Cervical Cancer: Can India Eliminate it Through Vaccination and Screening?

What is Cervical Cancer?

Cervical cancer is a type of cancer that develops in the cervix, or lower section of the womb connecting the uterus (womb) to the vagina (birth canal). It is important to know that even before cancer develops, abnormal cells start appearing in cervical tissue. If abnormal cells remain untreated, they multiply and may turn into cancer cells. These cancer cells can then spread deeper into the cervix and nearby tissues.¹

The Indian Scenario

In 2020, cervical cancer was reported to be the fourth most common cancer in women worldwide, and every 3 minutes, one woman lost her life due to cervical cancer.² The Indian Council of Medical Research (ICMR) figured that nearly 96,000 new cases and more than 60,000 deaths were due to cervical cancer in India in 2020. Furthermore, according to the World Health Organization (WHO), almost one-fourth of the deaths worldwide from cervical cancer caused by HPV infection occur in India.³ Cervical cancer is the second most common cancer in women in India.⁴

The World Health Organization (WHO) called for the implementation of three coordinated measures in 2018 to eradicate it worldwide by 2030:

1. 90% HPV vaccination
2. 70% high-performance cervical screening, and
3. 90% early effective treatment for individuals who are already infected and affected by the disease.²

Link between HPV infection and Cervical Cancer

Human papillomavirus (HPV) infection is the leading cause of cervical cancer, which is most common in India.^5,6  It is the first kind of cancer in women that can be prevented by vaccines, identified in the pre-cancer stage before a frank tumour appears, and effectively treated if discovered early.  Hence, regular check-ups, early detection and treatment are most important in decreasing disease occurrence and deaths due to cervical cancer.⁵

Prevention strategies 

Cervical cancer is preventable. The preventive methods become most important in decreasing the occurrence of HPV infection and related diseases.⁴ 

• Role of Vaccination: 

High-risk HPV strains such as HPV-16 and HPV-18 account for the vast majority of cervical cancer cases. Vaccination against HPV is one of the most effective preventive measures. For maximum efficiency in avoiding HPV infection, vaccination is advised for both sexes.

• Role of Regular Cervical Cancer Check-ups: 

Methods like PAP smear or HPV DNA testing can identify suspicious lesions early, preventing the development of cervical cancer and helping in timely treatment.

• Role of Health Education:

Increasing public awareness about HPV spread, the value of vaccines, and the necessity of routine check-ups are of great importance. Additionally, following safe sexual practices decreases the risk of HPV spread. To effectively battle HPV-related infections, vaccination, screening, health education, and the promotion of safe sexual practices. ⁴

Barriers in strategies against Cervical Cancer 

The majority of South Asian nations, including India, were unable to promote this vaccination despite its necessity. In the year 2009, the Indian states of Gujarat and Andhra Pradesh, in collaboration with the Programme for Appropriate Technology in Health (PATH), commenced a “demonstration pilot project” for HPV vaccine antibody testing. However, this trial was terminated prematurely due to the unfortunate demise of a few school-aged girls following HPV vaccination. Subsequent investigations, however, revealed no correlation between the vaccination and the deaths.

Despite this, the safety and efficacy of HPV vaccines continue to be a matter of contention among the public, thereby contributing to India’s low HPV vaccination rates. In terms of the significance of this event, it is worth noting that this incident has had a pivotal impact on the public’s perception of HPV vaccines in India. In conclusion, the controversy surrounding the safety and effectiveness of HPV vaccines remains an intricate and multifaceted issue in the Indian healthcare landscape, warranting further research and public education to address the misconceptions and promote vaccination coverage.⁷

Indian Government’s efforts to eliminate Cervical Cancer 

Understanding the importance of cervical cancer prevention, the Government of India has made significant strides in cancer prevention, treatment, and research through various methods, as under:

For Screening and Check-ups

ASHA and medical professionals serve as the community’s link with the healthcare system in villages. To ensure early detection of breast cancer and cervical cancers, frontline healthcare providers themselves go to the residences of patients and record the results and responses using the Community-Based Assessment Checklist (CBAC) form. For additional care, these individuals with early signs of cancer are then sent to higher centres. These Ayushman Bharat programs aid in the early identification of risk factors and the early diagnosis of cancer.⁸ 

For Vaccine Development

The Drug Controller General of India (DCGI) recently approved the new, affordable HPV vaccine CERVAVAC®. Now, girls in India aged 9 to 19 can receive it as a single dose⁹

