Catch the crab: HPV vaccination programme can cut cervical cancer cases by 90%

CHENNAI: The Tamil Nadu budget announcement on progressively providing vaccination against human papillomavirus (HPV), which causes cervical cancer, to all 14-year-old girls has earned laurels from the medical fraternity.

According to doctors, this was a ground-breaking move which could help eliminate cervical cancer, among the most common cancers among women in India and a leading cause of deaths.

"This step will bring down the incidence of cervical cancer by around 90 per cent. The advancements in the medical field have already brought down the mortality rate due to cervical cancer. If en masse vaccination is done, the death rate can be reduced further," said Dr K Kalaivani, former director of Institute of Obstetrics and Gynaecology, Egmore.

Cervical cancer accounts for 15.3 per cent and is the second-most common cancer among Indian women, with an estimated 75,000 new cases and nearly 42,000 deaths annually. India contributes to one-fifth of the global cervical cancer burden.

“The primary cause is persistent infection with high-risk strains of the human papillomavirus (HPV), which is responsible for over 95 per cent of cervical cancer cases," said Dr Swaramya Chandrasekaran, senior consultant, department of obstetrics and gynaecology, Rela Hospital.

If a mass vaccination drive is undertaken, India can prevent as many as 60,000 cervical cancer cases every year. The cost of treatment is another factor. According to Dr Swaramya, studies estimate that every rupee spent on HPV vaccination could save up to five times the cost in future cancer treatment.

“In India, only 22 per cent of women aged 30 – 49 undergo cervical cancer screening. The vaccination drive could improve awareness, leading to better uptake of pap smears and HPV testing, reducing late-stage diagnoses," she added.

"Cervical cancer spreads mainly through sexual activity. One of the challenges is that the cancer is determined only in a later stage, as one of the major symptoms is white discharge which is normal in women and not taken seriously. This delays treatment. Other main symptoms are bleeding and back pain. Regular screening must be done because the chance of curing is high if it is determined early. In many cases, the number of cervical cancer patients is more in rural areas," said Dr Naveen Ravel, head of oncology department, Government Stanley Medical College Hospital.

Globally, HPV vaccination programmes have led to an 83 per cent decline in HPV infections among teenage girls in countries with high vaccine coverage, pointed out Dr Swaramya. In Australia, where the HPV vaccination programme was introduced in 2007, cervical cancer is now on track to be eliminated as a public health issue by 2035. “Tamil Nadu's initiative could have a similar transformative impact in India," Swaramya said.

However, there are challenges as well. A 2023 study found that nearly 40 per cent of Indian parents were hesitant about HPV vaccines due to misinformation. That is why education is important.

For maximum impact, at least 80 per cent of eligible girls must be vaccinated. The success of the initiative will depend on accessibility, logistics, and outreach, especially in rural areas, Dr Swaramya said.

The same virus also causes oropharyngeal, anal, and penile cancers in men, including boys, she said, adding that the future vaccination drives could further reduce HPV transmission and cancer burden.

It may be noted that Tamil Nadu's move aligns with the World Health Organisation’s global strategy to eliminate cervical cancer by 2030, which aims for 90 per cent HPV vaccination coverage, 70 per cent screening, and 90 per cent treatment for cervical cancer cases.

The Big Burden

According to a study conducted by the State Health and Family Welfare Department in 2010, globally, there were 2,75,128 deaths due to cervical cancer. In India, approximately 72,825 women died due to this cancer. Every year, 1,32,082 Indian women are diagnosed with cervical cancer.

Women in developing countries are most vulnerable, accounting for about 86 per cent of the total cases. About 11.4 per cent of women are estimated to harbour HPV infection of the cervix at a given time and 70.9 per cent of invasive cervical cancers in the world are attributed to HPVs of type 16 or 18.

In India, about 7.9 per cent of women in the general population are estimated to harbour cervical HPV infection at a given time and 82.5 per cent of invasive cancers are attributed to HPVs of type 16 or 18.

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How to diagnose

Traditionally, papanicolau test or the pap smear test has been the screening test used widely to screen for cervical cancer. But it requires a certain level of skill to take adequate smear, a cyto technician to process the specimen, and a pathologist to interpret the results.

It needs proper infrastructure and well-equipped labs for testing, skilled technicians, and transport facility. There is also a time delay for the report to be ready, increasing the risk of losing the patient in the meantime.

Visual inspection with acetic acid followed by visual inspection with Lugol's Iodine (VIA/VILI) was a method that had been introduced and used on a small scale in India for screening cervical cancer.