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

Shobha Shukla *

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 disease occurring 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).

Raising cervical cancer awareness and health literacy among people with HIV

As women living with HIV are 6 times more at risk of cervical cancer, communities and networks of people with HIV must come forward to find ways to integrate cervical cancer screening as well as for other cancers (such as breast cancer) programmatically and in people-centred manner, said Daxa Patel, co-founder of National Coalition of People living with HIV in India (NCPI Plus) and its former President.

Agrees Pooja Mishra, Secretary of NCPI Plus that it is unacceptable when cervical cancer, which is preventable and curable - and the only cancer which can be eliminated - still kills 350,000 women worldwide. We also need to raise awareness, health and treatment literacy among the young people, said Mishra.

That is why NCPI Plus took leadership in organising a national dialogue and stakeholder consultation on preventing cancers among people with HIV, especially women.

Truenat HPV-HR Plus test is critical for closing the screening gap, particularly for asymptomatic women and women who are at higher risk for persistent HPV infection. By shifting HPV screening closer to the most-at-risk people and communities, this test ensures early detection, better triaging, and timely treatment - especially in historically underserved populations.

Over 10,000 Truenat RT-PCR molecular test machines are already deployed globally in over 85 countries (mostly for TB), and mostly in the Global South nations in remote settings. Truenat is a battery operated (with solar power charging), laboratory independent, de-centralised and point-of-care test that provides highly accurate diagnosis for over 30 diseases (including TB, HPV, HCV, HBV, STIs, COVID-19, etc) within an hour – thus enabling same day test and treat, counselling and follow-up.

Superiority of Truenat HPV-HR Plus test

Older Pap smear test detects precancerous or cancerous cervical cancer cells whereas Truenat HPV-HR Plus test detects the presence of high-risk HPV DNA (8 genotypes).

Pap smear is a cytological screening test and depends on the observing medical expert’s skill and slide quality, whereas Truenat is a PCR-based nuclear acid amplification test with very high sensitivity and specificity.

False negative reports are higher and false positive reports are also moderate when pap smear is used whereas both are low with Truenat HPV-HR Plus. The most recent validation of Truenat HPV-HR Plus showed 100% specificity and 100% sensitivity.

Truenat HPV-HR is designed to work with cervical swab samples collected by a clinician (self-collection of samples is still under evaluation), and it gives highly accurate results in just 60 minutes. Whereas, a pap smear results may take 3-7 days as these are laboratory dependent.

Easy to use and with high stability at room temperature, Truenat HPV-HR Plus requires minimal biosafety and is optimised for use at both the laboratory and near-patient settings. This test overcomes shortcomings of current diagnostic methods, including variable sensitivity and specificity, high costs, complex workflows, and dependence on advanced equipment, said Dr Sachdeva.

Highlighting the importance of developing health technologies in the Global South, Rajesh S Gokhale, Secretary, Department of Biotechnology, Ministry of Science and Technology, Government of India said, “Truenat HPV-HR Plus represents the kind of diagnostic innovation we need - dependable, scientifically rigorous, locally developed, and built to serve our public health system. It is a huge step forward in strengthening cervical cancer screening across India.”

"HPV infection is common. However, persistence of HPV infection could be deadly. Studies show that nearly half of persistent HPV infections do not resolve by 24 months. These silent carriers drive the progression to high-grade pre-cancerous lesions and cancer. That’s why extended HPV genotype detection is crucial," shared Dr Sachdeva.

HPV also causes oropharyngeal cancers

Oropharyngeal cancers related to HPV vary from 28% to 68% in the richer nations. Indian studies also show alarming numbers though, more research is needed for science-informed responses towards eliminating HPV related cancers in our population, said Dr Ishwar Gilada, President Emeritus of AIDS Society of India (ASI) and Governing Council member of International AIDS Society (IAS).

“While there is increasing evidence of HPV-associated oropharyngeal cancer in both men and women globally, there still remain gaps in gender-neutral HPV vaccination policies globally,” said Dr Sachdeva.

Community leaders like Manoj Pardeshi, who is among the co-founders and inspiring lights of NCPI Plus, said that regardless of gender, all those eligible and at risk of HPV related cancers, must be vaccinated against HPV. Programme addressing cervical cancer elimination should expand to eliminate all HPV related cancers in people-centred ways, regardless of gender.

HPV is transmitted through:
- Sexual contact: Transmission mode is through vaginal, anal, or oral sex with an infected person.
- Skin-to-skin contact: Transmitted through non-penetrative sexual activities involving skin-to-skin contact.

The WHO Guidelines recommend HPV detection via molecular test after age of 30 (and every 5 years thereafter). Vaccination against HPV is highly recommended for younger people under the age of 15 or before the initiation of sexual activity.

Do not leave equity behind

“Truenat HPV-HR Plus test is about equity in detection. By expanding beyond traditional targets, we reach the genotypes that matter more in our populations for cervical cancer elimination. This means earlier intervention, fewer missed cases, and better outcomes,” said Dr Sachdeva. Truenat HPV-HR Plus offers the best of both worlds - critical genotype coverage and real-world deploy-ability.

What does it mean to eliminate cervical cancer by 2030?

To eliminate cervical cancer, all countries must reach and maintain an incidence rate of below 4 per 100,000 women. Achieving that goal rests on three key pillars and their corresponding targets:

vaccination: 90% of all eligible young people must be fully vaccinated with the HPV vaccine by the age of 15.

screening: 70% of women should be screened using a high-performance test by the age of 35, and again by the age of 45;

treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed.

No other cancer but cervical cancer is fully preventable and curable if detected and managed early. Even one death from it is a death too many.