In India, every few minutes, a mother, a daughter, a sister or a wife loses her life to cervical cancer. These deaths are completely preventable. Cervical cancer is one of the few cancers we already know how to defeat. When detected early, it can be cured in more than 90% of cases. And, more importantly, it can also be prevented. Yet, it is the second most common cancer among Indian women, and cases in India account for the second highest burden in the world. The challenge lies not in the absence of solutions, but in early and equitable access to them. Today, two-thirds of women in India are diagnosed only after the disease has spread, and when survival rates drop to around 46%.
India has made commendable progress in building the foundation for cervical cancer screening through the National Programme for Non-Communicable Diseases, NP NCD under the National Health Mission. Yet, despite years of effort, only 40% of eligible women have ever been screened. In some states, the rate is still below one percent. Social barriers like stigma, fear, and lack of awareness continue to discourage women from seeking screening. The challenge also lies in the primary screening method itself.
For years, India has relied on Visual Inspection with Acetic Acid (VIA) as the primary method for cervical cancer screening, a strategy that has played an important role in expanding access, particularly in low-resource and hard-to-reach settings. VIA enabled the rapid roll-out of screening services under national programmes and helped establish the foundations of population-based screening. However, as programmes mature and scientific evidence evolves, so must the tools they use. In its 2021 guidelines, the World Health Organization (WHO) recommends HPV DNA testing as the preferred primary screening method and advises countries using VIA to transition rapidly. This shift reflects growing evidence that while VIA has value, it also has limitations at scale. Its accuracy is operator-dependent, and quality assurance is difficult to maintain across large workforces, while lower specificity can lead to unnecessary referrals and anxiety. Importantly, VIA detects changes only after abnormalities have developed, limiting its preventive potential. Advancing toward HPV DNA testing, therefore, represents not a rejection of earlier efforts, but a natural, evidence-based progression to strengthen and future-proof India’s screening programme.
High-risk HPV infections take 10 to 15 years to progress to cancer, giving us a generous window to act. HPV DNA testing identifies those infections early, long before pre-cancerous changes appear. It is sensitive, more accurate than cytology-based methods and cost-effective in the long run, because it requires fewer frequent tests and follow-up visits. WHO now recommends HPV DNA testing as the primary screening tool, urging countries to screen women by age 35 and again by 45.
The urgency of strengthening cervical cancer screening is particularly evident in large, high-burden states such as Uttar Pradesh. As the most populous state in India, Uttar Pradesh accounts for around 16.5% of the country’s total population, making its health indicators especially consequential for national outcomes. The uptake of cervical cancer screening in Uttar Pradesh remains very low, with data showing less than 1% of women undergoing screening in some districts.
In India, a standout example of evidence-based programming in action comes from Amethi, Uttar Pradesh, where Jhpiego led a pathbreaking pilot demonstrating the feasibility of integrating high-performance HPV DNA testing into the public health system.
The Amethi initiative adopted a centralised hub-and-spoke model, with a high-throughput laboratory serving as the testing hub for samples collected at community health centres. To improve accessibility and acceptability, women were offered the option of self-sampling, with support from Accredited Social Health Activists (ASHAs) and Community Health Officers (CHOs).
This experience demonstrated that when technology is paired with strong delivery systems and women’s agency, scale and participation can be achieved rapidly. It also reflects the government of Uttar Pradesh’s commitment to innovation and evidence-based approaches that strengthen public health delivery.
This is where the vision of Nari Shakti, the government’s central pillar of women’s empowerment, takes real meaning, in safeguarding women’s health. The recently implemented Swasth Nari, Sashakt Parivar Abhiyaan embodies this commitment, reaffirming that a healthy woman forms the foundation of a healthy, empowered family and, by extension, a stronger nation.
To achieve this, India must make HPV DNA testing the national standard for cervical cancer screening. Policy alignment under NPCDCS, government procurement of affordable test kits, and strong public–private partnerships can accelerate access and affordability. With these steps, India can lead the world in eliminating a cancer that no woman should die from.
The government’s renewed focus on HPV vaccination for adolescent girls, marks a crucial long-term investment. But vaccination alone will not change outcomes in the short term. Screening and early treatment must move in parallel, ensuring that women already at risk are not left behind. By embracing HPV DNA testing as part of a continuum of prevention, India can strengthen its leadership in women’s health and move closer to eliminating cervical cancer as a public health threat.
The country has already shown that it can scale major health interventions from polio eradication to hepatitis control when action is driven by evidence and sustained commitment. This same approach can help move India from reactive detection to true prevention, building on the foundation already created through national programmes like NPCDCS.
Cervical cancer is not inevitable. It is preventable, detectable, and curable when caught early. The time to make HPV DNA testing India’s standard of care is now. For every woman, for the strength of every family, and for the enduring promise of Nari Shakti and Swasth Nari, Sashakt Parivar, fulfilled through health, dignity, and hope.
This article is authored by Dr. Nuzhat Husain, professor & head of pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, UP & Dr Sanjay Tripathi, state lead, Health System Strengthening and State Programme Manager, UP, Jhpiego.
