QUAD countries join hands to prevent Cervical Cancer

The Quad countries are making a concerted and ambitious effort to pool expertise and share experiences to eradicate cervical cancer caused by the human papillomavirus (HPV). It is a collaborative effort of Quad countries Indo-Pacific partners, through extended access to vaccines, screening, and treatment.

Background: United States, Australia, India, and Japan are launching a ground-breaking effort to help end cancer in the Indo-Pacific, starting with cervical cancer, a largely preventable disease that continues to be a major health crisis in the region, and laying the groundwork to address other forms of cancer as well. This initiative is part of a broader set of announcements made at the Quad Leaders Summit held on September 21, 2024 in the USA.

Narendra Modi led Indian Government, is committed to  share technical expertise in digital health through its National Non-Communicable Disease (NCD) portal. As part of its $10 million commitment to support the World Health Organization (WHO) led Global Initiative on Digital Health, India will provide technical assistance to the Indo-Pacific region. This includes offering technical support for the use of its National Non-Communicable Disease portal, which tracks long-term data on cancer screening and care.

Introduction:

Cervical cancer is a significant global health concern, ranking as the third most common cancer among women worldwide. In 2008, approximately 5,29,000 new cases were diagnosed globally. It affects women across all age groups, notably those in their reproductive years. Data from the U.S. shows that 28% of cervical cancer cases between 1988 and 2004 occurred in women aged 20 to 39. Despite being one of the most preventable cancers due to effective screening methods, disparities in healthcare infrastructure, resources, and education hinder its control.

What is Cervical Cancer?

Cervical cancer refers to a malignant tumour originating from the uterine cervix. It predominantly manifests as squamous cell carcinoma (80%), with the remainder being adenocarcinomas, adeno-squamous carcinomas, or other rare subtypes.

Risk Factors

Factors contributing to cervical cancer include:

1. Early sexual activity.
2. Multiple sexual partners.
3. Smoking.
4. Prolonged oral contraceptive use.
5. Use of Immunosuppression.
6. Low socioeconomic status.
7. Micronutrient deficiencies.
8. Persistent infection with high-risk strains of Human Papillomavirus (HPV).

Cervical Cancer in Global Contexts

1. India

• India accounted for 18.3% (1,23,907) of global cervical cancer cases in 2020.
• Barriers: High density rural population , low literacy rates, scanty healthcare facilities, and late manifestation of disease.
• Interventions: HPV vaccination, visual inspection with acetic acid (VIA), Pap smear testing, and HPV DNA testing are employed.
• Add in NCD program: Initiatives like the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) integrate cervical cancer screening with other cancer types under the Ayushman Bharat scheme.

2. Australia’s effective model in controlling Cervical Cancer

• The National Cervical Screening Program (NCSP) has successfully reduced cervical cancer incidence and mortality since 1991.
• “Renewal” Process (2017): Transitioned to 5-yearly primary HPV screening with genotyping for high-risk HPV types (16/18). This method is projected to reduce cervical cancer rates by 20–30% further.

3. Japan

• Despite being a developed nation, Japan faces an increasing incidence of cervical cancer due to delayed HPV vaccination (introduced in 2010) and lifestyle changes like smoking.
• Data (2018): Over 10,000 cases and nearly 3,000 deaths.

4. United States

• Over the past 35 years, significant reductions in cervical cancer incidence have been observed, though disparities persist across racial and ethnic groups.
• Advanced screening technologies and preventive measures, including vaccination, have contributed to these improvements.

Prevention and Screening

• HPV Vaccination: Prophylactic vaccines targeting high-risk HPV strains (16/18) are critical in primary prevention.
• Screening Techniques:
  • Pap Smear (Cytology): Effective but requires extensive infrastructure and skilled personnel.
  • HPV DNA Testing: Highly sensitive and specific but costly.
  • VIA/VILI: Affordable and suitable for low-resource settings but less precise.

Challenges in Implementation

• Barriers to Screening:
  • Limited awareness about cervical cancer.
  • Cultural stigma and embarrassment.
  • Infrastructure limitations in rural and low-income areas.
  • Deficiency of trained healthcare staff.
• Technological Gaps:
  • Expensive HPV DNA tests.
  • Limited vaccine availability in resource-poor settings.

Conclusion

To curb cervical cancer, especially in resource-limited regions, comprehensive strategies integrating affordable screening, vaccination, and community education are crucial. Ensuring accessibility, empowering women, and addressing societal barriers are pivotal to the success of cervical cancer control programs.

Dr. Pratibha Uppar , MHA, 2^nd Year, KAHER, Belagavi