Deep Dive into Approaches toward Cervical Cancer Screening: Understanding the Barriers and Opportunities in India

Cervical cancer poses a significant health burden in India, with late-stage diagnosis contributing to high mortality rates. This white paper emphasizes the critical need for screening strategies using human papillomavirus (HPV) testing to improve early detection, thereby reducing the mortality. Current screening rates are inadequate and are limited at various levels vis-a-vis patient, provider, and systemic. The paper provides an overview of the various cervical screening methods, including visual inspection with acetic acid, cytology (Pap and liquid-based cytology), and HPV deoxyribonucleic acid (DNA) testing. It also highlights the World Health Organization’s recommendation for primary HPV DNA testing due to its superior sensitivity, specificity, longer screening intervals, and compatibility with self-collected samples, along with healthcare professional-collected samples. The importance of HPV assays with extended genotyping capabilities for accurate risk stratification and informed clinical management further underlines the need for adapting this test in routine screening. Furthermore, self-collection for HPV testing is crucial to expand screening access, particularly in underserved populations and widespread country such as India. The paper has tried to address the cost-effectiveness of HPV testing over conventional methods; however, identifying the need to further build on effective models in Indian settings. Finally, it outlines the latest management guidelines (American Society for Colposcopy and Cervical Pathology and Federation of Obstetric and Gynecological Societies of India) for HPV-positive women, further emphasizing the risk-based approaches based on HPV genotype and cytology results. To conclude, this white paper provides a comprehensive information regarding the current screening modalities with a focus on HPV testing and its importance to change the cervical cancer dynamics in Indian women.