A joint effort of government, healthcare professionals and related non governmental organisations is the need of the hour to spread awareness of early detection and prevention of cervical cancer in the country through methods like Pap smear test, say experts.

The human papillomavirus (HPV) infection is the most common cancer among women in low-resource countries where 85 per cent of the global cervical cancer burden of approximately 4,93,000 cases and 2,73,000 deaths occur annually. In India, according to the estimates of World Health Organisation (WHO), every year 1,32,082 women are diagnosed with cancer and 74,118 women die from the disease. Further, risk of the disease is growing at 2.4 per cent in women in India, which is higher when compared to the 1.3 per cent risk growth globally.

Though the disease is traceable at early stage through simple baseline Pap smear screening, which is available in any standard diagnostic centre in the country, lack of awareness and social acceptance of the disease has restricted the use of such tests from massive use, says Dr Gagan Saini, attending consultant, Radiation Oncology with Max Cancer Centre, Max Hospital.

Even as vaccines were launched in the country to prevent two major types of HPV causing cervical cancer, prevention of the disease will need early detection of cervical cancer precursors through frequent testing for several years. There are about 50 to 70 types of viruses related to the cervical cancer and annual screening for the first three years and once in three years, later, are necessary for early detection of precursors.

“Many a time, women are shy or afraid to come forward even if they have problems related to HPV. Further, lack of awareness of the disease is another problem to prevent the disease in early stage, though it is one of the most common illness faced by the women in India. The NGOs and government should work on spreading awareness about tests like Pap screening,” said Dr Saini.

Even though there are discussions about the uninform success rate of Pap smear screening, it is found that the wide-spread use of Pap smear test for screening has successfully and substantially reduced cervical cancer deaths in developed countries. According to a document released by the American College of Obstetricians and Gynaecologists (ACOG), published in mid 2009, widespread use of the Pap test has led to a greater than 50 per cent decline in cervical cancer incidence over the past 30 years, from 14.8 cases per 100,000 women in 1975 to 6.5 cases per 100,000 women in 2006.

The organisation brought in a new guideline in April 2009, changing the timeline to initiate baseline Pap test to age 21 to avoid unncessasery treatment of adolescents. Thought the HPV infection is common in sexually active adolescents, cervical cancer rarely occurs in women younger than 21 years, added the report.

In India, the International Agency for Research on Cancer (IARC) in collaboration with the Nargis Dutt Memorial Cancer Hospital, Barshi and Tata Memorial Centre (TMC), Mumbai has recently published a report of the largest randomised controlled trial on the disease in Osmanabad in Maharashtra. The study result, released in April, 2009, shows a significant reduction in advanced cervical cancer and deaths followed a single round of HPV testing in this remote area.

In the study, 131 806 healthy women aged 30-59 were invited to take part in the study and 32,000 - 34,000 women were randomly allotted to receive either a single round of screening by HPV testing or visual inspection with 4 per cent acetic acid (VIA) or Pap smear and compared cervical cancer cases and deaths with those of the 31,500 women allotted to the usual care and health education. Women found positive on any of the screening tests were investigated with colposcopy and biopsies and those with cervical pre-cancer and cancer received appropriate treatment.

The results showed 127 cervical cancers cases, 39 advanced cancers and 34 cervical cancer deaths in the HPV screened group; 152 cervical cancer cases, 58 advanced cancers, and 54 deaths in the Pap smear group; 157 cervical cancer cases, 86 advanced cancers and 56 deaths in the visual screening group compared with 118 cervical cancers, 82 advanced cancers and 64 deaths in the unscreened control group of women.

“It is of utmost importance to set up organized screening programs in low-resource populations to reduce the current high burden of cervical cancer in the near future, parallel to immunization programs when affordable HPV vaccination is available. For HPV screening to be feasible, low cost, HPV testing should be made available as rapidly as possible,” concludes the study.