Cervical cancer is the 4th most common cancer in women worldwide but most common cause of cancer related death in India. All over the world, including India, there is decreasing trend of cervical cancer.

1. CERVICAL CANCER:
GLOBAL BURDEN & WHERE DO
WE STAND TODAY?

2. Dr. Niranjan Chavan
MD, FCPS, DGO, DFP, MICOG, DICOG, FICOG
Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H
Chairperson, FOGSI Oncology and TT Committee (2012-2014)
Treasurer, MOGS (2017- 2018)
Chair and Convener, FOGSI Cell- Violence against Doctors (2015-2016)
Chief Editor, AFG Times (2015-2017)
Editorial Board, European Journal of Gynecologic Oncology
Editor of FOGSI FOCUS, MOGS, AFG & IAGE Newsletters
Member, Managing Committee, IAGE (2013-2017)
Member , Oncology Committee, AOFOG (2013 -2015)
Recipient of 6 National & International Awards
Author of 15 Research Papers and 19 Scientific Chapters
Course Co-Ordinator, of 11 batches, of MUHS recognized Certificate Course of
Basic Infertility Management Including Endoscopy (BIMIE) at LTMGH

3. DECLARE THE PAST,
DIAGNOSE THE PRESENT
FORETELL THE FUTURE
- HIPPOCRATES

4. CERVICAL CANCER
• Cervical cancer is the fourth most
common cancer in women, and the
seventh overall.
• Large majority (around 85%) of the
global burden occurs in the less
developed regions, where it
accounts for almost 12% of all
female cancers.

5. TIMELINE OF CERVICAL CANCER
• 400 BCE : First description of cervical
cancer by Hippocrates.
• 1834 : Cervical cancer is identified as a
sexually transmitted disease.
• 1898 : Austrian gynaecologist Ernst
Wertheim describes the operation of
radical hysterectomy including removal
of the parametrium and pelvic lymph
nodes
HIPPOCRATES
ERNEST WERTHEIM

6. TIMELINE OF CERVICAL CANCER
• 1925 : German gynaecologist Hans
Hinselmann first describes the foundation of
the colposcope.
• 1928 : Greek cytopathologist Georgios
Papanikolaou develops a cervical cytology
smear test (today called Pap smear) to
detect cancer cells.
• 1985 : Harald Zur Hausen and Lutz
Gissmann demonstrate the presence
of HPV DNA in cervical cancer cells.
Hans Hinselmann
Georgios Papanikolaou

7. Luc Montagnier, Francoise Barre Sinoussi, Harald zur Hausen
Nobel Laureates in Medicine 2008
1985
zur Hausen group detects HPV DNA in cervical cancers
new HPVs – HPV 16 and HPV 18

8. TIMELINE OF CERVICAL CANCER
• 1988 : The Bethesda system (TBS) is introduced.
• 1989 : Loop electrosurgical excision
procedure (LEEP), is first described.
• 2006 : United States FDA approves Gardasil, a
vaccine that prevents infection with the two high-
risk strains of human papillomavirus (HPV) known
to cause about 70 percent of cervical cancers.

9. GLOBAL
SCENARIO

10. GLOBAL INCIDENCE
• Cervical cancer is the fourth most common cancer in
women with an estimated 528,000 new cases in 2016.
• A large majority (around 85%) of the global burden
occurs in the less developed regions, where it accounts
for almost 12% of all female cancers.
• High-risk regions, with estimated AGE STANDARDISED
RATES over 30 per 100,000, include Eastern Africa ,
Southern and Middle Africa.
• Rates are lowest in Australia/New Zealand and Western
Asia.
• Cervical cancer remains the most common cancer in
women in Eastern and Middle Africa.

