India is currently facing a significant public health challenge as cervical cancer cases continue to rise across the nation. According to medical experts, one of the primary reasons for the rapid spread of this life-threatening disease is the lack of timely diagnosis. While cervical cancer remains a major threat, experts are now looking towards indigenous testing methods as a more effective and affordable alternative to expensive diagnostic procedures. The primary cause of cervical cancer has been identified as persistent infection with the Human Papillomavirus (HPV), particularly in cases involving cHPV.
Expert Insights on Diagnostic Challenges
Dr. Neerja Bhatla, who serves as the head of the National Cancer Institute (NCI) in Jhajjar and is the former Head of the Department of Obstetrics at AIIMS New Delhi, has shared critical insights into the current diagnostic landscape. She emphasizes that while the HPV test is the most accurate method available for detection, its high cost remains a significant barrier for the general population, while on the other hand, the Visual Inspection with Acetic Acid (VIA) test is much more affordable, but it has not been able to expand its reach effectively across the country. Dr. Bhatla suggests that there is an urgent need for affordable Point-of-Care (PoC) HPV tests. By implementing a strategy of testing women twice—at the ages of 35 and 45—India could potentially eliminate cervical cancer from the country.
Focus on Point-of-Care (PoC) Testing
Dr. Neerja Bhatla advocates for a shift towards Point-of-Care (PoC) testing. This refers to diagnostic tests that can be performed on-site with immediate results, eliminating the need to send samples to distant laboratories or wait weeks for reports. If affordable, easy-to-use, and reliable PoC HPV tests are introduced, screenings could be conducted at the Primary Health Centre (PHC) level or even by ASHA workers. This would Notably increase the coverage of screening programs and help India meet its target of eliminating cervical cancer by 2030. A dedicated study is currently underway to evaluate these possibilities.
Evaluating Indigenous Innovations
The ongoing study is one of the first in India to apply the World Health Organization (WHO) Target Product Profile (TPP) and International Agency for Research on Cancer (IARC) criteria to evaluate locally developed HPV tests, while the initial step was to suggest the development of HPV tests capable of detecting the 8 most common HPV types found in cervical cancer cases. These tests are designed to be used in district and sub-district level facilities, requiring minimal training and expertise. Dr. Bhatla noted that these innovations aim to address the shortcomings of existing tests, which were mostly developed in high-income countries and targeted numerous HPV types, thereby increasing cost and complexity. The study demonstrates that indigenous platforms can achieve clinical validation, quality standards, and accuracy comparable to global gold-standard tests, making them a game-changer for early detection in India.
The Scale of the Problem in India
The magnitude of the cervical cancer problem in India is staggering. Dr. Bhatla pointed out that it remains a major public health issue, with approximately 127000 new cases reported every year. Tragically, about 80000 women lose their lives to cervical cancer annually in the country. Currently, the recommendation is that women over the age of 30 should undergo screening every 3 to 5 years to catch the disease at a pre-cancerous or early stage. While the government's national program includes screening for breast, oral, and cervical cancers using the VIA method, the overall coverage remains low as many women are unable to access these services.
WHO Recommendations and the Path Forward
The World Health Organization (WHO) maintains that HPV testing is the most effective way to eliminate cervical cancer. According to WHO, if high-quality HPV tests are utilized, just two screenings in a lifetime—at ages 35 and 45—are sufficient. However, the primary obstacle is that most HPV tests are prohibitively expensive and require large machines, specialized labs, and advanced technology, while these resources are often unavailable at last-mile facilities in rural areas, highlighting the critical need for the indigenous PoC solutions currently being studied.