Cervical cancer, a largely preventable disease, remains a significant public health concern globally and in India. The estimated prevalence of cervical cancer in 2023 or the estimated number of women with cervical cancer in 2023 was over 3.42 lakhs. NCRP’s data on estimated mortality shows that close to 3.19 lakh women lost their lives to cervical cancer in the last decade from 2014 to 2023
Cervical cancer, a largely preventable disease, remains a significant public health concern globally and in India. As the fourth most common cancer among women worldwide, cervical cancer accounted for approximately 660,000 new cases in 2022, with 94% of the 350,000 related deaths occurring in low- and middle-income countries. The highest incidence and mortality rates are observed in sub-Saharan Africa, Central America, and Southeast Asia, regions where inequalities in access to vaccination, screening, and treatment services persist. Human Papillomavirus or HPV is responsible for 95% of cervical cancer cases, making early vaccination and regular screening critical in reducing incidence and mortality.
In India, cervical cancer is the second most common cancer among women, following breast cancer and the third leading cause of cancer-related deaths among women. In this story, we look at the trends in cervical cancer mortality in India and some of the challenges in preventing and controlling this largely preventable disease.
Incidence of Cervical Cancer has increased over the years
Over the years, there has been an increase in the incidence of cervical cancer among women, across the country. This is the overall trend indicated by various parliament answers that have provided the data from the National Cancer Registry Programme’s (NCRP) reports and state cancer registries. However, the incidence estimates are based on population estimates which has given rise to inconsistencies in the figures reported across different years. For instance, the incidence projected using the 2012-2016 data in the registries reported 71,415 cases of cervical cancer in 2018 in contrast to 1.01 lakh cases reported for the same year as per 2012-2014 population-based cancer registry reports. Further, data for 2021 and 2022 are unavailable in these responses or on the National Centre for Disease Informatics and Research’s website which usually publishes the NCRP’s reports.
Prevalence is different from incidence. Prevalence refers to the persons with a condition at a specific point in time while incidence refers to the new cases identified during a period of time. The estimated prevalence of cervical cancer in 2023 or the estimated number of women with cervical cancer in 2023 was over 3.42 lakhs.
Cervical cancer is most prevalent in UP, TN, Maharashtra, and WB
Uttar Pradesh reported the highest prevalence of Cervical Cancer with more than 45,000 cases followed by Tamil Nadu with more than 36,000 cases and Maharashtra with more than 30,000 cases. Including West Bengal, the four states together accounted for 40% of the cases estimated in the country in 2023. Karnataka and Bihar also reported more than 20,000 cases each. These six states together were estimated to have 53% of the cases in the country.
Higher detection in Tamil Nadu could be why the state has a higher number of incidences
There could be multiple reasons for why some states are estimated to have such a significant number of cases. One, it could be due to poor preventive measures being implemented. Two, the numbers could be skewed since some states with higher populations can have a higher number of cases. For instance, Uttar Pradesh which has recorded over 45,000 cases has only about 40 cases per one lakh women while Bihar with more than 23,000 cases recorded 37 cases per one lakh women. This normalized figure is much lower than that recorded by Punjab with more than 10,000 cases but with 71 cases per lakh women or even Mizoram with 646 cases reported which is close to 105 cases per lakh women in the state. (Note: For normalizing, the projected female population as of October 2023 has been taken from Dataful).
Higher screening rates could also be a reason for higher prevalence in certain states. Tamil Nadu has the highest screening rate among states which could be why it reported 36,000 odd cases or 93 cases per lakh women.
87 women die every day in India due to cervical cancer
NCRP’s data on estimated mortality shows that close to 3.19 lakh women lost their lives to cervical cancer in the last decade from 2014 to 2023. This roughly translates to an average of 87 deaths a day. The total number of yearly deaths due to the disease has increased by about 26% during this period.
Of the average 87 deaths recorded a day, around 12 are from Uttar Pradesh, 9 from Tamil Nadu, 8 from Maharashtra, and 7 from West Bengal. A total of 12 states have reported more than 10,000 deaths each during this period, and together account for 80% of the deaths reported in the country.
Regional disparities exist in screening for cervical cancer
As per the National Family Health Survey -IV’s (NFHS-IV) findings for 2015-16, about 22% of the women in the 15-49 years age bracket responded that they had undergone screening for cervical cancer. However, in the NFHS-V, the share dropped drastically to 1.2% of the 7.65 lakh women surveyed in 2019-21. Such a drastic reduction can be attributed to the change in the questions used for the survey.
NFHS-V’s data reveals that the screening is comparatively higher in the south Indian states. In Andhra Pradesh, the screening rate was 3.2%, 2.3% in Kerala, and 2.1% in Telangana. Tamil Nadu had the highest with 7%. This could be the reason why the prevalence was higher in these states. On the other hand, the screening was below 1% in the states of Bihar, Jharkhand, Odisha, West Bengal, and Karnataka. The share of screening in West Bengal was 0.1%.
Socio-economic factors also influence a woman’s access to cervical cancer screening
The survey’s results further reveal that Muslim women were slightly less likely than other women to undergo an examination of the cervix (0.8%) while Jain women were particularly likely to have undergone screening of the cervix (2.9%). Studies also noted that screening is much more common among educated people, older individuals, Christians, people from scheduled castes, those with government health insurance, and those with higher household wealth. It’s much less common among women from scheduled tribes, people from general castes, those without government health insurance, those with many children, and those who use oral contraceptives or tobacco.
Among the 30-49 years age group, India’s (2%) neighbours, Bangladesh (7%), Sri Lanka (27%), and China (31%) have much better screening rates. Even among BRICS nations, India’s screening is very low.
India is far away from achieving the WHO targets
India, along with other countries, has committed to the World Health Organization’s strategy to increase screening and eliminate the disease by 2030. The WHO Global strategy defines elimination as reducing the number of new cases annually to 4 or fewer per 1,00,000 women and sets three targets to be achieved by the year 2030 to put all countries on the pathway to elimination in the coming decades:
- 90% of girls vaccinated with the HPV vaccine by age 15
- 70% of women screened with a high-quality test by ages 35 and 45
- 90% of women with cervical disease receive treatment.
Cervical cancer vaccination is proposed to be made a part of UIP
The 2024-25 interim Union Budget of India, presented by Finance Minister Nirmala Sitharaman in February 2024, includes several initiatives to encourage vaccination against cervical cancer. The budget aimed to make HPV vaccines available for girls between the ages of 9 and 14. The vaccines will be introduced as part of a universal immunization program (UIP), with a one-time catch-up for girls in this age group. The cost of the vaccine currently is a few thousand rupees and is not accessible by all women and girls. Even though this is a good step forward, India is lagging behind these targets and is not on track to achieve these in the next 5 years.
India should put concerted efforts to eliminate preventable cancer
To combat cervical cancer effectively, India should focus on enhancing awareness, expanding screening programs, and improving vaccine accessibility. Increasing public education through community outreach and media campaigns is essential for raising awareness about cervical cancer, its risks, and preventive measures. Strengthening screening programs by making them more accessible and affordable, particularly in underserved areas, is critical for early detection. The affordability of the HPV vaccine is another critical issue; reducing costs through government subsidies and public health programs can make vaccines more accessible. India should also ensure the availability of good-quality data which can be used for policymakers and researchers to come up with necessary interventions.
