Background

Cancer of the cervix uteri is the second most common cancer among women worldwide, with an estimated 529,409 new cases and 274,883 deaths globally in 2008. About 86% of the cases occur in developing countries, representing 13% of female cancers. Worldwide, mortality rates of cervical cancer are substantially lower than incidence with a ratio of mortality to incidence to 52% (IARC, GLOBOCAN 2008).

India has a population of 366.58 million women aged 15 years and older who are at risk of developing cervical cancer. Cervical cancer ranks as the 1st most frequent cancer among women in India, and the 1st most frequent cancer among women between 15 and 44 years of age. About 7.9% of women in the general population are estimated to harbor cervical HPV infection at a given time, and 82.5% of invasive cervical cancers are attributed to HPVs 16 or 18. With a Crude Incidence Rate of 23.5, current estimates indicate that every year 134,420 Indian women are diagnosed with cervical cancer with the figure for new cervical cases projected to reach 203,757 by 2025*. It is estimated that at present approximately 72,825 women die due to cancer of the cervix. By 2025*, this number is projected to rise to 115,171.

While HPV is a necessary cause of cervical cancer, it is not a sufficient cause. Other cofactors which have been established as necessary for progression from cervical HPV infection to cancer are tobacco smoking, high parity, long-term hormonal contraceptive use, and co-infection with HIV. It is also established that well-organized cervical screening programs or widespread good quality cytology can reduce cervical cancer incidence and mortality. It is increasingly evident that information about sexual and reproductive health behaviors is essential to the design of effective preventive strategies against cancer cervix.

Pilot Programme on Screening for Cervical Cancer

Pilot Districts

As 80% of the women detected with Cervical Cancer in developing countries come from rural areas, Theni and
Thanjavur (being agricultural districts) were selected as the pilot districts.

Target Population

All women within the age group 30 to 60 years, irrespective of the presence of symptoms were screened for Cervical Cancer.

Upscaling

The pilot was assessed to positively demonstrate that VIA/VILI is an appropriate cost effective screening tool in low resource settings. With appropriate provision of service delivery for efficient follow up of screened positive cases, the pilot was demonstrated to be conducive for scaling up across the state.

In this background, the Govt. of Tamil Nadu has proposed to upscale the pilot to 16 districts in Phase I (2010 - 2011) and the remaining 16 districts in Phase II (2011 – 2012) of the Additional Financing phase of the Tamil Nadu Health Systems Development Project. The scale up will also include a concurrent screening program for Breast Cancer.

Services Provided

• Screening
• Further Evaluation and Confirmation
• Treatment

Expected Outcomes

As Tamil Nadu has shown a considerable improvement in strengthening the health system and bringing a change in the health seeking behaviour of the population, total women expected to be benefited one time by the programmes will be 69 lakhs.

The total women expected to be diagnosed with Cervical Cancer/ Breast Cancer and treated will be 34,500.

Programme Brochure