For the past month, I have been using every opportunity I can to highlight a disease that kills a quarter of a million women each year — cervical cancer. Sadly, one in four of those women is in India. In terms of number of cases and deaths, India has the highest burden of the disease in the world. The social and economic costs of losing women to cervical cancer are devastating; many families are losing their mothers, sisters, daughters, breadwinners and caretakers.
And yet, this is a disease that can be prevented. Effective interventions exist to save lives. There are screening techniques for early detection of cervical pre-cancer, simple procedures to treat pre-cancerous lesions, and there is a vaccine against the human papillomavirus (HPV).
The technology behind the first HPV vaccine was developed more than 25 years ago by Ian Frazer, Jian Zhou and their colleagues at the University of Queensland, Australia. The vaccine protects against the high-risk types of HPV that are responsible for over 70 per cent of cervical cancers.
Australia was the first country to implement a national school-based HPV immunisation programme for females in 2007, which was expanded to males in 2013. The programme provides the HPV vaccine in schools, free of charge, to both females and males aged 12-13.
In contradiction to popular belief, HPV does not just affect women. These viruses are associated with cancers in men as well, and expanding the vaccine to males reduces the prevalence of HPV in the community.
In 2018, Australia will commence using a new HPV vaccine that protects against nine strains of HPV. This vaccine has been included in Australia’s National Immunisation Program following rigorous testing by the Australian Therapeutic Goods Administration. The vaccine’s safety has also been demonstrated in many Australian and international academic studies.
Another key element of Australia’s prevention programme is our National Cervical Screening Program. Since the programme’s commencement in 1991, the rate of cervical cancer in Australia has halved and our cervical cancer mortality rate is now among the lowest in the world.
Schemes such as this are only effective if women know they exist, are able to access their services, and are encouraged to use them. In Australia, cervical cancer prevention campaigns raise awareness of the importance of vaccination and screening. Culturally appropriate screening services are also available, including provision of female health practitioners, and the costs of attending services are kept to a minimum.
Likewise, the success of the HPV vaccination programme in Australia has been the result of educational campaigns that have raised awareness of the vaccine and addressed concerns, including through the provision of evidence-based information to parents, adolescents and immunisation providers since the programme commenced in 2007. These activities have contributed to the high HPV immunisation coverage rates for both males and females in Australia (73 per cent and 79 per cent, respectively).
Across the world — from India to Australia and beyond — stigma around women’s sexual and reproductive health issues is a barrier. Many women in India have never heard of cervical cancer, let alone know what actions they can take to prevent the disease. Less than 5 per cent of the eligible women in India have ever been screened for cervical cancer.
Although it will take many years for screening and treatment services to be made uniformly available for women across India, it is a worthwhile investment to make.
The government of India has already taken commendable steps toward reducing the burden of cervical cancer. For example, screening guidelines have been introduced by the Ministry of Health and Family Welfare, recommending screening for women aged 30-59 every five years.
A comprehensive approach that includes HPV vaccination, screening and treatment is the surest way to protect India’s women and girls from cervical cancer. Australia has taken these steps, and we are already seeing the benefits.
Cervical cancer prevention is an investment in the lives of women today, the health of our daughters tomorrow, and the strength and prosperity of generations to come.