Very few women are screened for cervical cancer despite India accounting for 16 per cent of total cervical cancer cases occurring globally. Screening is a preventative service and different techniques have been found effective in reducing the incidence of the disease. But despite the increasing burden, screening for cervical cancer has not been a priority in the last five years, according to findings of the fifth National Family Health Survey (NFHS) 2019-20.
Cervical cancer takes a life every eight minutes in India. Though the cancer is entirely preventable, NFHS 5 shows that very few states have taken up screening of women actively.
Mizoram does the most screening for cervical cancer in women, with a 6.9 per cent rate, while Andhra Pradesh has screened 4.7 per cent women, Kerala is at 3.5 per cent, Telangana is at 3.3 per cent, Manipur at 2.1 per cent and Goa at 1.2 per cent.
According to the district estimates of NFHS-5, Pune’s screening rate, at 3.8 per cent, is higher than Maharashtra’s 2.8 per cent screening rate for cancer.
In the remaining states, less than 1 per cent women have been screened.
According to Dr K S James, director of International Institute of Population Sciences, the NFHS-5 has included new focal areas like non-communicable diseases (NCDs), including screening for cancers that have a high burden, like cervical, breast and oral cancer.
“There has been a complaint that NFHS does not collect enough information on other aspects like NCDs, which has been on the rise in the country,” Dr James told The Indian Express.
Data for screening of cancers has been newly reported in NFHS-5 and hence they are not progression based estimates, Dr James said, adding that it was a clear indication of low awareness levels despite non-communicable diseases being on the rise. “Western countries have to some extent controlled some of the NCDs as the screening is efficient. It is time to make a beginning here,” said Dr James.
Different screening techniques like visual inspection with acetic acid, Pap Smear, HPV-DNA testing and others have been found effective in reducing the incidence of the disease and the programme needs a push from the Centre.
“…we have a long way to go,” says Dr Vinay Kulkarni, coordinator of Pune-based Prayas Health Group. “There are no organised programmes in the public sector. Household surveys are conducted for non-communicable diseases but they are largely tobacco related. Only a few states like Sikkim and others have rolled out a vaccination programme for adolescents against HPV (Human Papillomavirus),” said Dr Kulkarni.
Recently, the World Health Organisation launched a global strategy to eliminate cancer, and on the occasion, at a virtual event, the Prayas Health Group was felicitated for its work in screening over 20,000 women for cervical cancer. Prayas was among seven NGOs from across the country that was felicitated by the Federation of Obstetric and Gynaecological Societies of India & International Federation of Gynaecology and Obstetrics (FIGO ).
WHO’s cervical cancer elimination strategy recommends two doses of HPV vaccination of 90 per cent for girls aged 9 to 15 years. Sikkim was the first state in India to include HPV vaccination in its public health programme for girls aged 9 to 15, followed by Punjab, Delhi, Uttar Pradesh and Himachal Pradesh, Tamil Nadu will soon be added in the list.
“Though Maharashtra is committed, there is no organised programme for vaccination for adolescents. A public health impact can be assessed only if there are organised programmes – presently the coverage of screening or vaccination is limited to doctors advising mothers that their daughter needs to be vaccinated,” Dr Kulkarni said, adding that they have taken up several campaigns to screen women for cervical cancer. “Still, our efforts are like a dot in the ocean,” he said.
Dr Smita Joshi, senior scientist at Prayas Health Group,said there are about 97,000 new cases and over 60,000 deaths due to cervical cancer every year. “Awareness seems to be increasing gradually but there is a need for a structured programme and wider availability of better tests at affordable rates,” said Dr Joshi.
There should be sufficient awareness among doctors too about screening women with an HPV test whenever it is affordable. The vaccines are not really effective once the sexual life of a woman begins. But for all women aged 30 and above, a simple test called cervical cancer screening is recommended.
“Maybe it is time to use advanced technology and leave pap smears, to use the screen and treat strategy when follow-up cannot be ensured,” Dr Joshi said. She pointed out that there are efforts to come out with an affordable HPV test and in Pune, GenepathDx lab has received a grant to develop one such low-cost HPV test.
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