India can eliminate cervical cancer by 2079, estimates a global analysis published in ‘The Lancet Oncology’. The estimates take into account introduction of the HPV vaccine and cervical cancer screening — India plans to introduce human papilloma virus (HPV) vaccine in the government programme by 2020, and has just started screening for cervical cancer in health and wellness centres under the Ayushman Bharat programme.
The article states: “India rates are declining at 3.8% per year, and applying this declining factor indefinitely would result in cervical cancer being eliminated without any requirement for intervention strategies. Therefore, we assume that rates will dampen over time, and will plateau to 0% change per year by 2030 (in the case of China, plateau by 2020).” The estimates are the first of their kind at a global scale.
The study estimates that vaccination and screening could result in cervical cancer being eliminated as a public health problem, with average rates across countries falling to less than 4 cases per 1 lakh by 2055-59 in countries with very high levels of development (the US, Finland, the UK, and Canada, among others), 2065-69 for countries with high levels of development (including Mexico, Brazil, and China), 2070-79 for countries with medium levels of development (including India, Vietnam, and the Philippines), and 2090-2100 onwards for countries with low levels of development (such as Ethiopia, Haiti, and Papua New Guinea).
Why combating cervical cancer is important
HPV, a group of more than 150 viruses, is responsible for majority of cervical cancers. In India, 1,22,844 women are diagnosed with cervical cancer every year and 67,477 die from the disease, according to 2012 estimates. It is the second most common cancer among women - after breast cancer. The Lancet estimates suggest that combining the vaccine and screening in all countries from 2020 onwards could prevent up to 13.4 million cases of cervical cancer within 50 years - or by 2069.
Without expanding current prevention programmes, the study predicts that 44.4 million cervical cancer cases would be diagnosed over the next 50 years —- rising from 6,00,000 in 2020 to 1.3 million in 2069 due to population growth and ageing.
Cervix is the second most common site for cancer in Indian women, preceded only by breast. More Indian women die of cervical cancer than in any other country in the world, and one quarter of the world’s cervical cancer burden is in India.
Estimates on the National Health Portal say: “India has a population of 436.76 million women aged 15 years and older who are at risk of developing cervical cancer. Every year 1,22,844 women are diagnosed with cervical cancer and 67,477 die from the disease (estimations for 2012). In India cervical cancer is the second most common cancer among women and also the second most common cancer among women between 15 and 44 years.”
Globally, cervical cancer is the fourth most common cancer in women. In December 2017, the National Technical Advisory Group on Immunistation (NTAGI), the highest expert group in the country on vaccination, approved the HPV vaccine for inclusion in the universal immunisation programme.
Prof Karen Canfell from the Cancer Council New South Wales, Sydney, Australia, who led the study, stated, “More than two-thirds of cases prevented would be in countries with low and medium levels of human development like India, Nigeria, and Malawi, where there has so far been limited access to HPV vaccination or cervical screening. The WHO call-to-action provides an enormous opportunity to increase the level of investment in proven cervical cancer interventions in the world’s poorest countries. Failure to adopt these interventions will lead to millions of avoidable premature deaths.”