Author: Ms. Anila Goswami (Deputy General Manager, Projects, ECHO India) and Ms. Anisha Mathew (Senior Executive, Monitoring, Evaluation, and Research, ECHO India)

"One woman dies of cervical cancer every two minutes… Each one is a tragedy, and we can prevent it." Call to Action - May 2018: Cervical Cancer: An NCD We Can Overcome (stated by the Director General-WHO) (1) underscored the urgent need for global action against cervical cancer.

Since then, substantial progress has been made in the fight against this preventable disease. Efforts have focused on prevention, early detection, diagnosis, and treatment. Despite these advancements, the statistics remain sobering. Globally, in 2022, the incidence of new cases is 662,301 and 348,874 deaths, with a corresponding age-standardized incidence of 14·1 cases per 100,000 women and a mortality rate of 7·1 deaths per 100,000 women, highlighting the ongoing challenge we face. (2)

In India, cervical cancer ranks as the third most common cancer. According to GLOBOCAN 2022, there were an estimated 127,526 cases and 79,906 deaths, with an age-standardized incidence of 17.7 cases per 100,000 women and a mortality rate of 11.2 deaths per 100,000 women. These statistics highlight the critical need for continued vigilance, awareness, and action in combating this disease. (3)

One of the most effective strategies in the fight against cervical cancer is regular screening, which is essential since precancerous lesions often do not cause symptoms. Women are encouraged to undergo cervical screening every 5–10 years, starting at age 30, with women living with HIV advised to begin at age 25. The global strategy for cervical cancer elimination emphasizes at least two-lifetime screenings by age 35 and again by age 45. As of 2023, six HPV vaccines are available globally, all of which protect against the high-risk HPV types responsible for the majority of cervical cancers. (4)

The global strategy aims to eliminate cervical cancer as a public health problem by reaching a threshold of 4 per 100,000 women. This involves meeting the 90-70-90 targets by 2030: 90% of girls fully vaccinated with the HPV vaccine by age 15, 70% of women screened with a high-performance test by age 35 and again by age 45, and 90% of women identified with cervical disease receiving treatment. Achieving the 90-70-90 targets by 2030 would mean that the median reduction in cervical cancer incidence rate would be 2%, 42%, and 97% by 2030, 2045, and 2120, respectively, resulting in 74 million cases averted. (1)

India has demonstrated a solid commitment to the global fight against cervical cancer. In 2022, the National Technical Advisory Group for Immunization (NTAGI) recommended introducing the HPV vaccine into the Universal Immunization Programme (UIP). This initiative includes a one-time catch-up for girls aged 9-14 and routine vaccinations starting at age 9, primarily administered through schools. The Indian government has reaffirmed its dedication to this effort, with the Finance Minister emphasizing the importance of vaccinating girls in the 2024 budget. This national commitment is crucial in reducing the burden of cervical cancer in India. (5)

ECHO India has played a pivotal role in enhancing cancer care nationwide through its innovative 'All Teach, All Learn' approach. The ECHO model, which leverages case-based learning, shared experiences, and best practices, fosters a 'community of practice' among healthcare providers. This approach has been particularly effective in training healthcare professionals in cancer care, including early detection and screening. In collaboration with leading institutions such as the National Institute of Cancer Prevention and Research (NICPR), Homi Bhabha Cancer Hospital and Research Centre, Vishakhapatnam, CanKids, Tata Memorial Hospital, National Cancer Grid, as well as the State Nursing Councils and National Health Mission, ECHO India has been instrumental in building the capacity of healthcare workers in the screening and early diagnosis of major cancers. These efforts are especially critical in remote areas, where a lack of awareness and resources contributes to the high prevalence of undiagnosed cervical cancer cases.

Looking ahead, ECHO India is making significant strides in strengthening cancer care across the country. One key initiative focuses on enhancing the knowledge and skills of nurse professionals in the early detection and prevention of cervical cancer. This training program has already been launched in seven states—Andhra Pradesh, Punjab, Sikkim, Maharashtra, Mizoram, Delhi, and Goa—covering essential topics such as diagnosis, screening, early detection, treatment, childhood vaginal cancer, and the role of nurses in prevention. Empowering nurses to be strong advocates for patients within multidisciplinary teams is vital in the ongoing fight against cervical cancer.

In furthering this mission, ECHO India hosted a National Roundtable Summit on Cervical Cancer in Bengaluru in collaboration with Artists for Her and the Karnataka State Obstetrics and Gynecologist Association. The summit focused on taking actionable steps towards achieving a Cervical Cancer Mukt Bharat, reflecting a collective commitment to advancing the mission of cervical cancer elimination in India.

As part of this broader effort, ECHO India's Cancer Mukt Bharat program and webinars, held in collaboration with various organizations, are designed to enhance the knowledge and skills of medical officers, nurses, and Community Health Officers (CHOs) in oncology care. The goal is to improve cancer outcomes by raising awareness, increasing access to survivorship services, and fostering collaboration within rural healthcare communities. This effort will ultimately lead to better palliative care and patient support.

Aligned with the World Cancer Day 2022-2024 theme, "Close the Care Gap," which emphasizes recognizing and addressing inequities in cancer care worldwide, (6) ECHO India's efforts are bringing us closer to a future where cervical cancer is no longer a threat to women’s health. Through its comprehensive programs and partnerships, ECHO India is significantly contributing to the fight against cervical cancer.

References:

1. Global strategy to accelerate the elimination of cervical cancer as a public health problem [Internet]. [cited 2024 Aug 13]. Available from: https://www.who.int/publications/i/item/9789240014107

2. 23-cervix-uteri-fact-sheet.pdf [Internet]. [cited 2024 Aug 13]. Available from: https://gco.iarc.who.int/media/globocan/factsheets/cancers/23-cervix-uteri-fact-sheet.pdf

3. 356-india-fact-sheet.pdf [Internet]. [cited 2024 Aug 12]. Available from: https://gco.iarc.who.int/media/globocan/factsheets/populations/356-india-fact-sheet.pdf

4. Cervical cancer [Internet]. [cited 2024 Aug 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer

5. HPV Vaccination Received a Push in Budget 2024 | India Science, Technology & Innovation - ISTI Portal [Internet]. [cited 2024 Aug 13]. Available from: https://www.indiascienceandtechnology.gov.in/listingpage/hpv-vaccination-received-push-budget-2024

6. Campaign theme (Close the Care Gap) | World Cancer Day [Internet]. [cited 2024 Aug 16]. Available from: https://www.worldcancerday.org/sites/default/files/styles/max_2600x2600/public/2021-12/WCD22_web%20thumbnail_ENG.png?h=f36f5bad&itok=Iqx2uh3H