Keep it wholesome: On shaping a national cervical cancer control programme

A national cervical cancer control programme should be made accessible to all

Health is seldom uni-dimensional, and it must not be seen as such. Government policy, particularly, must fathom (to understand someone or why someone acts as they do) the entirety of the issue, and assimilate (to understand and remember new information and make it part of your basic knowledge so that you can use it as your own) multiple aspects in a field strategy, for optimum (best; most likely to bring success or advantage) realisation of the intended goal. Union Finance Minister Nirmala Sitharaman’s announcement during the presentation of the interim Budget that the government plans to encourage (to talk or behave in a way that gives someone confidence to do something) vaccination against cervical cancer for girls aged nine to 14, is no doubt a step in the right direction. While the scheme will be fleshed (to add more details or information to something) out post elections, it is also time to question if any programme to handle cervical cancer would be wholesome if it did not assimilate a screening aspect. Cancer of the cervix (literally, the neck of the womb) is unique among cancers because almost all the cases (99%, according to the World Health Organization) are linked to infection with the human papillomavirus (HPV), a common virus transmitted (to pass a disease from one person or animal to another) through sexual contact. While most HPV infections resolve spontaneously and the women remain symptom-free, persistent (lasting for a long time or difficult to get rid of)  infection can lead to cervical cancer. It is the second leading cause of cancer-related deaths among women in India (over 77,000 annually), and is estimated to be the second most frequent cancer among Indian women between 15 and 44 years. While the good news is couched in the availability of a vaccine, the sobering (making you feel serious or think about serious matters)  fact is that the average national prevalence (the fact of something existing or happening often) of cervical cancer screening (a test or examination to discover if there is anything wrong with someone) hovers at just under 2% and outcomes depend on the stage of detection.

Ironically, cervical cancer can be easily diagnosed (to recognize and name the exact character of a disease or other problem by making an examination) in a public health setting with minimal tools — the human eye, a dilution of white vinegar, and a dab of Lugol’s iodine. These are known as VIA and VILI tests and help look for precancerous lesions and cancer, much before an advanced stage of the disease can be picked up with cytology. A simple, short procedure, cryotherapy, can then be done while the patient is awake, to destroy the abnormal (different from what is usual or average, especially in a way that is bad) growth. Given that it is easy to prevent (to stop something from happening or someone from doing something), identify and treat cervical cancer, it is unacceptable that so many women are dying of the disease. As the government rolls out its vaccination program, it must also mandate (the authority given to an elected group of people, such as a government, to perform an action or govern a country) screening right at the primary health centre, and if abnormalities (something abnormal, usually in the body) are identified, offer cryotherapy right then. It is unlikely that vaccination of young girls alone will have a far-reaching impact in the short and medium term. The only way to prevent deaths is to deploy the entire assembly (the process of putting together the parts of a machine or structure) of tools as part of a national cervical cancer control programme, accessible to all women, irrespective of age, education, affordability or social status.

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