FACT SHEET: INDIA www.hpvcentre.net

Neerja Bhatla, MBBS, MD, FICOG, FAMS, FRCOG (Hon.), FNASc
Professor & Head, Department of Obstetrics & Gynaecology;
Shobha S. Wenger Distinguished Chair of Gynecologic Oncology, National Cancer Institute;
All India Institute of Medical Sciences, New Delhi, India
neerja.bhatla07@aiims.edu

Gina Albero MSc, MPH, PhD
Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO)-IDIBELL, Barcelona, Spain. Centro de Investigación Biomédica en Red-CIBERESP, Madrid, Spain. ICO-IARC HPV Information Centre.
g.albero@iconcologia.net

Laia Bruni MD, MSc, MPH, PhD
Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO)-IDIBELL, Barcelona, Spain. Centro de Investigación Biomédica en Red-CIBERESP, Madrid, Spain. ICO-IARC HPV Information Centre.
lbruni@iconcologia.net

Nº 257

FACT SHEET: INDIA www.hpvcentre.net

Quote this article as:

N. Bhatla, G. Albero, L. Bruni (January 2024). India. Human Papillomavirus and Related Cancers, Fact Sheet.
www.HPVWorld.com, 257

Comment:

Cervical cancer is a major public health problem in India, contributing nearly one-quarter of the global burden. Within the country there is wide variation in the incidence rate and availability of facilities.¹ Complexity and cost of screening and treatment programmes have been the primary barriers. Since 2016, India’s National Programme for Screening of Common Cancers has given special thrust to breast, oral and cervical cancer screening, the last using visual inspection with acetic acid (VIA) with a screen-and-treat strategy to reduce loss to follow-up.² The lower sensitivity and specificity of VIA results in missing early stages of cervical cancer or over-treating false-positives. Coverage remains low at about 50% of districts. Communication systems, referral linkages and training programmes are yet to be fully developed. Reported levels of coverage do not reflect the quality and reliability of the method.³ Transition to HPV testing is recognized as an urgent need. The Covid pandemic facilitated availability of molecular testing at secondary level facilities, but costs need to come down. Several indigenous HPV tests are emerging and undergoing validation. It is expected that these will be game changers in the quest for cervical cancer elimination.

HPV vaccination has now been approved for inclusion in the national schedule by the National Technical Advisory Group on Immunization (NTAGI). An indigenous, affordable quadrivalent HPV vaccine has been developed by Serum Institute of India Limited in collaboration with the Department of Biotechnology.³ It is expected that this will soon be rolled out among eligible girls in three phases, starting with multi-age cohorts and eventually targeting 9-year old girls.⁴

Key challenges include:

the need to improve awareness and participation in screening and vaccination programmes;
overcoming inequities in incidence and mortality;
developing a method for digital record-keeping and linkage with cancer registries.

References

1. Mathur P, Sathishkumar K, Chaturvedi M, et al. Cancer Statistics, 2020: Report From National Cancer Registry Programme, India. JCO Glob Oncol. 2020 Jul;6:1063-1075. Available from: https://doi.org/10.1200/go.20.00122

2. Operational Framework: Management of Common Cancers. Ministry of Health and Family Welfare (MoHFW), India. Available from: https://main.mohfw.gov.in/sites/default/files/Operational%20Framework%20Management%20of%20Common%20Cancers_1.pdf

3. Mehrotra R, Yadav K. Cervical Cancer: Formulation and Implementation of Govt of India Guidelines for Screening and Management. Indian J Gynecol Oncol. 2022;20(1):4. Available from: https://doi.org/10.1007/s40944-021-00602-z

4. Serum Institute Of India-News. Serum Institute Of India launches the first made-in-India qHPV vaccine. 24 January, 2023. Available from: https://www.seruminstitute.com/news_sii_cervavac_launch_240123.php

The Catalan Institute of Oncology (ICO) in Barcelona, Spain and the International Agency for Research on Cancer (IARC) in Lyon, France jointly lead the HPV Information Centre, a web-based resource that compiles, processes and disseminates published information on HPV infection and HPV-related diseases for all countries of the world.

Country-specific Fact Sheets are standardized summaries of HPV-related disease burden and associated risk factors, prevention strategies, screening activities, and immunization programs for each of the 194 WHO member states. Fact Sheets include concise, self-explanatory graphs and tables to offer a quick overview of the situation in the designated population. The system allows queries to generate statistics for individual countries, groups of countries, geographical regions or worldwide summaries.

More elaborated supplementary tables and comments can also be found in country-specific, regional and worldwide Full Reports from the original database (www.hpvcentre.net). The HPV Information Centre publishes internationally recognized review monographs and targeted scientific publications to address relevant questions in the path to the cervical cancer elimination campaign. The HPV Information Centre is an open access, publicly funded resource to support the work of the scientific HPV community worldwide.

INDIA:
I. KEY DATA ON HPV AND HPV-RELATED CANCERS

India has a population of 511.4 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates (Globocan 2022) indicate that every year 127526 women are diagnosed with cervical cancer and 79906 die from the disease. Cervical cancer ranks as the 2nd most frequent cancer among women in India and the 2nd most frequent cancer among women between 15 and 44 years of age. About 5.0% of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 83.2% of invasive cervical cancers are attributed to HPVs 16 or 18.