Providing free screening for cervical cancer from state-run health facilities across the country was among the measures the government outlined in its annual policies and programmes of the fiscal year 2023-24 to prevent deaths of women from the disease.

In the current fiscal year, however, the budget for free screening has been allocated to only a few local governments.

“We can carry out free screening of cervical cancer only in the few local units of 11 districts,” said Sarmila Dahal, chief of the Family Planning and Reproductive Health Section at the Family Welfare Division of the Department of Health Services. “The total budget for the programme is insufficient even to provide services to all women of that particular local level.”

Cervical cancer is among the most common and a major cause of deaths among Nepali women, with an age-standardised incidence rate of 14.4 cases per 100,000 in 2020, with 2,244 new cases and 1,493 deaths. Most patients of cervical cancer in Nepal—80.9 percent—are diagnosed at a late stage, contributing to the higher mortality rate.

Health officials agreed that it would be best to prevent cancer from occurring, which can only be done with the help of free screening, awareness drives and administration of the vaccine against human papillomavirus.

“Symptoms of cervical cancer can be detected 10 to 12 years before, through screening,” said Dahal. "But most patients seek treatment in the third or fourth stages of cancer, when their condition already gets complicated.”

According to Dahal, free screening will be carried out in the local units of Sarlahi, Mahottari, Rautahat, Palpa, Dolakha, Kaski, Surkhet, Kailali, Sindhupalchok, Kavrepalanchok and Lalitpur districts in the current fiscal year that started this week.

The budget for free screening can purchase around 130,000 test kits, which means only that number of women can be screened, said Dahal.

Oncologists say early treatment can prevent up to 80 percent of cervical cancer cases.

“Survival rate of cervical cancer is up to 95 percent if the treatment is started in stage 1 and up to 75 percent in stage 2,” said Dr Shivaji Poudel, executive director at the Chitwan-based BP Koirala Memorial Cancer Hospital. “The important thing is that problems must be diagnosed at an early stage and treatment started.”

Experts say awareness and free screening, along with the administration of vaccines against human papillomavirus, could help lessen the burden of cervical cancer in Nepal. If the problem is diagnosed early, the ailment can be cured at a small cost, they add.

Health officials complained that the budget was not sufficient to carry out nationwide vaccination against human papillomavirus (HPV), which they planned to start in the first quarter of 2025. They say that the Global Alliance for Vaccine and Immunisation (GAVI) has agreed to provide vaccine doses enough for 1.7 million girls between 10 and 14.

Human papillomavirus is a viral infection that spreads through skin contact. The virus causes cervical cancer, which is the second-most common cancer in the developing world. Hundreds of women get diagnosed with cervical cancer every year in Nepal.

Doctors say most cervical cancers are associated with the HPV, a sexually transmitted infection. Widespread immunisation could reduce the impact of cervical cancer and other cancers caused by the HPV worldwide.

Countries like Bhutan, Sri Lanka, Thailand and the Maldives have introduced HPV vaccines nationally while India and Indonesia have introduced them in some districts.

Last year, Nepal purchased 20,000 doses of the HPV vaccine, which were administered to around 9,000 girls aged between 14 and 15 years from all seven provinces. Health authorities administered the vaccines at schools after other measures failed to increase the vaccine’s uptake.

The World Health Organisation says HPV vaccination is recommended as part of a coordinated strategy to prevent cervical cancer and other diseases caused by the virus.

Nepal is also among the countries that have committed to eliminating cervical cancer by 2030. For that, the country has to meet 90-70-90 targets, which means vaccinating 90 percent of the girls with the HPV vaccine by the age 15, performing screening on 70 percent of women using a high-performance test by the age 35 and again by 45 years and provide treatment to 90 percent of women who are pre-cancer tested and manage 90 percent of the women with invasive cancer.