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Indian Journal of Cancer, Vol. 43, No. 3, July-September, 2006, pp. 139 Letter To Editor The relevance of cervical cancer screening and the future of cervical cancer control in India in the light of the approval of the vaccine against cervical cancer Basu M Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram - 695 011, Kerala Code Number: cn06023 Sir, With a death toll of approximately 237,500 women each year, cervical cancer is the primary cause of cancer deaths among women in many developing countries.[1] Cancer of the cervix is the most common cancer among women in India. It has been estimated that 100,000 new cases of cancer of the cervix occur in India every year and 70% or more of these are stage III or higher at diagnosis.[2] This clearly indicates the lack of awareness and facilities for cervical cancer screening in India. With the Food and Drug Administration′s approval of the vaccine Gardasil, marketed by Merck and Co. Inc. in USA and with a similar vaccine in the name of Cervarix by the GlaxoSmithKline waiting for approval sometime later this year the future may seem to hold some promise for the crusade against the second biggest cancer killer in women. The vaccine prevents infection with certain types of human papilloma virus mainly types 16 and 18 which are responsible for 70% of the cervical cancer cases. Requiring three doses in over six months with a catalogue price of $120 per dose, the total cost of vaccination is expected to be around $ 360, well out of the reach of women in developing countries.[3] Moreover the vaccine may not protect people already infected with HPV and may increase their risk of the kind of lesions that can lead to cervical cancer. The target age for receiving Gardasil has been kept low (girls and women between 9 to 26 years of age) because the vaccine works best when given to girls before they begin having sex and run the risk of HPV infection. So it is clear that the vaccine can in no way be considered a replacement for the standard screening test which remains the gold standard for early detection and better prognosis of the killer disease.[4] Thus in countries like India where a huge section of the population live below poverty line and where awareness among women for cervical cancer control and treatment remain very limited even years after implementation of the National Cancer Control Program in 1975 the recent breakthrough in the global war against cervical cancer does not seem to have much impact. Moreover with the lack of high level government efforts to promote organised screening programmes for cervical cancer despite acknowledging the importance of the screening programmes the future of cervical cancer continues to remain bleak in India. It is overdue that the government responds to the need of the hour and strengthens information, education and communication efforts on cervical cancer along with providing widespread screening facilities. References
Copyright 2006 - Indian Journal of Cancer |
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