Telangana: Cervical cancer, a ticking time-bomb across State needs to be defused

• In rural areas, cervical cancer prevalence is nearly comparable to breast cancer
• Low-income or socially disadvantaged individuals are disproportionately affected by cervical cancer
• Caused by persistent infection with the human papillomavirus (HPV)
• Women living with HIV are six times more likely to develop cervical cancer compared to those without HIV
• Prophylactic vaccination against HPV, along with screening and treatment of pre-cancerous lesions, are highly effective and cost-effective methods for reventing cervical cancer
• Globally, efforts are underway to accelerate the elimination of cervical cancer by 2030, with agreed-upon targets to be met by that time

Hyderabad: Amidst the recent announcement made in the interim budget 2024–25 by Finance Minister Nirmala Sitharaman over the vaccination programme for girls aged 9–14 against cervical cancer, there is a growing concern in two Telugu-speaking States, over this malignant tumour.

The rising numbers of cervical cancer cases are being significantly exacerbated by two main factors: the limited awareness among women about the disease and its prevention and the socio-economic conditions of the rural populace. These challenges are major obstacles, making it difficult to curb the spread of this disease and necessitating urgent attention to educate and provide necessary healthcare resources to these communities, as doctors pointed out.

Despite cervical cancer being the second most common type of cancer among women after breast cancer, many doctors report that its prevalence is nearly on par with breast cancer, particularly in rural areas. In most Asian countries, nearly 60 per cent of the cancerous cases are cervical cancer.

Cervical cancer is the second most prevalent form of cancer among women, not only in India but also in the Telugu-speaking States, with its incidence nearly matching that of breast cancer. At any given moment, approximately 350,000 individuals are battling this disease in these regions.

In 2023, MNJ Cancer Hospital in Hyderabad reported nearly 1,800 cases of cervical cancer, with patients presenting at various stages of the disease. It is important to note that early detection, particularly at stage 1, significantly enhances the treatability of cervical cancer. Unlike many other cancers, cervical cancer is closely associated with a definitive cause: the Human Papillomavirus (HPV). This virus is particularly prevalent among women and individuals with compromised immune systems and can be easily transmitted through sexual contact, often from men. Poor sexual hygiene standards further contribute to its spread. However, one of the key advantages in the fight against cervical cancer is its detectability at a precancerous stage. It is possible to identify the risk of cervical cancer much earlier, allowing for interventions that can prevent the progression to cancerous stages.

Vaccination against HPV is crucial for preventing cervical cancer. Unfortunately, in India, vaccination for cervical cancer has not been included in the national immunisation schedule, leading to a significant shortfall in vaccination rates. Currently, less than 2 per cent of the population has received the vaccine. To combat this disease effectively, it is imperative to make HPV vaccination mandatory and accessible to all eligible individuals.

In Telangana, districts like Adilabad, Khammam, Nizamabad, and Medak are witnessing the highest numbers of cervical cancer cases in the State. Several factors contribute to this concerning trend, including a lack of awareness about the disease, low socio-economic status, and the presence of social stigmas surrounding health issues. In these regions, many individuals may not prioritise their health or seek medical tests due to cultural or economic barriers.

Looking ahead to the early 2030s, it is anticipated that the number of cervical cancer cases may continue to rise, underscoring the urgency of implementing vaccination programmes and strengthening healthcare infrastructure. Vaccination efforts can play a pivotal role in altering this trajectory by reducing the incidence of HPV infections, which are a primary cause of cervical cancer.

The MNJ Cancer Hospital sees an influx of nearly 50 new patients daily seeking initial consultations for cervical cancer, in addition to the regular patients who are at various stages of treatment. Unlike many other cancers, cervical cancer is closely associated with a definitive cause: HPV. It is possible to identify the risk of cervical cancer much earlier, allowing for interventions that can prevent the progression to cancerous stages. - Dr Jayalatha, Director, MNJ Institute of Oncology and Cancer Research

The introduction of vaccination against cervical cancer is indeed a positive step forward in combating this disease.

However, to effectively address the challenge of cervical cancer, it is essential to bolster the infrastructure needed for comprehensive screening and diagnosis, particularly in rural areas.

This includes ensuring the availability of diagnostic centres equipped to perform screening tests and facilitate early detection. - Dr Sandeep Tula, Radiation Consultant Oncologist, Yashoda Hospitals

The absence of a cancer population registry poses significant challenges in accurately quantifying its prevalence. However, based on available data and regional factors, it is estimated that nearly one-fifth of cervical cancer cases in India originate from the two Telugu-speaking States. Additionally, it is important to acknowledge that these states have high rates of HIV cases, which are also sexually transmitted diseases and may exacerbate the risk of cervical cancer. Many women in these areas are reluctant to undergo screening for cervical cancer, further contributing to underdiagnosis and late-stage detection. - Dr C Sairam consultant oncologist, Udai Omni Hospital