Authors
1 Institute for Medical Epidemiology, Biostatistics and Informatics, Martin‑Luther‑University Halle‑Wittenberg, Halle (Saale), Germany
2 Research Triangle Institute Global India Private Limited (RTI International), New Delhi, 100 037, India, International Agency for Research on Cancer (IARC/WHO), Lyon CEDEX 08, France
Abstract
BACKGROUND: Although there is a reduction in cervical cancer incidence over the years, it keeps
the second position of the most common cancers among females in India. The aim of this review
is to understand the challenges of health promotion and education strategies to prevent cervical
cancer in India.
MATERIALS AND METHODS: This review is based on 78 studies published during 1993–2017 on
the topics of awareness, attitude, and acceptance toward cervical cancer, screening, and human
papilloma virus vaccination among Indians. The extracted information was summarized according to
different populations such as people from different social and community groups, women and men
attended clinics, students (nursing/medical/nonmedical), health‑care providers (doctors, nurses, and
other health workers), migrated Indians, and cervical cancer patients.
RESULTS: The awareness about cervical cancer and its prevention was very poor among women
from different communities and the majority had a negative attitude toward screening and vaccination
in general. The health professionals and medical students were more aware of cervical cancer and
its prevention compared to the general population. Majority of students irrespective of medical or
nonmedical background had a positive attitude toward vaccination. Only a small proportion of women
in the general population were ever screened.
CONCLUSIONS: Observations from this review indicate immediate attention of the public health
authority to take appropriate actions to educate and motivate general population toward cervical
cancer prevention and to improve the facilities to incorporate the much needed preventive and early
detection interventions in India.
Keywords
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2. World Health Organization. Comprehensive Cervical Cancer
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Press; 2014. p. 38‑44.
3. Miller AB. Epidemiologic Studies in Cancer Prevention and
Screening. 1st ed. New York: Springer; 2013.
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cancer cervix in India. Indian J Med Res 2009;130:219‑21.
9. Badwe RA, Dikshit R, Laversanne M, Bray F. Cancer incidence
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10. Sankaranarayanan R, Swaminathan R, Brenner H, Chen K,
Chia KS, Chen JG, et al. Cancer survival in Africa, Asia, and central
America: A population‑based study. Lancet Oncol 2010;11:165‑73.
11. Thulaseedharan JV, Malila N, Swaminathan R, Esmy PO,
Cherian M, Muwonge R, et al. Survival of patients with cervix
cancer in rural India. Clin Gynecol Obstet 2015;4:290‑6. Available
from: http://dx.doi.org/10.14740/jcgo367w. [Last accessed on
2018 Jun 20].
12. Jayant K, Sankaranarayanan R, Thorat RV, Muwonge R,
Hingmire SJ, Panse NS, et al. Improved survival of cervical cancer
patients in a screened population in rural India Asian Pac J Cancer
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13. Nigam A, Saxena P, Acharya AS, Mishra A, Batra S. HPV
vaccination in India: Critical appraisal. ISRN Obstet Gynecol
2014; vol. 2014, Article ID 394595. Available from: http://dx.doi.
org/10.1155/2014/394595.[Last accessed on 2018 Jun 20].
14. Sankaranarayanan R, Bhatla N, Gravitt PE, Basu P, Esmy PO,
Ashrafunnessa KS, et al. Human papillomavirus infection and
cervical cancer prevention in India, Bangladesh, Sri Lanka and
Nepal. Vaccine 2008;26 Suppl 12:M43‑52.
15. Thulaseedharan JV. Evaluation of Sociodemographic,
Reproductive and Screening‑related Factors on Risk of and
Survival from Cervical Cancer in Rural South India. Dissertation.
Tampere: Acta Electronica Universitatis Tamperensis 1764;
2017. Available from: http://tampub.uta.fi. [Last accessed on
2017 Jul 22].
16. Sullivan R, Badwe RA, Rath GK, Pramesh CS, Shanta V,
Digumarti R, et al. Cancer research in India: National priorities,
global results. Lancet Oncol 2014;15:e213‑22.
17. Dhamija S, Sehgal A, Luthra UK, Sehgal K. Factors associated
with awareness and knowledge of cervical cancer in a community:
Implication for health education programmes in developing
countries. J R Soc Health 1993;113:184‑6.
18. Pai M, Pai N, Bilal S, Ashok M, Radhika P. Cervical cancer
screening: Is it a priority among nurses? Natl Med J India
2001;14:59‑60.
19. McCaffery K, Forrest S, WallerJ, Desai M, Szarewski A, Wardle J.
Attitudes towards HPV testing: A qualitative study of beliefs
among Indian, Pakistani, African‑Caribbean and White British
women in the UK. Br J Cancer 2003;88:42‑6.
20. Desai M. An assessment of community based cancer screening
program among Indian women using the anganwadi workers.
J Obstet Gynecol India 2004;54:483‑7.
21. Forrest S, McCaffery K, WallerJ, DesaiM, Szarewski A, Cadman L,
et al. Attitudes to self‑sampling for HPV among Indian, Pakistani,
African‑Caribbean and white British women in Manchester, UK.
J Med Screen 2004;11:85‑8.
22. Dabash R, Vajpayee J, Jacob M, Dzuba I, Lal N, Bradley J, et al.
A strategic assessment of cervical cancer prevention and treatment
services in 3 districts of Uttar Pradesh, India. Reprod Health
2005;2:11.
23. Ramanakumar AV, Balakrishna Y, Ramarao G. Coping
mechanisms among long‑term survivors of breast and cervical
cancers in Mumbai, India. Asian Pac J Cancer Prev 2005;6:189‑94.
24. Aswathy S, Sumithra S, Valsala LS, Sandheep S, Lohidas V,
Shobha P, et al. Self reported morbidity and awareness regarding
common cancers in elderly women. J Commun Dis 2006;38:106‑11.
25. Basu P, Ghoshal M, Chattopadhyay K, Mittal S, Das P,
Choudhury D, et al. Cervical screening by visual inspection with
acetic acid (VIA) is well accepted by women – Results from a
community‑based study in rural India. Asian Pac J Cancer Prev
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