Cervical Cancer Awareness Month: India holds 25% of worldwide cervical cancer cases. How can regular screening reduce the number?

Cervical cancer develops in the cervix or the layer of the cervix wall. The cervix is a fibrous, cylindrical organ in the female reproductive tract. It plays a vital role in various aspects of women’s life, including fertilization, menstruation, and vaginal delivery. However, the cervix is vulnerable to HPV infections, which can cause cervical cancer.?

The human papillomavirus (HPV) is a sexually transmitted infection (STI) that can be passed on through any type of sexual contact. There are 100 types of HPV, although HPV-16 and HPV-18 are two high-risk types that cause 76.7% of cervical cancer in India. In 2020, India accounted for 24% of the world’s HPV-related cancer cases, and a significant factor is that immunization programs are not widely available and awareness is low.?

January is dedicated to ‘Cervical Cancer Awareness Month’ because it’s the time to raise awareness of cervical cancer and understand the importance of early detection, as cervical cancer is preventable and curable. A study showed that revertible cervical cancer cases were 51.7%, where Ahmedabad had a higher survival followed by Thiruvananthapuram and Kollam.?

Despite that, only 1% of women in India are screened for cervical cancer, which is much lower than women screened in developed countries (68%-84%). This lack of awareness and late detection are major causes contributing to cervical cancer. A 2023 study estimated that over 340,000 cases of cervical cancer occurred in India, making it the second-leading cause of casualties in India after breast cancer.?

Initially, cervical cancer brings no symptoms, but as it grows, there might be some symptoms. These include

• Vaginal bleeding after intercourse, between periods, or after menopause.?
• Pelvic pain or pain after intercourse.?
• Watery or bloody vaginal discharge that may be heavy.?
• Difficult or painful urination, sometimes blood in urine.?
• Dull backache or swelling in the leg

Cervical Cancer's Impact in India

Cervical cancer is the fourth leading cause of cancer mortality in women globally, and India accounts for 25% of the global burden. However, in 2018, cervical cancer claimed the lives of an estimated 311,000 women, representing 7.5% of all female cancers, with almost 90% occurring in less-developed regions.?

The number of casualties per 100,000 women is 11.2 in India, compared to the global average of 7.1. However, timely treatment, awareness, and preventive measures can cure people who have cervical cancer.?

Every year, about 123,907 women are diagnosed with cervical cancer, with around 77,000 executions in India. This is because HPV is high in India, with around 80% of sexually active women acquiring genital HPV by age 50. Nonetheless, under-reporting, low screening rates and an increase in HPV-positive head and neck cancers contribute equally to cervical cancer.?

Between 2014 and 2023, about 3.19 lakh women lost their lives because of cervical cancer. This roughly translates to an average of 87 mortalities in a day. On average, around 12 are from Uttar Pradesh, 9 from Tamil Nadu, 8 from Maharashtra, and 7 from West Bengal. Timely detection and vaccination can reduce this number. Moreover, the Government of India announced plans to encourage HPV vaccination. The recommended age for vaccination is 11 to 15 years. However, it can extend up to 26 to 45 years with medical consultation.?

North-Eastern Region??

A study found that 13% of women in the Northeast have persistent high-risk Human Papillomavirus (HPV) infections, elevating their risk of developing cervical cancer. The Papumpare district of Arunachal Pradesh has the highest incidence rates.

The study also unveiled the importance of timely HPV vaccinations, an effective measure to prevent future cervical cancer cases among women. Some crucial findings of the study,?

• 13% of overall HPV prevalence?
• 10% tested positive for HPV-16 and HPV-18?
• The mean age of HPV-positive participants was 46 years.?
• Cytology results underscore that 87% of participants were normal, 11% showed inflammatory changes, and 2% exhibited epithelial cell abnormalities.?
• 79% of participants were premenopausal with a functional menstrual cycle, while 21% were postmenopausal.?

Besides this, according to the latest study by ICMR-NCDIR, Mizoram and Nagaland have reported the highest cervical cancer burden in India. The burden peaked among the age group of 65 to 69 years, among which about 60% of the burden was experienced by women between 50 and 74 years of age. Karnataka and Arunachal Pradesh also reported the same.?

Uttar Pradesh?

Uttar Pradesh reported the highest prevalence of cervical cancer, with more than 45,000 cases, followed by Tamil Nadu (36,000 cases) and Maharashtra (30,000 cases). Including West Bengal, the four states together accounted for 40% of the cases in the country in 2023. Meanwhile, states like Karnataka and Bihar reported more than 20,000 cases each. Together, these six states were estimated to have 53% of the cases in the country.

