‘Cervical cancer need not be a death warrant’

Thanks to the development of highly accurate tests in the last few years for cervical cancer screening,as well as their wide availability,cervical cancer has all but been eliminated in the developed world. Unlike most other cancers,scientists have identified the cause of cervical cancer: a common virus known as the human papilloma virus or HPV.

Recently,they have also developed a new vaccine against HPV. First licensed in 2006,these vaccines are now available in North America and Europe and provide protection against about 70 percent of cervical cancers. Despite this progress,however,most young women in India do not have access to these vaccines. It is true they are expensive,but surely this can not become a reason not to save precious lives? We must ensure that the vaccine reaches those at highest risk.

It is,however,also worthwhile to remember that while vaccines can save young lives,they will do little to protect women who are already sexually active,because there is a high probability that they are already infected with HPV. For them,cervical cancer screening is a must. If women who are likely to develop cervical cancer can be identified through screening tests,their abnormal cervical lesions can be removed with simple non-invasive interventions even before they progress to cancer.

While the good news is that these tests are available in India,the bad news is that most women in India do not have access to quality screening,especially the most vulnerable and those at high risk who live in slums and villages. For the past 60 years,the main test for the disease has been the Pap smear,in which a swab is taken and the cervical cells are visually examined under a microscope for abnormalities. Although this test has saved many lives,it requires highly trained personnel both to conduct it properly and then to accurately interpret the results.

These people are at a premium. Consequently,doctors regularly see women in the prime of their life with advanced,incurable cervical cancer. There is little they can do to save a women’s life at this late stage or even improve her quality of life. Drugs to ease pain,such as oral morphine,and palliative care services that address distressing symptoms and provide psychosocial support are usually unavailable in these poor communities.

Scientists are currently working on developing a screening test with higher accuracy than the Pap smear for use in remote,rural areas of developing countries,including India. The test won’t require infrastructure such as electricity and clean water and can be run with little technical training and yet will have the potential to save many more lives. This is still in the future. At present,there is another method of screening for cervical cancer that is being used in developing countries.

This is known as “visual inspection with acetic acid” test or “VIA”. In VIA, vinegar is sprayed on a woman’s cervix and examined with the naked eye to see if any lesions appear. It has the advantage of not requiring highly trained personnel and can therefore be made more widely available at lesser cost than the Pap smear,however,the disadvantage is that it can only detect 41% of HPV cases.

To sum up,I believe that we have a moral obligation to make available to women in this country tools that can save their lives by preventing cervical cancer and catching it early while it is still curable. For this purpose,national and state governments,business leaders and NGOs must work together to ensure that girls at high risk have full access to HPV vaccines and that women of all ages are able to be tested for the HPV virus,irrespective of their socioeconomic status,no matter what the cost.

Harmala Gupta is a cancer survivor. In 1996,she founded CanSupport which runs a home based palliative care programme in Delhi and the NCR.