
Cervical cancer is one of the leading causes of cancer-related deaths among women worldwide. Despite being preventable and treatable when detected early, many women in India continue to face challenges in accessing timely diagnosis, effective treatment, and preventive measures like HPV vaccination.
Hemant Kumar Rout speaks to Dr Sachin Sekhar Biswal, medical oncologist at Manipal Hospitals, Bhubaneswar, to discuss advancements in diagnosis, treatment and vaccine availability.
Edited excerpts:
Q. What are the current trends in cervical cancer incidence and mortality rates in India, and how have they changed over the past decade?
Cervical cancer is the second most common cancer among women in India after breast cancer, with approximately 1.2 lakh new cases diagnosed annually. As per the data from global cancer observatory (Globocan 2022), cervical cancer is the ninth most common cause of cancer death worldwide. In India, it is the third most common cancer detected (both sexes combined).
Over the last decade, there has been a slight decline in incidence rates due to increased awareness, improved screening, and vaccination efforts. However, rural areas in the country still witness high mortality rates due to delayed diagnosis and inadequate healthcare facilities.
Q. Which age groups and demographic segments are the most affected, and what are the key risk factors contributing to these patterns?
Higher prevalence of human papillomavirus (HPV) is a major cause of cervical cancer in India and other southeast Asian countries. Women aged 30-50 years are the most affected by cervical cancer. Poor access to healthcare, multiple pregnancies, and lack of education about sexual health contribute to higher prevalence. The risk factors most commonly associated with cervical cancer are multiple sexual partners, smoking, poor genital hygiene, early marriage, and low socio-economic status.
Q. What are the most common diagnostic methods for cervical cancer, and how accessible are they in urban and rural areas?
The most definitive diagnostic method of cervical cancer is a cervical biopsy. Before proceeding for cervical biopsy patients are often screened with the available tests such as pap smear, visual inspection with acetic acid (VIA) and HPV DNA testing. Since the latent period of the virus is high, screening plays a major role in the natural history and early detection of cervical cancer. In urban areas where availability of facilities is not an issue, the usual recommendation is a co-testing (pap smear and HPV DNA) once every five years. In rural areas, however, where the molecular diagnostic methods are not easily accessible, simple pap smear or VIA might be done for screening.
Q. What are the standard management and treatment options available for cervical cancer patients?
Once the diagnosis of cervical cancer is done, next comes staging. It is usually done with the help of a cross-sectional imaging such as CT scan, MRI or a PET-CT scan. In early cervical cancer, the disease can be cured with surgery. Even in advanced stages, the disease can be cured with chemoradiation (combined radiation and chemotherapy). Patients with metastatic disease (disease spread to distant organs) are seldom cured. Metastatic cervical cancer is treated with systemic therapy (chemotherapy, targeted therapy or immunotherapy). Outcomes of disease vary as per the nature of the healthcare facilities. The outcome is better in centres equipped with modern radiation and imaging techniques with high volume than patients treated at low volume centres.
Q. How accessible is the HPV vaccine in India, and what initiatives are being undertaken to improve vaccination coverage?
HPV vaccines are now universal and widely accepted. Accessibility has also improved with the costs going down. The need of the hour is to make the vaccines more and more accessible by reducing costs, creating awareness and availability through government schemes. Initiatives are being taken at different levels to increase awareness as well as vaccination coverage. The government is planning to integrate the HPV vaccine into the national immunisation schedule. Efforts are underway to develop an indigenous effective vaccine to reduce the economic burden. Currently available quadrivalent and nonavalent vaccines are recommended for prevention of cervical cancer as well as some other HPV related diseases.
Q. What are the red flags and how cervical cancer can be prevented?
Cervical cancer often develops gradually, starting as precancerous changes in the cervix. Recognising early symptoms and signs can significantly improve the disease outcomes. Some red flags include abnormal vaginal bleeding, pelvic pain, unexplained fatigue, frequent urination or urinary issues and leg swelling. Early diagnosis and treatment of abnormal cervical cells detected through screening can prevent progression to cervical cancer.
Awareness is also the key to reduce the burden of cervical cancer. January is observed as global cervical cancer awareness month. WHO has its global strategy for cervical cancer elimination by the year 2030 through 90% HPV vaccination coverage, 70% screening coverage, and 90% access to treatment for cervical pre-cancer including access to palliative care.
Q. What role does diet play in the prevention and management of cervical cancer, and are there specific dietary recommendations for affected individuals?
A healthy diet rich in fruits, vegetables, and antioxidants can boost the immune system and may reduce the risk of cervical cancer. Maintaining an ideal weight and an active lifestyle can help reduce the cancer burden, not only in case of cervical cancer but also in other cancer types. Avoiding smoking and alcohol consumption will also lead to a decrease in the possibility to develop cervical cancer. Foods rich in antioxidants help to decrease the chance of developing cervical cancer. Specific dietary recommendations are there for patients undergoing active treatment for cervical cancer.