11. ESTIMATED INCIDENCE
Estimated numbers (in thousands) Cases Deaths 5-year Prevalence
World 528 266 1547
More developed regions 83 36 289
Less developed regions 445 230 1258
WHO Africa region (AFRO) 92 57 236
WHO Americas region (PAHO) 83 36 279
WHO East Mediterranean region (EMRO) 15 8 42
WHO Europe region (EURO) 67 28 225
WHO South-East Asia region (SEARO) 175 94 465
WHO Western Pacific region (WPRO) 94 43 299
IARC membership (24 countries) 206 103 595
United States of America 13 7 47
China 62 30 190
India 123 67 309
European Union (EU-28) 34 13 115
* International Agency for Research on Cancer, WHO, 2015 (GLOBOCON 2012)

12. Age specific ASIRs of Cervical Cancer
www.hpvcentre.net, Feb 7, 2014

13. Age standardized incidence rates (ASIRs) for
Cervical Cancer
Globally – 527 624 new cases
India – 122 844 new cases
67 477 deaths
GLOBOCAN 2012, IARC
www.hpvcentre.net, Feb 7, 2014

14. According to WHO
2015 data , India is in
the zone of highest
incidence.
Estimated age-standardised rates (World) per 100,000

15. World Wide Prevalence of Cervical Cancer in 2015

16. TRENDS IN GLOBAL INCIDENCE
• Decreased significantly by 1.3% per year
among women.
• Decreased significantly by 1.1% per year
among white women.
• Decreased significantly by 2.3% per year
among black women.
• Decreased significantly by 3.9% per year
among Hispanic women.
• Decreased significantly by 3.0% per year
among Asian/Pacific Islander women.

17. Data from GLOBOCON 2012, INTERNATIONAL AGENCY FOR RESEARCH ON CANCER, WHO

18. GLOBAL MORTALITY
• There were an estimated 266,000 deaths from cervical
cancer worldwide in 2016, accounting for 7.5% of all
female cancer deaths.
• Almost nine out of ten (87%) cervical cancer deaths
occur in the less developed regions.
• Mortality varies 18-fold between the different regions
of the world, with rates ranging from less than 2 per
100,000 in Western Asia, Western Europe and
Australia/New Zealand to more than 20 per 100,000 in
Melanesia (20.6), Middle (22.2) and Eastern (27.6)
Africa.

19. Estimated age-standardised rates (World) per 100,000
Highest mortality
region

20. TRENDS IN GLOBAL MORTALITY
• Decreased significantly by 0.9% per year among women.
• Decreased significantly by 0.6% per year among white women.
• Decreased significantly by 2.2% per year among black women.
• Decreased significantly by 2.3% per year among Hispanic women.
• Remained level among American Indian/Alaska Native women.
• Decreased significantly by 3.1% per year among Asian/Pacific Islander women.

21. HPV INFECTION
• The human papillomavirus infection is
responsible for an estimated 530 000 cases of
cervical cancer and 264 000 cervical cancer
deaths each year;
• It also causes vulvar, vaginal, anal, and penile
cancers as well as precancerous lesions of
vulva/vagina, genital warts, and respiratory
papillomatosis.
• At least 50% of men and women will acquire
genital HPV infection during their lifetime.
• All sexually active women are infected with HPV
at least once during their lifetime, and the
highest prevalence is seen soon after the onset
of sexual activities.

22. SCREENING
• An analysis of population-based surveys indicates that coverage of cervical
cancer screening in developing countries is 19% compared to 63% in
developed countries and ranges from 1% in Bangladesh to 73% in Brazil.
• However, older and poor women who are at the highest risk of developing
cancer are least likely to undergo screening.

23. DECLINING HPV PREVALENCE IN THE
POST-VACCINE ERA
• Infection with HPV has declined by nearly two-thirds
among teenage girls since HPV vaccination was
recommended in the United States. (CDC 2016)
• In the United States, routine vaccination against HPV,
has been recommended since mid-2006 for 11- to
12-year old girls and for females up to age 26 who
have not previously been vaccinated.
• HPV vaccination has been recommended for males
since 2011.

24. INDIAN
SCENARIO

25. INTRODUCTION
• Cervical cancer is the commonest cancer cause
of death among women in India.
• It is the second most common cancer in women
aged 15–44 years.
• Every year in India, 122,844 women are
diagnosed with cervical cancer and 67,477 die
from the disease.
• India has a population of 432.2 million women
aged 15 years & above who are at risk of
developing cancer.

