Tamil Nadu reported the second-highest number of cases in India, with around 36,014 cases in 2023, behind UP at 45,682 cases,
Published Feb 05, 2024 | 8:09 AM ⚊ Updated Feb 07, 2024 | 4:41 PM
Cervical cancer is a type of cancer that originates in the cells of the cervix, which is the lower, narrow end of the uterus. (Shutterstock)
Actor Poonam Pandey “passing away” due to cervical cancer at 32 on Friday, 2 February, and then revealing a day later that it was a ploy to bring attention to the disease did create a lot of controversy.
However, there is no denying that the stunt also served the intended purpose of raising awareness and sparking discussions about the disease.
After all, the estimated number of cervical cancer cases in India is around 3.42 lakh. The southern states also had a high number of cases in 2023.
It should be noted that, according to the World Health Organisation, India in 2022 reported 1,27,526 cases and 79,906 deaths due to cervical cancer.
In India, after breast and lip-and-oral-cavity cancer, cervical cancer has the most cases as well as mortality.
Tamil Nadu reported the second-highest number of cases in India in the year 2023, with the number being 36,014, according to the National Cancer Registry Programme report.
It was behind only Uttar Pradesh, which reported 45,682 cases last year.
Karnataka reported 20,678 cases, Andhra Pradesh reported 17,146 cases, Telangana reported 11,525, and Kerala reported 7,765 cases in 2023.
However, the highest age-adjusted incidence rate (AAR) per one lakh population in southern India was in Bengaluru.
The AAR is a statistical measure that accounts for variations in age distribution among populations, providing a standardised rate per 1 lakh people to compare the incidence of a specific health event across different groups.
In Bangalore, the AAR per 1 lakh population was 17.7, while it was 14.8 in Chennai, 11.7 in Hyderabad, and 6.8 in Thiruvananthapuram.
Cervical cancer is a type of cancer that originates in the cells of the cervix, which is the lower, narrow end of the uterus.
It is most commonly caused by persistent infection of the human papillomavirus (HPV) and usually develops slowly over time, often starting with pre-cancerous changes in the cervical tissue.
“This cancer is more prevalent in low socioeconomic conditions, as these individuals with unsafe sexual practices and multiple partners are often seen in lower-income populations,” Chennai-based Kauvery Hospital’s Director and senior consultant radiation oncologist Dr AN Vaidhyswaran told South First.
“Unsafe sexual practices and frequent childbirth, along with illegal abortions, contribute to higher instances of cervical cancer in rural areas compared to metropolitan cities, where breast cancer is more prevalent,” he said.
“Unusual vaginal bleeding, such as after intercourse, between periods, or after menopause; increased vaginal discharge; pain during sexual intercourse; pelvic pain or pain during urination; difficulty or pain during bowel movements or bleeding from the rectum; and swelling of the legs are the some of the common symptoms of cervical cancer,” Hyderabad’s Yashoda Hospitals’ Gynaecologist, Obstetrician, and Laparoscopic Surgeon Dr Sarada M told South First.
There are two main types of cervical cancer. The first is squamous cell carcinoma, which develops from cells in the ectocervix. The second is adenocarcinoma, which develops in the glandular cells of the endocervix.
The doctors emphasised that cervical cancer is not a “sexually transmitted disease” and is not associated with being “promiscuous”. Furthermore, it is not exclusive to any specific profession or lifestyle; instead, it can affect women from all walks of life.
Early detection happens through screening tests such as the Pap-smear test. During the test, a healthcare provider collects cells from the cervix using a soft brush or a flat scraping device. The cells are then placed in a bottle containing a solution to preserve them or smeared onto a glass slide.
Later, the cells are checked under a microscope to see if they look normal or if there are any pre-cancerous or cancerous changes. The Pap smear is usually done in conjunction with a pelvic exam, and it is recommended that women begin screening at age 21.
Cervical cancer screenings, such as Pap smears and HPV tests, require gynaecological examinations that involve exposing intimate body parts to healthcare professionals. This can be a significant barrier for many women, especially in rural India, where cultural norms and modesty regarding the female body are deeply ingrained.
Dr Annapurna V, an oncologist, gynaecologist, and obstetrician from Shankara Hosptial in Bengaluru, told South First: “Several times when we have organised screening camps, women do not come. They are also scared of diagnosis. They believe that everything is alright with them. There is a need to spread awareness of the screening and vaccination for HPV.”
She added that this fear is not only about the diagnosis itself but also about the potential social implications, such as the perception of promiscuity associated with sexually transmitted infections like HPV, which is linked to cervical cancer.
“Cervical cancer can be controlled if it is detected early. The diagnosis can be made easily,” said Annapurna.
A study done in 2020 in three states of the country — including Karnataka — found that there are many societal barriers amongst women.
Several women noted that their spouses and family elders were unsupportive of their decision to undergo cervical screening and lacked awareness of its importance. This resulted in women avoiding screening and dismissing symptoms until they became severe.
Also, discussions about screening raised concerns about modesty or trust, making women hesitant to mention the topic.
Family support for cervical screening depended on the relationship dynamics, understanding between the couple, and the health literacy of family members.
In addition, some women were deterred from screening due to extended waiting times in public hospitals, leading them to visit only when necessary.
Many women, despite having the means to afford private screening, expressed being too occupied with housework to find time for the test.
A majority felt they were in good health and, consequently, did not perceive the need for screening. When asked why they had no intention to undergo screening, the most common response was the belief that screening is only necessary when symptoms arise.
States like Tamil Nadu, which launched a pilot project for the screening of cervical cancer in the Theni and Thanjavur districts, also encountered the same issues.
“When we set up the camp and, with the help of ASHA and ANM workers, women were made aware of the screening programme, many turned up for the screening,” said the health official of Theni district to South First.
Addressing the issue of cervical cancer, Union Finance Minister Nirmala Sitharaman in the interim Budget announced that the Union government would “encourage” HPV vaccination.
The price of the HPV vaccine in India varies depending on the type of vaccine and the provider.
The nonavalent vaccine, Gardasil-9 — which offers protection against nine types of HPV that are responsible for a majority of HPV-related cancers — is priced at around ₹11,000 per dose.
Gardasil-4 targets four strains of HPV — 6, 11, 16, and 18 — and has been licensed for use in India since 2008. It is commercially available for ₹2,000-4,000 per dose.
The Indian-made vaccine Cervavac also targets HPV 6, 11, 16, and 18. A two-dose vial is available for ₹4,000, making it ₹2,000 per dose.
Some states in India, like Assam, have announced free HPV vaccination programmes for schoolgirls in specific districts, and the National Technical Advisory Group on Immunisation (NTAGI) has recommended the introduction of the vaccine for adolescent girls in the 9-14 age group with routine introduction at nine years of age.
Whether it should be encouraged or made mandatory is a matter of debate. Some argue it should be a part of the immunisation schedule, similar to other vaccines administered by paediatricians after delivery.
The challenge lies in ensuring widespread acceptance and participation, as seen with other booster doses in immunisation programmes.
Making it a routine part of the health programme would likely enhance its effectiveness in preventing cervical cancer in the long run.
“The vaccination is absolutely needed for women. Just like the polio vaccination stopped polio in India, this will help in keeping women safe from cervical cancer. Studies have said that women get 97 percent protection after vaccination,” said Dr Sarada M.
