A lecturer at a suburban college in Mumbai, Dipti Patil (name changed for confidentiality) and her husband just couldn't believe that at 28 years of age she could be a victim of cervical cancer. They had been married just three years ago and had a 14-month-old son.

It was similar disbelief for homemaker Kusumtai. In her early 60's and nearly 10 years into menopause, she suddenly started bleeding. She too was diagnosed with cervical cancer, which is the cancer of the cervix or mouth of the uterus and is caused by the sexually transmitted human papilloma virus (HPV).

Unfortunately, Dipti and Kusumtai are not alone. Every year, 1,32,082 women in India are diagnosed with cervical cancer, according to the World Health Organization (WHO). Of them, 74,118 succumb to the disease. The growing risk of cervical cancer in women (aged 0-64 years) in India is said to be 2.4 per cent - higher than the 1.3 per cent for the world.

Pelvic pain or pain during intercourse, bleeding between periods, post-menstrual bleeding and discharge from the vagina are some of the symptoms of this disease. Delaying sex till one is older, ensuring good health and maintaining proper hygiene are some of the ways to help prevent this cancer. Since inadequate nutrition and improper hygiene as triggers the condition, it is not surprising that the prevalence of cervical Cancer fertility is higher in slums. 

"It is a major killer in India. At the TATA Memorial Center and Research Institute, 15 to 20 per cent of total patients admitted were that of cervical cancer. Maybe the number has marginally reduced now," says Dr Suresh Advani, a reputed oncologist, Padma Bhushan recipient, and former head of the oncology department at TATA hospital. He is currently a consultant with leading Mumbai hospitals such as Jaslok, the Asian Institute of Oncology (S.L. Raheja Hospital) and Breach Candy Hospital.

The issue caught renewed public attention with the tragic death from cervical cancer of Jade Goody, British television celebrity of the 'Big Brother' reality show. Now there is a new vaccine being advertised to address this cancer. Featuring celebrities like Konkana Sen, it emphatically markets the advantages of an HPV (human papillomavirus) vaccine. 

 Manufactured in India by GlaxoSmithKline ('Cervarix') and MSD Pharmaceuticals ('Gardasil'), the vaccine was discovered nearly two decades ago when researchers at the USA-based National Cancer Institute (NCI) and other institutions began searching for the underlying causes of cervical cancer. The vaccine protects against infection from the two types of human papillomavirus (HPV-16 and HPV-18) that are said to cause the majority of cervical cancers worldwide. To ensure maximum benefit and protection from this vaccine, it would be necessary to administer it before the onset of sexual activity, say its promoters. 

"In the West and in South African countries many girls aged 9-10 become sexually active and many a time have multiple sex-partners. The vaccine was found essential for them. In India, in many communities, early marriage is still prevalent, although on the whole we still lead conservative lifestyle as far as pre-marital sex is concerned. This vaccine needs to be administered at a young age, preferably between age of 9-22 years and before the start of an active sex life to prevent the onset of cervical cancer," explains Dr Partha Guha Roy, obstetrician and gynecologist, Fertility Clinic & IVF Center, Grant Road.

Mumbai-based eminent obstetrician and gynecologist Dr Duru Shah, who runs Gynaec World Clinic at Gamdevi and is affiliated to the Breach Candy Hospital, Jaslok Hospital and Sir Hurkisondas Hospital, too, iterates that the vaccine, if it is to be useful, must be taken by girls before they become sexually active.

There are doctors who are so enthused by the vaccine that they recommend that the government subsidizes it and introduces it in the national immunization programme. They argue that this is important because a large number of beneficiaries of this vaccine are poor and the current cost of the three-vaccine dosage is at around Rs 7,500 per (US$1=Rs 45.6) person. Says oncologist Dr Advani, responding to critics of the vaccine, "This vaccine is a revolution. Lakhs of women will benefit from this. The government and all concerned people should step in and spread awareness of the HPV vaccine."

