Editorial: Battling cervical cancer

Published in The Hindu on April 9, 2009

Cervical cancer, an easily detectable and preventable form of the disease, kills about 50 per cent of the 500,000 women who are infected every year with the human papillomavirus (HPV). Four in five of the infected women are in developing countries, which account for 80 per cent of mortality from cervical cancer. In India, the incidence of cervical cancer is about 130,000, and nearly 80,000 women die from it every year. The unconscionably high mortality in the developing world reflects mainly the lack of timely detection. Early diagnosis usually means an excellent prognosis. This is evident from the fact that the typical latency of 25 to 30 years for the infection to become an invasive cancer provides an excellent window for detecting and treating the problem. Unfortunately, the opportunity is missed in most developing countries where women, especially in rural areas, are rarely screened. The absence of symptoms and of screening often means women become aware of the cervical cancer only after it reaches a fairly advanced stage when treatment is extremely difficult.

Since many women have a natural propensity to not allow the infection to progress to a cancerous stage — and even to get rid of it — one time screening that is inexpensive, simple, and accurate can produce highly beneficial results in low-resource countries. Such screening must be done at the right age to capture the maximum number of infected women and before the infection turns cancerous. A paper published recently in The New England Journal of Medicine, based on a study involving about 130,000 rural women in the Osmanabad district of Maharashtra, has found the HPV test that uses DNA taken from the cervix to be superior to the pap smear test and visual inspection of the cervix using acetic acid (VIA). While there was no significant reduction in the death rate in the VIA as well as the pap smear groups compared with the control group, a significant decline was seen in the rate of advanced cervical cancer and associated deaths in the group that took the DNA test during the eight-year study period. Although VIA is cheaper than DNA testing, the low specificity in the former picks up a larger number of false positives, thus making it unsuitable as a screening tool. A highly affordable HPV DNA test kit — tried out in China and recently subjected to field trials in India — holds great promise. This, combined with the HPV vaccine that can prevent infection, can make a world of difference to the well-being of tens of thousands of women and their families — and save a large number of lives.