January was observed as Cervical Cancer Awareness Month. Additionally, every year, March 4 is observed as International HPV Awareness Day.
Protecting women’s health includes protecting the cervix, the lower-most part of the uterus. With HPV vaccination, we can prevent cervical cancers that can seriously affect a woman’s health. As the fourth most common cancer among women worldwide, cervical cancer claims the lives of more than 3,00,000 women every year, or one life every two minutes. Nine out of 10 women dying of cervical cancer live in lower- and middle-income countries. In India, cervical cancer is the second most common cancer after breast cancer. Given the country’s population size, about 500 million women above the age of 15 are at risk of cervical cancer. If there is no action taken, the number of cases and deaths from cervical cancer are projected to rise significantly in the future. With the current population growth rate, the absolute number of new cases of cervical cancer for all ages in India in 2040 is estimated to be 1,91,347 — an increase of 54% over the number of new cases reported in 2020.
Strategies for prevention
It was in 1983 that German scientist Harald zur Hausen demonstrated that cervical cancer in humans is caused by certain types of papilloma viruses (wart viruses). Knowledge of HPV epidemiology and its role in causation of cancer has resulted in the development of two major strategies for prevention and early detection: HPV vaccination and screening for precancerous lesions. Although elimination of cervical cancer is a real possibility, the tragedy is that even today, many lower-resourced communities lack effective intervention programmes for elimination of cervical cancer as a public health problem. The World Health Organization’s strategy outlines a 90-70-90 triple pillar intervention to be implemented by 2030 with an additional focus on high-quality health care and equitable health care services. The intervention targets are: 90% of girls must be fully vaccinated with the HPV vaccine by the age of 15; 70% of women must be screened using a high-performance screening test by the age of 35 and again by 45; and 90% of women detected with cervical pre-cancer and cancer lesions must receive treatment and care.
A recent report titled ‘Accelerating global health pathways: to health equity for the G20’ highlighted the commitment of India’s G20 presidency to promoting equitable access to vaccines, particularly for lower- and middle-income countries. The HPV vaccine was introduced in India in 2008. After sufficient country-level studies and successful State-level roll-outs, it was recommended for inclusion in the Universal Immunization Programme in 2023. An initial announcement was made in this regard by the Health Ministry in early 2023 and, recently, by the Finance Minister in her Interim Budget speech. The vaccine now awaits a national launch.
Research indicates that the HPV vaccine is not widely accessible to all girls across India. Currently, it is available in the private market at a significant out-of-pocket cost. Many physicians underestimate the incidence and risk of cervical cancer and the HPV infection. Physicians also underestimate the safety and effectiveness of HPV vaccines. The lack of trust in vaccine safety and effectiveness leads to hesitation in recommending the HPV vaccine to parents of age-eligible adolescents. Physicians may also hesitate to recommend this cancer prevention vaccination because HPV infections are primarily transmitted through intimate skin-to-skin contact. They may also feel it might be time-consuming to answer parents’ questions regarding myths and misinformation about the HPV vaccine.
Facts and best practices
In support of the widely anticipated national roll-out of the HPV vaccine, the Federation of Obstetric and Gynaecological Societies of India (FOGSI) and the Indian Academy of Pediatrics (IAP), with a combined membership of over 80,000 physicians, have joined hands to remind member obstetricians-gynecologists and pediatricians about the facts of HPV vaccination and share best practices for effectively communicating with parents about this cancer-preventing vaccine. This safe and effective vaccine can help prevent six HPV cancers. Five of these occur in women: vulvar, anal, vaginal, throat, and cervical. Recommending the HPV vaccine to all adolescents starting at age 9 years is part of completing the IAP immunization schedule. Recently, the FOGSI Good Clinical Practice Recommendations, upon review of the body of evidence, reinforced its recommendation for HPV vaccination to the primary age group of 9-14 years as well as regular screening for every woman above the age of 30 years. As apex national medical societies with a track record of promoting health and well being of the population, the FOGSI and IAP seek to ensure that every girl grows up protected from cervical cancer through HPV vaccination and every woman is protected through regular cervical screening. In doing so, they are creating at least 20,000 HPV physician champions in their cadres by mid-2024. These member physicians will share the importance of HPV vaccination among their peers and and the community at large.
Physicians are the most respected leaders in society and the trusted source for health-related information. Their leadership is needed to eliminate cervical cancer in India.
Hrishikesh Pai is President, FOGSI 2023. Upendra S. Kinjawadekar is President, IAP 2023.
