Curbing cervical cancer in India

Dr. Abha Jaiswal, CNS Correspondent, India
“Cervical cancer? What is that?” wondered Shreya (name changed) when the doctor informed her about her condition. Shreya did not know much about cervical cancer and her first petrifying thoughts were that her two young daughters were going to become motherless. It was January 2010 Shreya, who had just turned 40, had been suffering from irregular menstrual bleeding and severe pelvic pain for a few months.

Blaming it on the hormonal changes in her body, she eventually visited her doctor who recommended a routine pap smear test. When the pap smear was positive she was asked to undergo a biopsy and visit a gynaecologist oncologist. Nevertheless, she was taken by surprise when diagnosed with cancer of the cervix—the most common cancer that affects women in India. She was at the prime of her career path and had been recently promoted as Senior Manager in her company. Even though she had a very supportive husband, she could not dare to share this information with friends and colleagues, thanks to the stigma attached with the disease. She was not able to share her anguish and agony with anyone.

The story of Shreya is not unique. There are many more like her. Sexually transmitted human papilloma virus (HPV) infection is the most important risk factor for cervical cancer. The worldwide incidence of cervical cancer is approximately 510,000 new cases annually, Globally, there are approximately 510,000 new cases of cervical cancer annually, with approximately 288,000 deaths worldwide, one third or 74,000 of which occur in India. However, no woman should die of cervical cancer as interventions are available for comprehensive cancer prevention and treatment. The disease can be cured when detected early on and treated. Moreover, vaccines are available to protect against the types of HPV that cause about 70% of cervical cancers. Unfortunately, HPV vaccine is available in India only in the private sector. This makes a large number of girls/women, who cannot afford the vaccine, vulnerable to a lifetime risk of cervical cancer. It is encouraging to know that the HPV vaccine was piloted in Punjab last year and there is a possibility that other states will follow suit.

Indian government’s National Family Health Survey 4 has, for the first time, collected data on screening of cervical, breast and oral cancer. The Government of India is seized with the extent of the problem,  and the national cancer screening framework was released in August 2016. The framework sets the grounds for recommendations for the country: what is practical, what is ideal, and what is actually feasible. The Ministry of Health and Family Welfare has two schemes under which it offers financial aid to patients living below the poverty line. The “Rashtriya Arogya Nidhi” allows free treatment in 27 regional cancer centres in the country, while the Health Minister’s Discretionary Grants offers up to Rs. 50,000 to poor patients where free medical facilities are not available. These safety nets are crucial so that no one is left behind.

Cancers fall under the category of non-communicable diseases (NCDs), which have now become a leading cause of premature deaths globally. This has led to organizations such as the Global NCD Alliance to reach out to ‘a broad cross-section of people living with NCDs to understand the main challenges that they face and how they want to be meaningfully involved in the NCD response’. The initiative advocates for people with NCDs to amplify their voices and views. This way it tries to demystify the misconceptions and develop an empathetic response to people who suffer from these diseases.

While governments are committed to reduce by one third premature deaths due to NCDs (including cancers) by 2030, all stakeholders, including the medical fraternity, decision makers, patients and champions must commit themselves to a comprehensive approach to curb cancer in India. This is essential to restore confidence in people suffering from the disease.

Shreya was lucky as her cancer was detected in the early stages. She was able to undergo surgery the same year and is now leading a normal life. However, she recalls her biggest challenge was the stigma and humiliation attached to the disease. This should not be so. All women should be able to access preventive and curative (if need be) treatment for cervical and other forms of cancer.

Dr. Abha Jaiswal, Citizen News Service - CNS
July 19, 2016

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