Cervical cancer – The major causes of cancer Death in India
Cervical cancer, Introduction, table of contents, Primary Source of cancer data, Cervical cancer and human papillomavirus, Primary and secondary prevention of cervical cancer, what do we need? A suggested approach
Cervical cancer
Introduction
If we consider the incidence depending on age -standerdization and mortality rates of 22 and 12.4 /100,000 women every year,
We can consider that cervical cancer is the second leading cause of death in all cancer deaths in India.Also 25% of all deaths occur wourldwide due to cervical cancer occur in India.
The main reason for this is lack of awareness, effective screening and timely treatment or access of it. If we look at the overall 5-year survival which is of 46% for all cervical cancers in India : it is strongly determined by the stage at diagnosis,
Also when is comes to survival rate in advance stages its as as low as 7·4% compared to 73·2% for localised cancer.
Source of cancer surveillance data in India – Primarily taken
National Cancer Registry Programme (NCRP) in 1981 was initialted by The Indian Council of Medical Research (ICMR). Three population-based cancer registries (PBCRs) at Bangalore, Chennai and Mumbai and three hospital-based cancer registries (HBCRs) at Chandigarh, Dibrugarh and Thiruvananthapuram were set up. The latest 3-year report (2012-2014) has data from 27 PBCRs and 17 HBCRs
Cervical cancer and human papillomavirus
Globally, 70–80% of cervical cancers are attributed to human papillomavirus (HPV), mainly genotypes 16 and 18. In India, HPV prevalence is 88–97% among women with cervical cancer and 10–37% among women with no gynaecological morbidities. Cervical cancer incidence is greater among women of lower classes, those less educated, and those with a larger number of children. (Sreedevi et al, Int J Womens Health. 2015)
Primary and secondary prevention of cervical cancer
The Government of India has commenced a program to screen all women aged 30-64 years for cervical cancer every 5 years using visual inspection by acetic acid under the National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke of the National Health Mission. The Operational Framework of Management of Common Cancers has provided broad programmatic guidelines as well as screening and management algorithm (see below). This is consistent with the WHO-recommended strategy for secondary prevention with treatment of pre-cancerous lesions.
What do we need?
Action is needed both for primary and secondary prevention of cervical cancer. HPV vaccination is now globally accepted as a safe and effective means of primary prevention of cervical cancer, and the issue of HPV vaccine introduction into government immunization programs has been intensely debated in India. Delhi and Punjab have initiated a public HPV vaccination program. Experiences gained at the programmatic and the community levels will be key to scaling up the program. Also urgent is to make the secondary prevention programs efficient, affordable, scalable and sustainable. In the case of VIA, quality control has proven to be highly variable, resulting from difficulties enforcing quality assurance and supportive supervision, impacting profoundly on both the sensitivity and specificity, as the interpretation of VIA is highly subjective. VIA positivity rates can vary as much as 10-fold, suggesting the need to bring in quality control measures. HPV DNA testing is being advocated, but pricing remains prohibitive. Over time, this strategy will likely replace VIA as an initial screening test, but VIA will continue to play a role in a secondary screen for those who test positive for the cancer-causing subtypes of HPV
A suggested approach
Mobile technologies are ideally suited to surveillance and are a fundamental component of health systems critical for measuring the progress of disease control and prevention measures, for appropriate targeting of resources, and for elimination of diseases. This also helps with data collection systems for patient and programme monitoring, which are confounded by lack of standardized tools and resources. The mobile smart phone-based platform allows nonphysician health providers to send cervical images and their diagnoses/treatment plans to more skilled health providers and peer-educators/trainers so that they can receive real-time supportive supervision and provide high quality cervical cancer screening services without requiring in-person training. This program can bridge the resource and health human resource gaps by facilitating supervision of newly trained cervical cancer screening providers from a remote site. We need to test this tool alongside a primary screen for HPV DNA, a study in which this approach is compared with the traditional VIA testing will be of great value. These tools enhance the skill of health providers, facilitate same day treatment for precancerous lesions, appropriate referrals for cancerous lesions and support a robust, real-time data monitoring and evaluation system that is accessed by government partners/stakeholders and other users at the local, district, state and national level.
