially. Cervical cancer has such few and vague symptoms that the diagnosis usually happens very late, which is why we have a strong focus on preventative measures — regular HPV screening and taking the HPV vaccine,” Dr Narendra said.
Treatment
The treatment for cervical cancer is based on what stage the cancer is at the time of the diagnosis. Dr Kulkarni said there are four stages of cervical cancer. "The main treatments for cervical cancer are surgery, radiation and a small dose of chemotherapy," the oncologist said.
"If it is an early stage of cervical cancer, we consider surgery for patients. For anything beyond stage 2, the treatment is radiation with a small dose of chemotherapy," he said.
He added that the cancer is treatable. "It is potentially treatable even up to the age of stage 3," he said. However, he said the earlier it is diagnosed the better the chances of a cure.
