Cervical cancer is the fourth most common cancer in women globally. In 2022, 6,60,000 new cases of cervical cancer and around 3,50,000 deaths caused by it were reported, as per the World Health Organization (WHO) data.
Cervical cancer can be cured if diagnosed and treated at an early stage of disease. However, doctors and health experts maintain that delayed diagnosis continues to be a major challenge in India.
As of 2023, there are 6 HPV vaccines available globally. All protect against the high-risk HPV types 16 and 18, which cause most cervical cancers and have been shown to be safe and effective in preventing HPV infection and cervical cancer, WHO reveals.
“… two most important preventive measures are, pap smear for women who are married between 30 to 16 years of age and HPV vaccination for adolescent girls. The ideal age group between 11 to 15 years, where we need to give 2 doses of, HPV vaccine, Cervavac. And, the next best time is anytime before becoming sexually active. So, national immunization program is, yet to be launched. We are hoping that it will be launched soon. That will be the major, landmark…the HPV vaccination rates are extremely low. So due to these, definitely we see a lot of cervical cancer cases in India. There are also estimates that almost 15 to 20% of the cervical cancer burden all over the world, is from India,” Dr Richa Bansal, a Consultant Gynec Oncosurgeon, Laparoscopic and Robotic Surgeon at Apollo Cancer Centres, Navi Mumbai told Financial Express.com during Apollo Cancer Conclave 2024 in Mumbai.
She also said that the oncologists are trying to increase the awareness, among the community as well as among our fellow doctors like general practitioners, gynecologists, pediatricians. She also highlighted that we still don’t have any “proper” national vaccination although there is an uptick in vaccination in urban areas.
On diagnostic and treatment challenges, Dr. Bansal revealed that in India, majority of our women are diagnosed in locally advanced or advanced stages of the disease.
“…that is the main problem that we need to deal with. Once the disease is locally advanced or advanced, cancer of any part of the body, you know, the treatment protocols are going to be complicated…they will require multi modality treatment with, maybe surgery, chemotherapy, radiation. Whereas early stage cancers would be curable with just surgery, alone. So, you know, almost 60 to 70 percent of women, are diagnosed in both the advanced and advanced stages. So this is, I think, the biggest challenge. And of course what will help in this is awareness screening, the population based screening, and HPV vaccination, programs,” she told Financial Express.com.
She also revealed that in advanced stage of cervical cancer, treatment protocols are more complicated and expensive.
“The success of treatment, decreases with more advanced stages. We cannot expect the same treatment outcome when we are treating a stage 1 cancer versus a stage 3 cancer,” she added.
Due to we have changed a lot over the last 2 decades because of our lifestyle and all these increase in NCDs.
On pregnancy and cervical cancer, Dr. Bansal said that fertility can be preserved for a woman with cervical cancer only when cancer presents in a very early stage of the disease.
“Tumor size should not be more than 2 centimeters. It should not have spread anywhere…we do expect that as screening will improve, you know, we will pick up these cancers at a very early stage and also at younger age where they would not have completed their family and definitely in those selective category of women fertility sparing surgery can be offered. So there is still scope of preservation of fertility despite having cervical cancer where we can have adequate cancer control also and fertility preservation also. But then for that, our population has to be more aware. They should be having regular screenings and so that cancer is picked up really, very early,” she informed.
Fertility sparing surgery when done appropriately for women with very early stage does not compromise cancer control, and we can still have a very good cancer control and very good prognosis, she said. She also said this surgery is definitely available at the major cancer institutes all over the country.
Cervical cancer is frequently diagnosed in women during their reproductive years. Consequently, fertility preservation is an essential part of their cancer treatment. According to a 2024 study published in Current Oncology journal, several fertility preservation modalities are available for patients with early stage cervical cancer.
“In cases where uterine preservation is not possible, fertility preservation can be performed using cryopreservation of oocytes, embryos, and ovarian tissues, as well as ovarian transposition. These methods enable patients to have future fertility through ART and surrogacy,” the study found.