26. Incidence of Cervical Cancer compared to other
Cancers in women of all ages in India
www.hpvcentre.net, Feb 7, 2014

27. INCIDENCE
• India has the highest age standardized incidence of
cervical cancer in South Asia at 22, compared to 19.2 in
Bangladesh, 13 in Sri Lanka, and 2.8 in Iran.
• In India the peak age for cervical cancer incidence is 55–
59 years.
• The recent NCRP (NATIONAL CANCER REGISTRY
PROGRAMME) data show that Aizawl district in had the
highest levels of cervical cancer at an age-adjusted rate
of 24.3, followed by Barshi Expanded at 19.5 and
Bangalore at 18.9.
• Cervical cancer rates among women in the 30–64 age
group decreased by 1.8% per year

28. ASIR of Cervical Cancer in countries of
Southern Asia
www.hpvcentre.net, Feb 7, 2014

29. INCIDENCE

30. India ~134,000
World ~ 529,000
India ~25% of new
Cervical Cancer cases in world
India ~ 73,000
World ~ 274,000
India ~25%
Rest of World - 75%
India ~27% of deaths
due to Cervical Cancer in world
Rest of World - 73%
India - 27%
CERVICAL CANCER – DISEASE BURDEN
Incidence Mortality
India ~27%
Rest of World - 73%
HPV and Cervical Cancer in the World. 2010 Report. WHO/ICO Information Centre on HPV and Cervical Cancer
(HPV Information Centre). Available at: www.who.int/hpvcentre

32. HPV PREVALENCE
• HPV prevalence among cervical cancer patients
in India has varied from 87.8% to 96.67%.
• HPV-16 has been found most commonly.
• HPV prevalence among women without cervical
cancer varied from 7.5% to 16.9% comparable
with a worldwide prevalence of HPV infection
between 9% and 13%.
• The prevalence was higher among high-risk
categories such as commercial sex workers at
25%, urban slum in Mumbai at 32.3% and HIV-
positive women from 41.7% to 56%.

33. SCREENING IN INDIA
• In the absence of a nationwide screening program,
there are disparities in screening, treatment, and
also survival.
• Opportunistic screening in various regions of India
varied from 6.9% in Kerala to 0.006% and 0.002% in
the western state of Maharashtra and southern
state of Tamil Nadu, respectively. *
• Most of the cases (85%) present in advanced and
late stages, and more than half (63%–89%) have
regional disease at the time of presentation.
*Aswathy S, Quereshi MA, Kurian B, Leelamoni K. Cervical cancer screening: current knowledge and
practice among women in a rural population of Kerala, India. Indian J Med Res. 2012;136(2):205–210.

34. SCREENING IN INDIA
• The national program NPCDCS has a plan of implementation at the primary,
secondary, and tertiary levels where the screening is opportunistic.
• Cytology based screening programmes are difficult to organise in India
because of issues related to absence of trained manpower, infrastructure,
logistics, quality assurance, frequency of screening and costs involved.

36. GLOBAL HEALTH STRATEGY 2016
(WHO)
• The global health sector strategy on sexually transmitted
infections focuses primarily on three infections that require
immediate action for control and that can be monitored:
Neisseria gonorrhoeae , Treponema pallidum, and Human
papillomavirus
• The programme has established a target for 2030 which is
“Sustain 90% national coverage and at least 80% in every
district (or equivalent administrative unit) in countries
with the human papillomavirus vaccine in their national
immunization programme”

37. CONCLUSION
• Cervical cancer is the 4th most common cancer in women worldwide but
most common cause of cancer related death in India.
• All over the world, including India, there is decreasing trend of cervical
cancer.
• Where countries like USA are celebrating a substantial decrease in HPV
infection owing to their immunization programme, India still lacks a
comprehensive screening programme.
• WHO emphasis on inclusion of HPV vaccine in National Immunisation
Programme.