Cervical cancer is the 4^th most common cancer worldwide. It is estimated that 604,127 women were diagnosed with cervical cancer, and 341,831 died from the disease in 2020 worldwide. Of these, India reported around 21% of the total cervical cases, as per the data^[1].
In India, cervical cancer is the second most common cancer among women. Every 8 minutes, one Indian woman dies from cervical cancer^[2]. Cervical cancer affects approximately 453 million (45.3 crores) Indian women aged 21 and older^[3]. Without intervention, it is predicted that 57,74,738 women in India will die from cervical cancer by 2070^[4] .
The disease burden in India is really high, despite the fact that cervical cancer is one of the most successfully treatable cancers when detected early and managed effectively. When diagnosed in early stages and provided with appropriate medical treatment, the chances of the patient surviving for at least 5-years after diagnosis is greater than 90%^[5]. Cervical cancer is preventable in up to 93% of cases and yet, India contributes to 21% of the world’s total cases of cervical cancer^[6]. Being part of CAPED India, an advocacy group raising awareness about diagnosis and prevention since the last 9 years, I have a first hand experience to the situation on the ground. There is a huge gap in awareness among masses about cervical cancer and HPV (human papillomavirus). Approximately, 99% of cervical cancer cases have been linked to infection with 'high-risk' types of (HPV), which is transmitted sexually^[7]. A research survey conducted by CAPED in December 2020 found that 52% of women were not even aware of the HPV vaccination and 41% of women are unaware about screening^[8]. Vaccination against high-risk HPV strains for girls of age 15 and below is important along with HPV screening for women in the age group of 30 to 65, to prevent cervical cancer.
Even though the cervical cancer ignorance rate is alarmingly high in the country, CAPED has achieved great success at the field level by conducting 179 awareness sessions, and organizing 366 screening camps, with 27,647 people screened by December 2022. Despite several screening campaigns and programs implemented in India over the years, the number of women seeking cervical cancer screening has remained low. Similar findings were supported by the CAPED survey (2022) where out of 147 respondents, only 18.40% (27) had opted for cervical cancer screening^[9]. This may be due to the stigma and lack of knowledge about the cervical cancer sampling technique.
The cervical screening methods recommended by WHO are as follows:

• For the general population of women, HPV-DNA detection is recommended as the primary screening method starting at the age of 30 years, with regular testing every 5–10 years.
• For women living with HIV, WHO recommends HPV-DNA detection starting at the age of 25 years, with regular screening every 3–5 years.

For screening of cervical pre-cancer lesions, the use of DNA-based HPV testing is considered a first-choice screening method by WHO^[10]. HPV DNA-based test is the preferred method, rather than visual inspection with acetic acid (VIA) or cytology (commonly known as a ‘Pap smear’), currently the most commonly used method globally to detect pre-cancer lesions. Pap smear screening looks for precancerous cell abnormalities, whereas HPV testing looks for high-risk HPV, the primary cause of cervical cancer. According to various reports, in developed countries, 68%-84% of women are screened for cervical cancer, but in India, this proportion is 2.6%-5% only^[11].
As a result, there is an urgent need to develop innovative strategies that go beyond the traditional healthcare response. HPV DNA self-sampling kits can be one such innovation. HPV self-sampling allows women to test for HPV outside of a clinical setting and has been shown to be as sensitive for HPV detection as physician-collected specimens^[12]. The self-sampling kits that have been introduced, provide women with ease, time and effort savings, cost-effectiveness, comfort, speed, safety and user-friendliness. These kits enable women to give their sample in a clinical setting or collect it themselves in the privacy of their homes as per instructions from a healthcare professional.
Therefore, Self-sampling can be a huge game changer as published in an article by WHO^[13]. Self-sampling can nearly double the use of cervical cancer screening services^[14] and it can help us achieve the global goal of 70% screening coverage by 2030.

Article by Mridu Gupta, CEO, CAPED



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