Cervical cancer remains a serious health crisis in India, affecting countless lives and accounting for a staggering one-fourth of the global burden. Every year, over 75,000 women in the country succumb to this largely preventable disease as per a study titled “Cervical cancer in India and HPV vaccination”. Without widespread screening and prevention efforts, the annual burden of new cases is projected to rise to 225,000 by 2025, according to WHO estimates.
While cervical cancer is behind breast cancer in its prevalence, an epidemiological study of cervical and breast screening in India (BMC Women's Health) shows that the 5 years survival rate of cervical cancer is much lower than breast cancer (51.7% and 66.4% respectively) primarily due to lack of screening, late diagnosis and lack of access to treatment. Although the government has initiated vaccination for the adolescent population in India, this stark reality that critically affects the quality of life of our women underscores the urgent need for coordinated and targeted action through early detection and prevention, emphasizing the critical role of timely screening.
Screening landscape in India
Cervical cancer screening is a game-changer, offering a lifeline through early detection, allowing for timely intervention and significantly improving survival rates. Yet, according to the National Family Health Survey (NFHS-5), only 1.9% of women aged 30–49 years have ever been screened for cervical cancer, with the prevalence slightly higher in urban areas (2.2%) compared to rural areas (1.7%). There are several screening methods, each with advantages and disadvantages.
Visual Inspection with Acetic acid (VIA) is a cost-effective method and suitable for low-resource settings. However, it is prone to subjective interpretation and false negatives, as its accuracy can be compromised by subjective interpretation. Another widely used method, the Pap smear which has been the global gold standard is effective in detecting abnormal cervical cells, but their sensitivity is limited and often requires frequent follow-ups and skilled professionals, especially in low-resource settings. HPV DNA testing, the recent innovation in cervical cancer screening directly targets the root cause by identifying high-risk HPV strains. Despite the high sensitivity, its use remains limited in India due to cost and accessibility challenges.
HPV DNA testing: The gold standard in screening
HPV DNA testing is transforming cervical cancer prevention by providing a more accurate and reliable screening method. The key difference between this and other screening methods lies predominantly in 2 aspects - what they detect and the level of accuracy.
Several studies have shown that the high sensitivity (90%) and specificity (95%) of HPV DNA testing have made it more reliable than other contemporary methods (Srivastava et al., 2018). This offers the added advantage of longer intervals between screenings, with negative results justifying screenings every 5 to 10 years.
In addition to improving the efficiency of cervical cancer prevention, it also reduces the burden on health systems, ensuring optimal resource allocation. According to WHO, one unique advantage offered by the method is the possibility of self-sampling, allowing women to collect samples in the comfort of their own homes. This not only enhances convenience and privacy but also reduces barriers such as fear, embarrassment, and logistical challenges associated with clinic visits. WHO recommends HPV self-sampling as part of its self-care intervention recommendations. By empowering women to take control of their health in a way that fits their lifestyle, self-sampling has the potential to improve women’s participation in cervical cancer screening, particularly in areas with limited access to healthcare facilities.
Challenges to screening in IndiaCervical cancer screening in India faces unique challenges that limit its uptake, particularly in rural and underserved areas:
Lack of awareness and social stigma: Lack of awareness and social stigma: Awareness about cervical cancer and the importance of screening remains alarmingly low among communities as well as health workers, especially in rural areas. Cultural taboos surrounding reproductive health and misconceptions linked with HPV testing being associated with promiscuity perpetuate hesitancy and prevent women from seeking preventive services.
Fear of a positive result: The fear of being diagnosed with cancer, along with the perceived stigma and emotional distress associated with a positive result, discourages many women from undergoing screening. Additionally, linking screening with invasive procedures and the potential discomfort also perpetuates avoidance. This fear is compounded by a lack of counseling and inadequate support systems to help women manage their anxiety about potential outcomes and the process itself.
Limited access to HPV DNA testing: While HPV DNA testing is a superior method for early detection, its adoption in India is restricted by financial and logistical constraints like inadequate supply chains, limited laboratory networks, and a lack of trained personnel, especially in non-urban settings. Additionally, the lack of evidence of the cost-effectiveness of DNA testing over cytology or VIA in real-life settings is also a deterrent to the wider uptake of the tests.
Unified approach needed to eliminate cervical cancerOvercoming these challenges requires a multi-faceted approach that combines education, innovation, and systemic reforms. As Benjamin Franklin said, an ounce of prevention is worth a pound of cure; which is especially true in the case of conditions like cervical cancer that significantly affect the quality of life. Here’s how we think India can move closer to eliminating cervical cancer:
Building awarenessOrganized and continuous awareness is crucial for the prevention where women are educated about cervical cancer risks and screening benefits. National campaigns using diverse approaches that is participatory, inclusive and community-led will dismantle myths and foster positive dialogues. Training healthcare providers to encourage preventive screenings as part of broader women and adolescent health interventions will promote early awareness and adoption towards positive practices.
Collaborations and partnershipsA unified approach involving policymakers, healthcare providers, and civil society is key to tackling cervical cancer in India. Public-private partnerships can pool resources, and expertise, and decentralize processes to make screening more accessible. Civil society organizations (CSOs) and grassroots networks can organize health camps, challenge stigma, and empower women to prioritize screening. Learning from successful collaborations such as the Polio eradication campaign and turning cervical cancer elimination into a shared public health priority will be crucial to putting an end to this.
Health system strengtheningLeveraging technology and investments to build robust infrastructure and equipment will be decisive in promoting equitable access to preventive measures like screening. Focused efforts to understand the feasibility of self-sampling kits in community settings, creating sustainable architecture for supporting women through digital health interventions to address access issues and building capacities of frontline workers like ASHA, etc. will expedite and amplify the current efforts. Last but not least, policy level changes like integrating cervical cancer screening as part of national health programs will grow the national cervical cancer elimination efforts by leaps and bounds!
A collective call to actionCervical cancer can go from the leading killer to a preventable condition in India, if we enable systemic shifts, scale innovations and promote awareness through collective action. The time to act is now. We can forge a future where prevention triumphs, access prevails, and no woman is left behind.
(Authors Ravneet Kaur, Dr. Syama B Syam are associate portfolio manager & portfolio manager of Evidence 2 Impact,
Swasti Health Catalyst)