January is observed as Cervical Cancer Awareness Month, a global initiative to highlight a cancer that is largely preventable, yet continues to cause avoidable illness and death among women—especially in low- and middle-income countries like India.
Understanding Cervical Cancer
Cervical cancer develops in the cervix, the lower part of the uterus. Strong scientific evidence has established that persistent infection with high-risk human papillomavirus (HPV) is the necessary cause of almost all cervical cancers. Among more than 200 HPV types, HPV-16 and HPV-18 account for approximately 70% of cases worldwide. Most HPV infections are transient and asymptomatic; however, persistent infection can lead to precancerous lesions that may progress to invasive cancer over several years if not detected and treated.
This long preclinical phase makes cervical cancer one of the most preventable cancers, provided effective vaccination and screening are implemented.
Global Trends Over the Years
Cervical cancer remains the fourth most common cancer among women globally. According to international cancer estimates, there are approximately 600,000 new cases and more than 340,000 deaths each year. The global distribution of the disease is highly unequal—over 90% of cervical cancer deaths occur in low- and middle-income countries, where access to screening, vaccination, and timely treatment is limited.
In contrast, countries with high HPV vaccination coverage and organized screening programmes, such as Australia, the United Kingdom, and several Nordic nations, have demonstrated steep declines in cervical cancer incidence. Australia is projected to eliminate cervical cancer as a public health problem within the next decade.
In response to these disparities, the World Health Organization (WHO) launched the Global Strategy to Accelerate the Elimination of Cervical Cancer in 2020, setting targets for vaccination, screening, and treatment by 2030.
Cervical Cancer in India: Trends and Realities
India bears nearly one-fifth of the global cervical cancer burden. Cervical cancer remains among the leading cancers affecting Indian women, particularly in rural and socio-economically disadvantaged populations.
Although population-based cancer registries show a gradual decline in incidence in some urban regions, mortality remains high, largely because many women are diagnosed at advanced stages. Contributing factors include:
- Limited population-based screening coverage
- Low awareness of HPV and cervical cancer
- Historically low HPV vaccine uptake
- Social stigma and barriers to accessing preventive care
Why Cervical Cancer Trends Change Over Time
Changes in cervical cancer incidence and mortality are influenced by:
- Prevalence and persistence of high-risk HPV infection
- Sexual and reproductive health patterns
- Tobacco use
- Immunosuppression (including HIV)
- Availability of vaccination and screening services
Countries that successfully integrate HPV vaccination with regular screening show the most rapid and sustained reductions in disease burden.
Prevention: What Science Clearly Shows
HPV Vaccination
HPV vaccination is the most effective primary prevention strategy for cervical cancer. Licensed vaccines include:
- Bivalent vaccines (HPV-16/18)
- Quadrivalent vaccines (HPV-6/11/16/18)
- Nonavalent vaccines (covering nine HPV types)
Large population studies have shown significant reductions in HPV infections, high-grade cervical lesions, and early cervical cancer indicators following vaccine introduction.
India strengthened its preventive potential with Cervavac, an indigenously developed HPV vaccine designed to improve affordability and scalability.
Why Cervavac Has Not Yet Been Rolled Out Across India
Despite approval, Cervavac has not yet been rolled out nationwide under the Universal Immunisation Programme (UIP). This delay is not due to safety or efficacy concerns but reflects programmatic and policy complexities.
Key reasons include:
- Non-inclusion in UIP so far
Introducing a new vaccine into UIP requires formal approvals, sustained financing, procurement contracts, cold-chain expansion, and workforce training—steps that are still underway. - Targeting adolescents rather than infants
HPV vaccination targets girls aged 9–14 years, a group outside the traditional UIP platform, requiring school-based or adolescent health delivery systems. - Production scale and supply assurance
Nationwide rollout requires guaranteed, uninterrupted vaccine supply at scale, which necessitates phased production expansion. - Historical caution around HPV vaccination
Earlier controversies around HPV demonstration projects in India led to a cautious, phased policy approach. - Low public awareness and demand
Awareness of HPV vaccination remains limited, affecting perceived urgency for immediate nationwide scale-up. - State-led initiatives filling the gap
Tamil Nadu’s state-funded HPV vaccination programme, targeting adolescent girls through a phased rollout, represents a major public health milestone and a potential model for national expansion.
Overall, Cervavac represents a missed opportunity only temporarily—its availability places India in a strong position for future cervical cancer elimination efforts.
Screening and the Role of Self-Sampling
Vaccination does not eliminate the need for screening. Screening is particularly important for adult women who may already have been exposed to HPV.
Screening methods include:
- HPV DNA testing
- Pap smear (cytology)
- Visual inspection with acetic acid (VIA)
HPV self-sampling has emerged as a promising strategy, especially in low-resource settings. Evidence shows self-collected samples are reliable and significantly improve screening participation by overcoming barriers related to privacy, distance, and stigma. Indian studies confirm high acceptability of self-sampling among women.
Why Cervical Cancer Awareness Still Matters
Despite effective preventive tools, lack of awareness remains a key barrier. Research consistently shows that awareness of HPV, vaccination, and screening strongly influences preventive health behaviour. Cervical Cancer Awareness Month plays a vital role in sustaining public attention and normalising conversations around women’s health.
Conclusion
Cervical cancer is no longer an inevitable disease. Effective vaccines, sensitive screening technologies, and self-sampling options make elimination a realistic goal. India’s progress—particularly the availability of Cervavac and state initiatives such as Tamil Nadu’s HPV vaccination programme—signals an important shift toward prevention-focused public health action.
The challenge ahead lies not in science, but in policy execution, programme scale-up, and sustained awareness.
References
- Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12-19.
- Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide. CA Cancer J Clin. 2021;71(3):209-249.
- World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: WHO; 2020.
- Bray F, Laversanne M, Weiderpass E, Soerjomataram I. The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer. 2021;127(16):3029-3030.
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- Sankaranarayanan R, Basu P, Kaur P, Bhaskar R, Singh GB, Denzongpa P, et al. Current status of human papillomavirus vaccination in India’s cervical cancer prevention efforts. Lancet Oncol. 2019;20(11):e637-e644.
- Basu P, Mittal S, Banerjee D, Singh P, Panda C, Dutta S, et al. Diagnostic accuracy of self-collected HPV samples compared with clinician-collected samples. Int J Cancer. 2021;148(5):1183-1191.
- Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360(14):1385-1394.
- Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination. Lancet. 2020;395(10224):575-590.
- Gaffney DK, Hashibe M, Kepka D, Maurer KA, Werner TL. Too many women are dying from cervical cancer: Problems and solutions. Gynecol Oncol. 2018;151(3):547-554.
