Despite being preventable and curable cervical cancer remains 4th biggest cancer in women

SHOBHA SHUKLA

PART-I

Cervical cancer (cancer of the cervix) is preventable and curable, only if it is detected early and managed effectively. Yet it is the 4th most common cancer among women worldwide, with the diseaseoccurring in 660,000 women and claiming the lives of 350,000 women in 2022 worldwide, as per the World Health Organization (WHO).

China, India, and Indonesia had the highest number of cervical cancer cases in 2022. Moreover 42% of cervical cancer cases and 39% of deaths associated with it worldwide, took place in China and India- 23% cases and 16% deaths in China, and 19% cases and 23% deaths in India. India reported over 123,000 new cases of cervical cancer and around 77,000 deaths – highest number of deaths worldwide in 2022.

Cervical cancer disproportionately affects younger women, and as a result, 20% of children who lose their mother to cancer do so due to cervical cancer, says WHO.

As cervical cancer is the only cancer that can be eliminated, the WHO Director General had called upon the governments in 2018 to eliminate it. All governments globally committed to do so by 2030 (by endorsing the global strategy to eliminate cervical cancer by 2030 at the World Health Assembly 2020). But despite some progress, the world is way off the mark from the elimination goal in 2025.

Where cervical cancer burden is greatest, access to lifesaving services is most broken

Cervical cancer reflects the global inequities between the Global North and the Global South: The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. In fact, 94% of the cervical cancer deaths in 2022 took place in these countries where access to health services is appalling. This reflects major health inequities which are driven by lack of access to vaccination, cervical cancer screening and treatment services.

Prophylactic vaccination against human papilloma virus (HPV) - which is one of the most common sexually transmitted infections and which causes cervical cancer - and screening, and treatment of pre-cancer lesions are very cost-effective strategies to prevent cervical cancer.

WHO’s call to deliver on #HealthForAll dates to the 1970s, but even now gaping health inequities and injustices plague the health systems – especially in the Global South.

Vaccines against HPV have existed since almost 20 years now. No surprise for guessing that both Cervarix (made by Glaxo) and Gardasil (made by Merck) were made in the rich nations – and their rollout in the Global South has been far from ideal.

In 2022, India-based Serum Institute in collaboration with the Department of Biotechnology of the government of India developed India’s first indigenously produced HPV vaccine called Cervavac. So, now there is a vaccine developed in the Global South too. But its rollout is far from ideal as of now. It is still not a part of India’s public health programme, for instance.

Same inequities block access to HPV screening in the Global South

"Almost all cervical cancers (~95%) are caused by persistent HPV infection. Women living with HIV are 6 times more likely to develop cervical cancer compared to the general population, and an estimated 5% of all cervical cancer cases are attributable to HIV,” said Dr Kuldeep Singh Sachdeva, former head of Indian government’s national TB and HIV programmes. Dr Sachdeva was speaking at the National Dialogue and stakeholder meet organised by National Coalition of People living with HIV in India (NCPI Plus) bringing together over 100 community leaders from almost all states of India. Dr Sachdeva currently leads Molbio Diagnostics as President and Chief Medical Officer.

He was speaking ahead of 10th Asia-Pacific AIDS & Co-Infections Conference (APACC 2025), Japan; 2nd Asia Pacific Conference on Point of Care Diagnostics for Infectious Diseases (POC 2025), Thailand; and 13th International AIDS Society Conference on HIV Science (IAS 2025), Rwanda.

Cervical cancer screening efforts in most settings of the Global South have long been hampered by reliance on outdated methods like pap smears and visual inspection with acetic acid (VIA) test, both of which suffer from poor sensitivity, high subjectivity, and dependence on specialised infrastructure. Advanced molecular HPV tests developed by the Global North, while highly accurate than pap smear and VIA, remain inaccessible for most women living in peripheral, rural, and resource-limited settings, especially of the Global South.

India’s first point-of-care HPV test that can be deployed at point-of-need in the Global South

In April 2025, India's first ever indigenously developed RT-PCR molecular test for HPV on Truenat (called HPV-HR Plus) got an independent multi-centric validation done by Government of India’s Department of Biotechnology, Biotechnology Industry Research Assistance Council (BIRAC) and Grand Challenges India. Truenat HPV-HR Plus test is made by Molbio Diagnostics in India.

This independent validation of Truenat HPV-HR Plus was conducted under the study “Validating Indigenous Human Papilloma Virus (HPV) Tests for Cervical Cancer Screening in India.” The study involved leading Indian government’s research institutes, including All India Institute of Medical Sciences (AIIMS) Delhi, ICMR National Institute for Cancer Prevention and Research (NICPR) Noida, and ICMR National Institute for Research in Reproductive and Child Health (NIRRCH) Mumbai, in collaboration with WHO's International Agency for Research on Cancer (IARC).

There are over 200 genotypes of HPV but those that put the infected person at risk of developing cervical cancer are few. Truenat HPV-HR Plus molecular test enables detection for 8 HPV high-risk genotypes – which account for over 96% cervical cancer cases worldwide. These HPV high-risk genotypes include 16, 18, 31, 33, 35, 45, 52 and 58. Out of these, 16 and 18 high-risk genotypes dominate globally as 77% of invasive cervical cancer cases are associated with them. These high-risk genotypes can also cause cancer of the anus, penis, vagina, vulva, and oropharynx (throat).

TO BE CONTINUED

 (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She also coordinates SHE & Rights initiative (Sexual health with equity & rights).