Manufactured in India by GlaxoSmithKline ('Cervarix') and MSD Pharmaceuticals ('Gardasil'), the vaccine was discovered nearly two decades ago when researchers at the USA-based National Cancer Institute (NCI) and other institutions began searching for the underlying causes of cervical cancer. The vaccine protects against infection from the two types of human papillomavirus (HPV-16 and HPV-18) that are said to cause the majority of cervical cancers worldwide. To ensure maximum benefit and protection from this vaccine, it would be necessary to administer it before the onset of sexual activity, say its promoters. 

"In the West and in South African countries many girls aged 9-10 become sexually active and many a time have multiple sex-partners. The vaccine was found essential for them. In India, in many communities, early marriage is still prevalent, although on the whole we still lead conservative lifestyle as far as pre-marital sex is concerned. This vaccine needs to be administered at a young age, preferably between age of 9-22 years and before the start of an active sex life to prevent the onset of cervical cancer," explains Dr Partha Guha Roy, obstetrician and gynecologist, Fertility Clinic & IVF Center, Grant Road.

Mumbai-based eminent obstetrician and gynecologist Dr Duru Shah, who runs Gynaec World Clinic at Gamdevi and is affiliated to the Breach Candy Hospital, Jaslok Hospital and Sir Hurkisondas Hospital, too, iterates that the vaccine, if it is to be useful, must be taken by girls before they become sexually active.

There are doctors who are so enthused by the vaccine that they recommend that the government subsidizes it and introduces it in the national immunization programme. They argue that this is important because a large number of beneficiaries of this vaccine are poor and the current cost of the three-vaccine dosage is at around Rs 7,500 per (US$1=Rs 45.6) person. Says oncologist Dr Advani, responding to critics of the vaccine, "This vaccine is a revolution. Lakhs of women will benefit from this. The government and all concerned people should step in and spread awareness of the HPV vaccine."

There are, however, many doctors who advise caution. "The advertisements are doing the job of informing people of the availability of such a vaccine but in their aggressive marketing strategy, they are misleading as they say, 'anybody can take these vaccines', which is wrong. The ads have to stress that prior to becoming sexually active, girls should take the three dosages of injections given on alternate months," stated Dr Roy.

Dr Shah, whose Gynecworld has been administering the injection to around one or two girls every day, says, "The general public has to be educated about all these myths and that work should be taken over by the government... I get menopausal women, mothers asking if they should take these injections." 

Furthermore, women must also be made aware of the fact that while contraindications have not yet been reported, studies are currently being conducted on the necessity of a booster dosage, following the primary three injections. The results of the research are still to come in. 

The vaccine has also met with stiff opposition from women's groups and health activists. A recent press release issued by Sama Resource Group for Women and Health and Saheli Women's Resource Centre to the Ministry of Health & Family Welfare, Drugs Controller, Indian Council of Medical Research (ICMR), GlaxoSmithKline, MSD Pharmaceuticals and other recipients, "condemned the blatant and irresponsible promotion" of the vaccine in India, stating that it is "not a vaccine to 'prevent' cervical cancer; only a vaccine against two among hundred HPV types". Amongst the several counterpoints cited were "serious long term side effects, astronomical costs and the fact that vaccine requires a robust screening system for cancer in order to benefit anyone." 

The positive aspect of this controversy has been to bring a much needed focus on the issue of cervical cancer in the country and the need for women to ensure their general health and hygiene. The fact is that that cervical cancer, if detected at an early stage, is 100 per cent curable. It is to ensure early detection that gynecologists advise women over 35 years of age to undergo a PAP-smear test every alternate year. 

The positive aspect of this controversy has been to bring a much needed focus on the issue of cervical cancer in the country and the need for women to ensure their general health and hygiene. The fact is that that cervical cancer, if detected at an early stage, is 100 per cent curable. It is to ensure early detection that gynecologists advise women over 35 years of age to undergo a PAP-smear test every alternate year.