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

Cervical cancer in Bihar: Time to revisit the shortcomings

Sangeeta Pankaj1, Anita Kumari1, Vijayanand Choudhary2, Babban Jee3,  
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

Correspondence Address:
Dr. Babban Jee
Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi
India




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;55:203-204


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 Sep 22 ];55:203-204
Available from: http://www.indianjcancer.com/text.asp?2018/55/2/203/249213


Full Text



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

1Muñoz 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.
2Saha 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.
3Tripathi 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.
4Available from: censusindia.gov.in/2011-Common/CensusData2011.html. [Last accessed on 2018 Jun 07].
5Available from: www.censusindia.gov.in/vital_statistics/AHSBulletins/AHS_Factsheets_2011_12. [Last accessed on 2018 Jun 07].
6Kumar RV, Bhasker S. Potential opportunities to reduce cervical cancer by addressing risk factors other than HPV. J Gynecol Oncol 2013;24:295-7.
7Kaarthigeyan K. Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol 2012;33:7-12.