Women are predisposed to being the ‘caretakers’ in any kind of unit – family, work, or society at large. But more often than not, they put themselves at the bottom of the priority list when it comes down to their health. We need to identify points of resistance that inhibit women from prioritising their health and wellbeing, and address each of these with strategic and tactical solutions so that the idea of being proactive about one’s health reaches more women and encourages them to take action.
Cervical cancer is the second most common type of malignancy reported in Indian women, alarmingly in the age bracket of 30–69 years. Therefore, any cervical cancer control measures implemented in India have the potential to impact the world. To learn how we can identify, control, and prevent cervical cancer, we conducted a study in South India, with a sample size of ~10,000 women across age groups. Some of our findings are highlighted below.

CAUSE
Close to 70% of cervical cancer cases in women are caused by the HPV 16 and HPV 18 viruses. HPV stands for Human Papillomavirus, a common virus that is transferred by skin-to-skin sexual contact. What makes it common is that over 80% of sexually active adults are more likely to get HPV at some point in their lives.

SCREENING
A Pap smear test, also known as a Papanicolaou test or Liquid Based Cytology (LBC), is a screening procedure to detect cervical cancer in women. However, HPV testing is the preferred screening modality globally due to its robust evidence establishing capabilities. In addition, HPV testing can be done in a gap of every 5-10 years, and is especially critical in identifying people prone to develop cancers, making it an important diagnostic tool in the early detection of cervical cancer and timely intervention.

STUDY & FINDINGS
Our study offered HPV DNA testing with partial genotyping in a community setting using an automated, high throughput technology. We applied this technology to test high‐risk HPV in cervical scrape samples collected from asymptomatic women aged between 30 and 60 years between March 2020 to November 2022. Other criteria included women not being pregnant, with a history of sexual activity or being sexually active, not menstruating during sample collection, and those who had not undergone screening before.

• The current study showed that the challenge of offering high risk HPV tests in a large population can be dealt with a fully automated molecular testing platform serving as a centralized facility.
• The current study has explored the feasibility for the first time in India in a community based screening setting.

This study established that with multiple screening options being available, it is possible to uniformly adopt HPV testing as the primary test and as the first choice in a cervical cancer screening program in South India.

The current study pointed out that HPV 16 and HPV 18 infections, when differentiated, can be very valuable in population screening.

• Out of the women tested, 5.73% were found to be at a high risk, 1.22% to be infected with HPV 16, 0.34% harboring HPV 18, and other pooled high‐risk HPV was found in 3.68% women, with multiple mixed infections found in 0.48%.
• There was an increased incidence of high‐risk HPV (HR‐HPV) infection in women aged 30–40 years, and a second peak of HR‐HPV infection in women aged 46–50 years, followed by a plateau with increasing age.
• There have been previous studies that show a correlation between women’s living conditions and a high prevalence of HR‐HPV due to a lack of organised screening programs, and the lack of access to timely treatment. Moreover, poor awareness of cervical cancer and the importance of screening contributes to high prevalence of the disease.

IMPLEMENTATION & RESULTS
HPV testing has been adopted globally as a primary screening modality in several guidelines and is core to the WHO strategy for cervical cancer elimination. There is substantial evidence from low and middle-income countries establishing HPV‐based tests being more effective and a financially sound alternative in cervical cancer prevention ^[1]
Early detection of the disease also brings down the treatment cost, so from a HECON perspective, screening proves to be an effective investment. Expanding the coverage of screening once in a lifetime to 50%, can lead to 2 to 3 times reductions in cervical cancer risk, and this can further lead to a more significant reduction in health disparity and increase the number of life‐years saved.

FORWARD
This study evidences the efficacy of using a centralised facility to transport and test samples, making a case for a hub and spoke model across the country for HPV testing to aid in early diagnosis.
In the last decade, HPV testing has been adopted globally as a primary screening modality in several guidelines framed due to robust evidence establishing the superiority of the HPV DNA test vs Pap testing and visual inspection with acetic acid (VIA) testing. There is substantial evidence that HPV‐based tests are highly sensitive and more effective in cervical cancer prevention than conventional cytology or VIA. ^[2,3,4]
Modern therapy emphasises precision medicine with high specificity which minimises over-treatment. A collective intent of action, especially coming in from proactive quarters has the potential for insurance against deadly diseases. More and more adult women should undergo periodic cervical screening, and encourage their peers in their community for the same.


Article by Dr. Vijayalakshmi Ramshankar, Head Department of Preventive Oncology (Research), Cancer Institute (WIA)

Disclaimer: The views expressed herein are those of the author and not of Roche Diagnostics.