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India accounts for 1 in every 5 cervical cancer cases, almost 1 in 4 deaths, finds Lancet study

Study by WHO's cancer research wing says incidence rates of cervical cancer a public health issue. Finds 39% cases occur in India & China, and is largely 'preventable' with HPV vaccine.

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New Delhi: About one in every five, or 21 per cent, cases of cervical cancer are reported from India, according to a study published in the journal The Lancet Global Health Thursday. It also notes that of the deaths that occur due to this type of cancer, 23 per cent — almost one in every four deaths — take place in India.

The study relied on the global 2020 database of the International Agency for Research on Cancer (IARC), a part of the World Health Organization (WHO), according to which there were over 6 lakh new cases of cervical cancer and over 3.4 lakh deaths worldwide in 2020.

“More than 58 per cent of all cases of cervical cancer globally were estimated in Asia followed by Africa (20 per cent), Europe (10 per cent) and Latin America (10 per cent) and more than half of deaths were estimated in Asia (58 per cent) followed by Africa (22 per cent), and Latin America (9 per cent),” notes the study.

The study adds that the bulk of all cases in Asia, 39 per cent, occurred in India and China — 21 per cent and 18 per cent, respectively. The countries also accounted for 40 per cent of the total deaths from cervical cancer (23 per cent in India, 17 per cent in China).

At 18 cases per 1 lakh woman-years the population-level incidence rate of cervical cancer in India is four and a half times higher than the threshold set by the WHO to consider cervical cancer eliminated as a public health problem.

Woman-years is calculated based on the study period and the period of time the woman is disease-free — 100 woman-years can either be 100 women over one year or 10 women over 10 years.

However, the study also pointed out that countries such as India, Brazil, Thailand and Poland have also seen a steep decrease in incidence rates thanks to declining fertility rates and access to screening and treatment services.

The study was conducted by researchers from IARC, Scuola Superiore Sant’Anna in Italy; US National Cancer Institute; Scientific Institute of Public Health, Belgium; and University of Ghent, Belgium. It warned that unless immediate steps are taken, the target to reach the WHO elimination threshold by 2030 will be missed.

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A largely ‘preventable’ cancer

Cervical cancer, which is among the most common cancers in women globally, has seen remarkable advances in recent years. In a statement, Dr Deependra Singh of IARC, who is one of the authors of the study, said, “HPV vaccination and screening technologies mean that cervical cancer is now largely preventable. Our study finds encouraging decreases in some high-income countries following the successful implementation of HPV vaccination programmes and screening — such as in Sweden, Australia, and the UK — but globally the burden remains high.”

HPV stands for the Human Papilloma Virus which is responsible for 95 per cent of all cervical cancers.

Globally, the cervical cancer incidence rate in 2020 stood at 13 cases per 1 lakh women per year and fatalities at seven deaths per 1 lakh women per year. Incidence rates in 172 out of 185 countries exceeded the WHO elimination threshold (4 cases per 1 lakh women).

Case rates ranged from two cases in Iraq to 84 cases in Eswatini — per lakh women per year. Mortality rates ranged from one death in Switzerland to 56 deaths in Eswatini per lakh women per year.

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HPV vaccination in India

India has been on the brink of a population-level HPV vaccination programme for some time now. In 2017, the National Technical Advisory Group on Immunisation (NTAGI), the highest advisory body on immunisation in the country, recommended the vaccine for both boys and girls. But experts had said that given the burden of the disease overwhelmingly in girls, they should be the first targets.

Sources in the Union health ministry told ThePrint that the government is currently considering a proposal to start administering the vaccine to nine to 14-year-old girls as part of the Universal Immunisation Programme (UIP).

The NTAGI recommendation when it first came, ran afoul of the Swadeshi Jagran Manch (SJM), the economic wing of the Rashtriya Swayamsevak Sangh (RSS). SJM protested the plans of the NTAGI to introduce the HPV vaccine in the UIP.

They wrote to Prime Minister Narendra Modi against the move, stating that it will “divert scarce resources from more worthwhile health initiatives”. But the recommendation was accepted and, in September this year, the Serum Institute of India announced that they have developed an indigenous version of the vaccine costing between Rs 200 to 400.

Some states have launched their own effort towards immunisation. Delhi led the way in 2016 to launch HPV vaccination as a public health programme. In 2017 and 2018, Punjab and Sikkim too launched their own programmes.

(Edited by Theres Sudeep)

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