Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :836
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (181 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed88    
    Printed1    
    Emailed0    
    PDF Downloaded45    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO THE EDITOR
Year : 2018  |  Volume : 55  |  Issue : 2  |  Page : 203-204
 

Cervical cancer in Bihar: Time to revisit the shortcomings


1 Department of Gynecological Oncology, Regional Cancer Centre, Patna, Bihar, India
2 Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
3 Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Babban Jee
Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_606_17

Rights and Permissions



How to cite this article:
Pankaj S, Kumari A, Choudhary V, Jee B. Cervical cancer in Bihar: Time to revisit the shortcomings. Indian J Cancer 2018;55:203-4

How to cite this URL:
Pankaj S, Kumari A, Choudhary V, Jee B. Cervical cancer in Bihar: Time to revisit the shortcomings. Indian J Cancer [serial online] 2018 [cited 2019 Jan 22];55:203-4. Available from: http://www.indianjcancer.com/text.asp?2018/55/2/203/249213




The state of Bihar covers an area of 94,163 km2 and is one of the less economically developed states of India. Approximately 89% of its total population lives in villages. The per capita income for majority of the people in the villages of Bihar is less than the national average. Due to poverty, they do not consume a healthy diet, have low immunity and are more prone to chronic infections. Further, girls of such households are married off at a young age and usually have multiple pregnancies. Sexual exposure during adolescence when the transition zone of the cervix is susceptible leads to initiation of malignancy.[1] Low literacy rate, lack of awareness, inaccessible health-care facility, and lack of trained oncologists are responsible for late presentation.[2],[3] There are no data related to carcinoma of the cervix in Bihar in the indexed medical literature.

Bihar: Population, issues and health facility

Bihar is the third most populated state of India with a population of 104,099,452; 44,267,586 of females live in the rural areas of Bihar and have a high risk of developing cervical cancer. Average literacy rate in Bihar for urban regions was reported to be 76.86% in which female literacy was 61.95% whereas in the rural population only 44.30% females were literate. Even urban poverty in Bihar (32.91%) is above the national average of 23.62%.[4]

A survey of women revealed that on an average 47.7% of females were either pregnant or already a mother at the age of 15–19 years.[5]

Multiparity is a marker of repeated cervical trauma and repair, which can induce dysplastic changes and persistent HPV infection which is a strong risk factor for cervical cancer. Similarly, poor genital hygiene also leads to persistence of HPV infections and is an important risk factor for cancer, especially in a state like Bihar where clean water and other sanitation facilities are limited for a majority of the rural population.[6]

In addition to the presence of the above mentioned potential risk factors for the development of cervical cancer, there is lack of an organized screening programs and treatment facilities for cervical cancer patients in Bihar. Of 38 districts in Bihar, trained gynecological oncologists and radiotherapy units are available only in Patna, the capital city of Bihar. Even in Patna, Regional Cancer Centre (RCC) of the Indira Gandhi Institute of Medical Sciences (IGIMS) is the only government center where department of gynecological oncology exists. In the government sector, the radiotherapy facility is present only in the IGIMS, and All India Institute of Medical Sciences (AIIMS), Patna.

Strategy to combat cervix cancer in Bihar

In our state, the best cost-effective solution is prevention, both at primary and secondary levels. We need to have a robust screening program, which should be practical and acceptable like visual inspection of cervix by application of acetic acid and Lugol's iodine and Papanicolaou (Pap) smear along with stress on increasing awareness among the general population especially for women from low socioeconomic strata.

Primary prevention in the form of vaccination is the real hope for reducing cancer morbidity and mortality in our state with vaccination of 9–13-year-old girls with two doses of HPV vaccine. Currently, two commercially available HPV vaccines namely Cervarix (GSK) and Gardasil (MSD) are costly (Rs. 2,000-3,000) and beyond the reach of the poor rural population of Bihar, who are at high risk of developing cervical cancer.[7] Like many other countries like Australia, Japan, and Austria, Government of India should strengthen its efforts to prevent cervical cancer by introducing HPV vaccine into routine immunization schedule as its use can reduce the chance of developing HPV related cancer by up to 80%.

A tremendous boost is also required in the availability of gynecological oncology and radiotherapy units, other infrastructures and trained personnel in the field of oncology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Muñoz N, Franceschi S, Bosetti C, Moreno V, Herrero R, Smith JS, et al. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 2002;359:1093-101.  Back to cited text no. 1
    
2.
Saha A, Chaudhury AN, Bhowmik P, Chatterjee R. Awareness of cervical cancer among female students of premier college in Kolkata, India. Asian Pac J Cancer Prev 2010;11:1085-90.  Back to cited text no. 2
    
3.
Tripathi N, Kadam YR, Dhobale RV, Gore AD. Barriers for early detection of cancer amongst Indian rural women. South Asian J Cancer 2014;3:122-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Available from: censusindia.gov.in/2011-Common/CensusData2011.html. [Last accessed on 2018 Jun 07].  Back to cited text no. 4
    
5.
Available from: www.censusindia.gov.in/vital_statistics/AHSBulletins/AHS_Factsheets_2011_12. [Last accessed on 2018 Jun 07].  Back to cited text no. 5
    
6.
Kumar RV, Bhasker S. Potential opportunities to reduce cervical cancer by addressing risk factors other than HPV. J Gynecol Oncol 2013;24:295-7.  Back to cited text no. 6
    
7.
Kaarthigeyan K. Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol 2012;33:7-12.  Back to cited text no. 7
  [Full text]  




 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow