India is home to over 500 million women and girls who are at risk of cervical cancer. More than 120,000 women are diagnosed with the disease each year across India, with 8,000 of these cases reported in my state of Maharashtra. Around 77,000 women die from the disease annually in India – the country has the highest burden of cervical cancer in Asia.
Yet, cervical cancer is preventable and curable, if detected early. However, this relies on women and girls having access to effective screening and human papillomavirus (HPV) vaccination services, as most cases are caused by infection with HPV. The growing burden of cervical cancer in India represents a major inequity that desperately needs correcting, to protect women and communities from the devastating effects of this disease.
We know how to eliminate cervical cancer as a public health problem. The elimination strategy of the World Health Organization outlines a clear pathway, with “90-70-90” targets for vaccination, screening and treatment to achieve this goal. Achieving elimination will require 90% of girls to be fully vaccinated with the HPV vaccine by the age of 15, and 70% of women to be screened using a high-performance test by the age of 35, and again by the age of 45. Eliminating the disease will also require 90% of women with pre-cancer to be treated and 90% of women with invasive cancer to have their cases managed. Cervical cancer is preventable through screening and vaccination.
Yet, millions of women in India are being left at the risk of the disease. We need to do more to make sure every woman has access to screening services and step up our efforts to eliminate the disease. Access to screening for cervical cancer should be a basic right, one which will improve the health and wellbeing of women across India.
India is committed to achieving the elimination of cervical cancer and is strengthening all levels of cancer care. The National Technical Advisory Group on Immunization (NTAGI), India’s apex technical advisory body, has recommended the inclusion of HPV vaccines in the country’s Universal Immunisation Programme. India has also developed its own indigenous and affordable HPV vaccine, offering greater accessibility to vaccination across the country. Women are being screened for cervical cancer across healthcare facilities. However, coverage of screening services remains low- less than 2% of women aged 30-49 years in the country have ever undergone cervical cancer screening. While the HPV vaccine will prevent girls from developing cervical cancer in the future, we must step up our efforts to protect the women of today through early screening and linkage to treatment.
Recently, at a policy consultation organized by FIND, a non-profit organization dedicated to enabling equitable access to diagnosis, I heard the story of a cervical cancer survivor whose harrowing journey and courageous battle against the disease highlighted the devastation that cervical cancer can wreak. Every woman in India should have access to screening for the disease, as a basic right, so stories like these can be relegated to the past.
Screening for cervical cancer empowers women to take control of their health, and seek the help they may need earlier, sparing them and their families from unnecessary suffering. However,
challenges around cervical cancer screening are preventing women from accessing these life-saving screening programs. The foremost is women not prioritizing their own health! It is not easy for a woman to speak about her private organs and much of it is considered taboo. Further, women, particularly those living in rural areas, may not always have easy access to screening programmes. Tackling the stigma around the disease is also an immense challenge. This requires a transformation in the social mindset and hence, creating awareness is necessary. The government must make elimination of cervical cancer a part of their advertisements. Elimination of cervical cancer is certainly not an impossible endeavor.
Moving forward, we need to adopt a holistic approach to cervical cancer screening and elimination that focuses on making screening accessible and acceptable to women. This can only be achieved through a collaborative, system-wide approach, which brings together clinicians, researchers, the public and private health sector, policymakers and civil society organizations to tackle the persistent barriers to cervical cancer screening. We need to prioritize and incentivize programmes, funding and infrastructure for screening, vaccination and treatment as part of a robust cervical cancer elimination strategy.
In all of this, we must centre women and consider what tools and strategies can provide the services women need, where they need it. In this context, innovative approaches – such as allowing women to take their own samples for HPV through self-sampling – can empower women and ensure that more women are screened and diagnosed in time, on their own terms.
We owe it to the women of India to make cervical cancer screening easy and accessible. Cervical cancer affects women at their most productive time in life and the consequences can be deadly. We need to ensure that every woman realizes that her health is a priority and provide them with the health services to protect their wellbeing for themselves, their children, and family. Eliminating cervical cancer in India is both necessary and possible. Now is the time for us to step up our efforts to diagnose, prevent and treat cervical cancer – doing so will save countless lives and help women across India prosper.
(Author: Dr Fauzia Khan, Member of Parliament, Rajya Sabha)
