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A BIANNUAL NEWSLETTER OF ASSAM CANCER CARE FOUNDATION A BIANNUAL NEWSLETTER OF ASSAM CANCER CARE FOUNDATION

The reasons for this excess burden are Nearly a decade later, the transition has not kept
multifactorial. They include persistent high-risk pace with the disease burden. Screening coverage
HPV infection, region-specific tobacco use remains very low, and many cervical cancer cases
patterns, early age at first intercourse, multiparity continue to be detected at advanced stages. This
in some communities, poor uptake of organised reflects not only the limitations of VIA but also low
screening and geographic barriers that delay awareness, discomfort with pelvic examination,
diagnosis and treatment. Tribal and rural women sociocultural barriers and weak follow-up after a
often face additional barriers, including limited positive screening test.
health literacy, stigma around gynaecological Community-based evidence shows why VIA alone
examination, long travel distances and shortage of is not enough as a long-term strategy. HPV DNA
female providers. testing has demonstrated much higher sensitivity
From Visual Inspection to Molecular Testing: The than VIA and Pap cytology, but programme success
Evolving Screening Toolkit depends on what happens after a positive result. If
India’s national screening framework, introduced women do not reach colposcopy or biopsy, high-
in 2016 under the Ministry of Health and Family risk cases are lost from the pathway. The lesson
Welfare’s operational guidelines for non- is clear: HPV DNA is the stronger primary test, but
communicable diseases, adopted VIA as the screening only works when referral, colposcopy
primary screening test because it was simple, low- and treatment are functional.
cost and feasible at the primary health centre level. Table 2 places the three principal screening
This was always an interim strategy, intended to modalities and colposcopy side by side for
continue until a reliable, low-cost HPV test became comparison.
available at scale.

Table 2. Comparative performance of cervical cancer screening and triage modalities

Modality Sensitivity Specificity Operator dependence Screening
(CIN2+/3+) interval
VIA ~32% ~87–88% High (subjective) Annual / per
programme

Conventional/liquid-based ~78% ~86% Moderate 3 years
Pap cytology (cytopathologist-dependent)

HPV DNA testing 98–100% ~90–91% Low (objective, molecular) 5 years
(negative test)

Colposcopy (triage of 86–91% 47–72% High, improves greatly with At point of
HPV-positive women) (CIN3+) standardisation/training referral

Figures are representative ranges drawn from community and registry-based studies cited in the text and are intended for
comparative orientation rather than as fixed values for clinical decision-making.

The Case for HPV DNA Testing, with Pap Smear in a ability to detect disease at a curable stage. This
Defined Supporting Role aligns with the WHO 90-70-90 elimination targets:

WHO now recommends HPV DNA-based testing 90% HPV vaccination coverage, 70% screening
as the preferred primary screening method for coverage with a high-performance test, and
cervical pre-cancer lesions, reflecting its stronger 90% management of detected disease by 2030.

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