Strategies to Eliminate Cervical Cancer in India: Suggests Review
A recent clinical update published in the Indian Obstetrics & Gynaecology in April 2025 highlights that India can eliminate its second most prevalent female malignancy (cervical cancer) by achieving the WHO’s 90-70-90 targets, primarily through 90% HPV vaccination coverage for adolescent girls by age 15. This strategic integration into the National Immunization Program is essential to drive incidence rates below the critical threshold of 4 cases per 100,000 women.
Globally ranked fourth, cervical cancer is the second most prevalent malignancy in India. HPV infection—primarily sexually transmitted—is the central causative factor, with early sexual onset and immunosuppression driving the prevention gap. To support the WHO goal of cervical cancer elimination, Dr. Dipanwita Bhaumik ESI PGIMSR & ESIC Medical College provides a clinical update on HPV vaccination strategies.
Therefore, the review outlines the 90-70-90 strategy for cervical cancer elimination: 90% vaccination of girls by age 15, 70% screening at ages 35 and 45, and 90% effective treatment coverage. Utilizing bivalent, quadrivalent, or nonavalent vaccines for individuals aged 9–45, the strategy aims to reduce India’s 6.6% HPV prevalence and halt progression to malignancy.
Key Clinical Findings of the Review Include:
• Broad-Spectrum Protection: The nonavalent vaccine offers the most comprehensive coverage, protecting against 98.4% of HPV-related cancers and diseases in both males and females.
• Optimized Dosing: Research supports a transition to single or two-dose schedules for those aged 9–20 years, which may improve compliance and simplify delivery in public health settings.
• National Integration: The Indian government has mandated the inclusion of HPV vaccines for girls aged 9–14 years through schools and primary health centers, addressing the primary prevention arm of the strategy.
• Screening Synergy: Eradication cannot rely on vaccination alone; it requires a 70% screening rate using advanced techniques like primary HPV testing or liquid-based cytology to identify pre-invasive lesions early.
• Gender-Inclusive Benefits: Vaccinating males up to age 45 is recommended to reduce the transmission of HPV and the incidence of associated anogenital and oropharyngeal malignancies.
The results suggest that if India maintains the 90-70-90 targets, it can achieve a 100% cure rate for treated pre-invasive lesions and effectively eliminate cervical cancer within the coming century. Clinicians should actively promote early vaccination and regular screening protocols to ensure patients benefit from the high efficacy and safety profiles of modern HPV vaccines.
While the review highlights significant progress, it notes that reduced-dose schedules for certain age groups still await formal approval from the Drug Controller General of India, suggesting a need for continued regulatory alignment and further research into long-term immunity for catch-up populations.
Reference
Bhaumik D, Bajaj M, Sreelatha S. Eliminating Cervical Cancer - An Update on HPV Vaccination. Indian Obstetrics & Gynaecology. 2025;15(02):52-56.