Among those 45,000 cases, UP had only about 40 cases per one lakh women, while Bihar (23,000) cases recorded 37 cases per one lakh women. This normalized figure is much lower than that of Punjab (10,000), with 71 cases per lakh women, or even Mizoram, with 105 cases per lakh women in the state.

HPV 16 and HPV-18 are responsible for most cervical cancer cases. However, experts also observed that many people are unaware of the importance of routine screenings and vaccines, as well as the significance of gynecological health. Additionally, lower socioeconomic status, early marriage, and multiple sexual partners are all other risk factors contributing equally.?

ICMR study also estimated the age-standardized incidence rate of cervical cancer in India for 2016 at 12.1 per 100,000 women, which is three times higher than the cervical cancer elimination target of 4 per 100,000 women, as set by the World Health Organization (WHO).?

In 2020, the World Health Organization (WHO) set a global strategy to eliminate cervical cancer by 2030. The approach involves three key areas.?

• Aged 15 will be fully vaccinated with the HPV vaccine 90% of women.?
• 70% of women will be screened for cervical cancer using a high-performance test by ages 35 and 45.?
• 90% of women with cervical cancer will receive treatment.?

Tamil Nadu?

Tamil Nadu ranks second after Uttar Pradesh, with the highest number of cervical cancer cases in India, with a key holding of 36,014 cases. In 2023, over 8,500 recent cases of cervical cancer were reported in Tamil Nadu. The prevalence of cervical cancer in Tamil Nadu has increased by 16.62% in the past 10 years, especially in women aged between 35 years to 44 years.?

The 5-year relative survival rate for cervical cancer in India is 46%, but this varies depending on the stage of diagnosis. The survival rate is 7.4% for advanced-stage disease, compared to 73.2% for localized cancer.

Age-wise distribution of Cervix Uteri Cancer?

Cervix uteri cancer is another name for cervical cancer. In India, cervical cancer contributes to approximately 6–29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries, with the highest being 23.07 per 100,000 in Mizoram state and the lowest being 4.91 per 100,000 in Dibrugarh district. The research found an age-wise distribution of cervix uteri cancer in India.

Why is Cervical Cancer Prevalent in India??

According to ICMR-NCRP, the number of cancer cases in the country is projected to go up from 14.6 lakh in 2022 to 15.7 lakh in 2025, and cervical cancer is a significant factor in it. One primary reason for the rise is the lack of awareness and education regarding cervical cancer and the right preventive measures to reduce the burden. Besides, a lack of access to healthcare services and delays in routine screenings and HPV vaccines cause delays in diagnosis and higher mortality rates.?

The rise of cervical cancer in India is a multifaceted issue influenced by a combination of factors, including lack of awareness, cultural norms, socioeconomic disparities, and inadequate healthcare infrastructure. To fight against this expanding public health risk, a comprehensive strategy that considers these interconnected challenges is necessary.?

Tips to Prevent Cervical Cancer?

Cervical cancer is curable if it’s diagnosed and treated early. A 5-year relative survival rate for cervical cancer is 91% when diagnosed early. Early detection benefits a healthcare professional to perform treatment methods, such as immunotherapy, targeted therapy, chemotherapy, and radiation therapy, which are the most successful treatment methods for cervical cancer. Nonetheless, cervical cancer is preventable with regular checkups like PAP smears and HPV vaccination.?

According to the Centers for Disease Control and Prevention (CDC), up to 93% of cervical cancers are preventable. The preventable methods include:

• Regular cervical cancer screenings- A woman should get screened for cervical cancer every five years. However, women with certain medical conditions must consult a doctor to determine the frequency.?
• Get the HPV vaccine—The HPV vaccine is an effective way to prevent cervical cancer. It is recommended that the vaccine be given at age 11 or 12, but it can be given as early as age 9. Three doses of the vaccine are given over about nine months.?
• Lifestyle Factors—Your daily habits determine your risk of certain medical conditions. Certain practices, such as a healthy diet, regular exercise, limited sexual partners, safe sex, and limiting (or avoiding) tobacco consumption, can prevent cervical cancer.?

How Can Prevention Put an End to the Number??

Studies revealed that cervical cancer cases are on the rise in India, and certain medical conditions like diabetes or hypertension can impact the prognosis for people with cervical cancer. Diagnostic tests can curb accountability by early detection and treatment, creating a barrier for precancerous cells to develop into one.?

The World Health Organization (WHO) recommends an HPV test as the primary screening method for cervical cancer. It can detect cervical abnormalities and reduce the risk of cervical cancer. Moreover, the PAP smear test is another important diagnostic test that can examine cervical cells for abnormalities to diagnose signs of cervical cancer. These blood tests can early diagnose cervical cancer by providing information about your overall health, organ function, and potential disease.?