In the quiet moments between hospital visits and blood transfusions, 58 year-old Anil Singh finds himself thinking about the future of his two 20-year-old daughters. After watching his wife endure years of cervical cancer treatment, he is now determined to get them vaccinated against HPV, the human papilloma virus responsible for most cervical cancers.
“Had this vaccine been available or had I known about it earlier, I would have ensured that my wife too, had a shot. Now doctors say that taking the HPV vaccine in your 40s can still provide benefits, specifically by protecting against high-risk HPV strains you have not yet been exposed to,” he says. While not routinely recommended for those over 26, the US Food and Drug Administration (FDA) has approved the Gardasil 9 vaccine for individuals up to age 45.
Singh has had a long, exhausting and financially draining journey since 2018, when his wife, Baby Singh, now 53, first developed symptoms. It started with watery discharge, followed by bleeding. They consulted a local gynaecologist who recommended a biopsy when the bleeding continued. The diagnosis marked the beginning of a relentless cycle of consultations and treatments. Singh sought multiple medical opinions before starting her treatment at a cancer hospital in East Delhi. Baby underwent 31 sessions of radiation (31 fractions) and seven cycles of chemotherapy over several months. The side effects were severe — vomitting, diarrhoea, hair loss, weakness, irritation and persistent pain in her limbs. “There were days she could barely sit up,” Singh recalls. Yet they did not miss a single follow up appointment, initially monthly and later spaced out over a few months.
Relapse and advanced cancer
Until last May, her condition seemed stable and she seemed to be in remission. But in June 2025, the watery discharge returned. Singh sensed something was wrong. Although doctors suggested waiting a few months before conducting further scans such as MRI or PET-CT, he sought additional consultations. Eventually, it was confirmed that the cancer had relapsed and progressed to an advanced stage. Dr Atul Sharma, chairman, medical oncology at Max Healthcare, formerly of AIIMS, explains that relapse in cervical cancer depends largely on the stage of the disease. “I was not surprised by her complication. For patients in their middle stages, relapses are more common. In most cases, when a relapse occurs, it is considered advanced, especially if the cancer has spread to multiple organs. Only very small recurrences can be treated with surgery alone,” he says.
Sometimes, small clusters of cancer cells may remain in the body, particularly outside the pelvis, after treatment. High-risk HPV strains (especially 16 and 18) survive treatment and can lead to new lesions. If cancer has spread to the lymph nodes, the risk of recurrence is higher. Currently, Baby is undergoing chemotherapy, which kills rapidly dividing cancer cells, and immunotherapy, which boosts the body’s immune system to destroy cancer cells more effectively. She has shown some response to treatment but the disease has not completely disappeared.
“That’s why,” Dr Sharma emphasises, prevention and early detection are crucial, as treatment becomes more challenging once the disease recurs. As of now, Baby continues to be fragile. She requires blood transfusions due to heavy bleeding, with platelet counts and haemoglobin levels dropping significantly. Now extremely weak, she can walk only short distances and depends on assistance for daily activities.
Burden of cost, and emotions
The financial strain has been staggering. Since 2018, Singh estimates that the family has spent nearly Rs 30 lakh, of which Rs 20-22 lakh came directly from his own pocket. Insurance covered only Rs 3 lakh. Among the most expensive components have been diagnostic tests and immunotherapy, which cost about Rs 4 lakh per session. Baby has undergone five such sessions so far. To keep up with expenses, Singh borrowed from siblings, in-laws and his son. He also lost his job in finance because he needed to accompany his wife to the hospital almost every day, making regular employment impossible.
At home, roles shifted quickly. His elder daughter now manages cooking, while both daughters assist with caregiving, including bathing, feeding and tending to their mother’s needs. The household routine revolves entirely around hospital appointments, follow-ups and treatment cycles. Singh considered care at government institutions such as All-India Institute of Medical Sciences (AIIMS), Delhi, but found them overcrowded and unable to provide the immediate and continuous attention his wife required, given the unpredictability of chemotherapy schedules. Battling financial insecurity and the emotional strain of caregiving, he says, “Everything is on hold.”
The vaccine shield
Amid this uncertainty, Singh is reading up on the HPV vaccine, which is primarily a preventive measure aimed at girls before they become sexually active. Dr Neerja Bhatla, former head of obstetrics and gynaecology at AIIMS Delhi, explains that the vaccine is most effective before age 15, which is why India’s free vaccination drive targets girls up to 14. Initially, the recommended age was between nine and 11 but current guidelines allow vaccination up to 14. Women in their 20s may still benefit but that dose is payable.
“There is some evidence suggesting that vaccination in older women may help prevent reinfection or recurrence of precancerous lesions but these cases are rare, and no national programme targets women older than 17–18 years,” adds Dr Bhatla. The vaccine targets HPV types 16 and 18, which cause the majority of cervical cancers, and offers some cross-protection against related types. When widely administered, it contributes to herd immunity once cover age exceeds 70 per cent. Modelling studies suggest that achieving 90 per cent coverage could reduce cervical cancer incidence by almost 90 per cent. Combining vaccination with just two rounds of HPV testing at ages 35 and 45 could cut the cancer burden by up to 97 per cent. The vaccination itself is straightforward and even a single dose addresses most of the risk.
Dr Bhatla also emphasises economic benefits: Vaccinating an entire cohort of girls costs much less than treating cervical cancer patients, which can be financially challenging. “For example, in Punjab, vaccinating class VI girl students at around Rs 456 ($5) per dose was far more cost-effective than the Rs 1.5 lakh the government typically spent per patient, excluding out-of-pocket expenses and lost wages. Pilot projects in states like Punjab, Sikkim and Bihar have shown coverage above 90 per cent, refusals being extremely rare,” she says.
Dr Sharma highlights that cervical cancer usually occurs between ages 30 and 50, with most cases presenting at advanced stages in public hospitals. “Vaccination and regular screening must be made mandatory,” he says. Meanwhile, Singh hopes that the single-shot vaccine will safeguard his daughters, sparing them the ordeal that their mother keeps going through.
Share
