India can avert more than 24 lakh cases of cervical cancer in the next 50 years and death of 100,000 women each year if the government takes up screening and vaccination of cervical cancer in a major way, suggests new research.
Such efforts could result in cervical cancer being eliminated as a public health problem with its average rate falling to less than four per 100,000 by 2070-70 in countries with the medium level of development such as India, Vietnam and Philippines, it says.
“Our research found that if vaccination coverage could be scaled-up to 80-100% coverage in India and if screening coverage could increase to 70% (twice per lifetime), over 2.4 million cases of cervical cancer could be prevented in India over the next 50 years,” said Kate Simms, a researcher at the Cancer Council, New South Wales, Sydney and first author of the paper, published in the Lancet Oncology on Tuesday.
In 2018, India recorded 12.8% prevalence of cervical caner among females and nearly 22% deaths due to cervical cancer. It remains one of the major causes of mortality.
“(If screening and vaccination are done) cervical cancer will be considered eliminated as a public health problem within the next 50 years in India. This would be an enormous achievement,” Simms told DH.
But this is easier said than done. The National Technical Advisory Group on Immunisation - India’s apex technical advisory body that recommends inclusion of any new vaccine in the universal immunisation programme - is yet to suggest the inclusion of HPV vaccine in the UIP, Anupriya Patel, the minister of state for health informed the Rajya Sabha earlier this month.
Introduction of the HPV vaccine would also depend on the outcome of a Supreme Court litigation that originated in the wake of the illegal 2009 trials of HPV vaccines among girls from a poor socio-economic background in Gujarat and Andhra Pradesh.
Government and Parliamentary panels found fault with two leading manufacturers of the HPV vaccine, Indian Council of Medical Research, Drugs Controller General of India and the non-profit agency PATH in permitting and carrying out the trials in which several girls died.
“Its a prediction study, but there are practical difficulties to implement such strategies in the developing world with varying religious beliefs and customs,” commented B C Das, a former director of the National Institute of Cancer Prevention and Research, Noida, who is not associated with the study.
Nevertheless, Simms said, India could play an important role in the global push for cervical cancer elimination as it was centre to the development of a new vaccine and a new trial to demonstrate the efficacy of vaccinating with only one dose which will be critical to effective, practical and rapid scale up.
Overall the study suggests that if high coverage HPV vaccination and cervical screening cannot be achieved globally, over 44 million women could be diagnosed with cervical cancer in next 50 years — two-thirds of these cases, and an estimated 15 million deaths, would occur in countries with low and medium levels of development.
In high-income countries like the USA, Finland, the UK, and Canada, cervical cancer can be eliminated as a public health problem within 25–40 years.