This recently created HPV vaccine, CERVAVAC, is far less expensive than earlier models. In comparison to international vaccines like Gardasil and Cervarix, which cost between Rs 2,000 and Rs 3,500 per dose, CERVAVAC, which was created by the Serum Institute of India (SII), is less expensive, costing Rs 200 and Rs 400 for one dose. India has made significant strides toward producing enough HPV vaccines to satisfy demand and opening the door to the eradication of cervical cancer.⁴

For Vaccination Scheduling and Awareness

For bringing awareness about cervical cancer prevention and  HPV vaccine among female students nationally, the central government has plans to work with all states and union territories.⁴

In January 2023, the Indian Ministry of Health and Family Welfare put their plan to action, by reaching out to 7 state governments, asking them to introduce HPV vaccines for girls aged 9-14 years, with a plan to expand this program to other states and Union territories by 2024-25.⁴ Soon, the HPV vaccination will be included into regular immunization schedules after they have finished immunizing this age group. 

One of the main pillars of the WHO’s global strategy to eradicate cervical cancer is vaccination. Strategies employed for this by the Indian Government are:

• Government and private schools will have HPV vaccination centers set up on school grounds to provide the vaccine to students in 5th  to 10th grade and dates scheduled so as to  avoid months of examination and holidays.
• To guarantee coverage for girls who are unable to attend school on the chosen campaign day, vaccination services would be extended at health facilities.⁴
• To include out-of-school females, with an emphasis on the 9–14 age range, community outreach will be employed. 
• Compliance of kids depends on awareness of parents, which will be ensured by the parents-teachers meetings (PTAs).⁴

Conclusion

As per the strategies employed, 68 million Indian girls are expected to receive the HPV vaccine in the end, and an additional 11.2 million 9-year-old girls are targeted each year for routine HPV immunization after that, which requires monitoring and assessment.

The Union Government of India launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) to strengthen cancer care at all levels of the health system. Furthermore, under this program, health authorities conduct population-based screenings every five years for breast, oral, and cervical cancer in individuals over the age of 30.

Even though there is a new, cheaper single-dose HPV vaccine (CERVAVAC®, Serum Institute of India Pvt. Ltd., Pune), it is unclear if India will be able to achieve this goal of eliminating cervical cancer. This is due to problems like overpopulation, poor health facilities, a lack of awareness, and social and religious myths.

To achieve this goal, the government, NGOs, the public health system, and the general public, must work together to raise awareness. Moreover, adequate healthcare facilities and at par training of various healthcare professionals, public health professionals, and social workers in primary health centers, community health centers, hospitals, and regional cancer centers will help for achieving  the successful eradication of HPV and cervical cancer in India.

References

1. What is cervical cancer? – nci [Internet]. 2022 [cited 2025 Apr 22]. Available from: https://www.cancer.gov/types/cervical
2. Global strategy to accelerate the elimination of cervical cancer as a public health problem [Internet]. [cited 2025 Apr 22]. Available from: https://www.who.int/publications/i/item/9789240014107
3. Bobdey S, Sathwara J, Jain A, Balasubramaniam G. Burden of cervical cancer and role of screening in India. Indian J Med Paediatr Oncol. 2016;37(4):278–85.
4. Bhattacharya S, Garg S, Gopal KM. Empowering India’s fight against cervical cancer: Harnessing routine HPV immunisation. Journal of Family Medicine and Primary Care [Internet]. 2025 Jan [cited 2025 Apr 22];14(1):22–8. Available from: https://journals.lww.com/10.4103/jfmpc.jfmpc_678_24
5. Gupta S, Kumar P, Das BC. Challenges and opportunities to making Indian women cervical cancer free. Indian Journal of Medical Research [Internet]. 2023 Nov [cited 2025 Apr 22];158(5 & 6):470–5. Available from: https://journals.lww.com/10.4103/ijmr.ijmr_1052_23
6. Sankaranarayanan R, Basu P, Kaur P, Bhaskar R, Singh GB, Denzongpa P, et al. Current status of human papillomavirus vaccination in India’s cervical cancer prevention efforts. Lancet Oncol. 2019 Nov;20(11):e637–44.
7. Bloem P, Ogbuanu I. Vaccination to prevent human papillomavirus infections: From promise to practice. PLoS Med. 2017 Jun;14(6):e1002325.
8. Lohiya A, Daniel RA, Smith RD, Nagar M, Shankar A, Lahariya C. Cancer prevention and control in India can get a boost through primary health care-based approach: A review. J Family Med Prim Care [Internet]. 2022 Aug [cited 2025 Apr 23];11(8):4286–92. https://pmc.ncbi.nlm.nih.gov/articles/PMC9638636/
9. The Lancet Oncology null. HPV vaccination in south Asia: new progress, old challenges. Lancet Oncol. 2022 Oct;23(10):1233.

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