New Delhi: India’s ambition to eliminate cervical cancer will remain elusive unless it fundamentally overhauls its screening strategy and moves from opportunistic, low-accuracy screening to an organised, population-wide programme anchored in HPV DNA testing, said Padma Shri Dr Neerja Bhatla, former Head of Obstetrics and Gynaecology at AIIMS Delhi.
In an exclusive interaction with ETHealthworld’s Prathiba Raju on National Doctors’ Day, Dr Bhatla argued that while HPV vaccination represents one of the most significant advances in cancer prevention, it cannot protect the millions of adult women already at risk. For that, she said, India urgently needs to scale high-quality molecular screening backed by strong governance, sustainable financing and measurable accountability.
“Vaccination and screening are sometimes presented as competing priorities, when in reality they are complementary. Vaccination protects future generations, while organised screening protects the current generation,” she said.
India continues to account for one of the world’s highest cervical cancer burdens despite the disease being largely preventable through timely screening and treatment. While the national programme currently relies primarily on Visual Inspection with Acetic Acid (VIA), Dr Bhatla believes the evidence now overwhelmingly favours HPV DNA testing as the preferred primary screening tool.
“The WHO recommends HPV DNA testing because it is significantly more sensitive and accurate than cytology or VIA. Wherever quality-assured molecular testing is available, it should become the first-line screening modality,” she said.
However, she cautioned that adopting molecular diagnostics alone will not solve India’s screening challenge.
“A successful population-based programme requires leadership, accountability, trained human resources, financing, quality assurance, monitoring systems and measurable coverage targets. India has demonstrated repeatedly that it can execute large-scale public health programmes when these elements are in place.”
According to Dr Bhatla, India now has an opportunity to modernise screening guidelines in line with global evidence.
She noted that while VIA played an important role because of its affordability, its lower accuracy and higher false-positive rates make it less suitable as the long-term foundation of a national elimination strategy.
“In settings where molecular testing is not immediately available, VIA and cytology remain appropriate interim options because some screening is better than none. But they should increasingly be viewed as a bridge rather than the destination,” she said.
She also stressed that policy decisions should be guided by clinically validated assays rather than assuming all HPV tests perform equally.
Why specificity matters as much as sensitivity
While public health discussions often focus on detecting as many cases as possible, Dr Bhatla argued that specificity deserves equal attention in resource-constrained health systems.
Every false-positive result, she said, triggers unnecessary referrals, colposcopies and biopsies, placing additional pressure on India’s already stretched tertiary care facilities while causing avoidable anxiety for women.
“Our goal should not simply be generating more positive tests. It should be identifying the women who genuinely require treatment while using healthcare resources efficiently.”
She pointed to emerging evidence that targeted HPV genotype assays can maintain high clinical sensitivity while improving specificity, thereby reducing unnecessary procedures without compromising cancer detection.
Beyond diagnostic accuracy, Dr Bhatla believes patient convenience will determine the success of future screening programmes.
She highlighted the potential of validated point-of-care HPV tests capable of delivering results within an hour, allowing counselling and clinical decisions during the same visit.
“Women often travel long distances, arrange childcare and lose wages to attend health facilities. If screening requires multiple visits, many simply do not return.”
Same-day results, she said, could significantly improve follow-up rates and make organised screening programmes more effective.
Price alone should not drive procurement
As indigenous HPV molecular platforms enter the market, Dr Bhatla urged policymakers not to base procurement decisions solely on cost.
“A screening test is not merely a commodity. It is an investment that determines clinical outcomes, healthcare utilisation and programme sustainability.”
Before being integrated into national programmes, she said, new diagnostics should undergo rigorous multicentric clinical validation, health technology assessments and continuous post-market surveillance.
“The emergence of indigenous diagnostics is a tremendous opportunity for India. But affordability must go hand in hand with robust clinical evidence and quality assurance.”
Analytical performance is essential, but for India’s public health ecosystem, molecular platforms must also demonstrate their value in real-world screening programmes. Rapid, near-point-of-care technologies such as Truenat HPV-HR Plus exemplify the kind of innovation that can support this transition. Backed by multicentric clinical validation, the platform combines reliable molecular performance with the ability to deliver results in under an hour, enabling faster clinical decision-making and improving the likelihood of same-visit counselling and follow-up.
Designed for operational simplicity, Truenat HPV-HR Plus can bring quality HPV DNA testing closer to women in decentralised and resource-variable healthcare settings without dependence on highly complex laboratory infrastructure. Beyond the assay itself, the Truenat ecosystem incorporates standardised workflows, quality assurance processes, digital connectivity and an established deployment network, creating a practical foundation for organised, programme-led implementation. By integrating validated accuracy with accessibility, speed and scalability, such platforms can help strengthen India’s transition towards population-based cervical cancer screening.
No one-size-fits-all model
On the question of whether India should centralise HPV testing or decentralise it to district hospitals, Dr Bhatla rejected the idea of choosing one model over the other.
Large metropolitan regions, she said, would continue to benefit from centralised, high-throughput laboratories, while decentralised molecular testing could significantly improve access in remote and underserved areas.
“The architecture should be driven by population needs rather than a one-size-fits-all approach.”
Vaccination alone is not enough
Although HPV vaccination has gained significant policy momentum in recent years, Dr Bhatla warned against allowing screening programmes to lose focus.
“The majority of women currently at risk were beyond the target age when vaccination programmes were introduced. For them, organised screening remains the most effective strategy for preventing cervical cancer.”
Looking ahead, she believes the fastest reduction in cervical cancer mortality will come not from choosing between vaccination and screening but from implementing both simultaneously while strengthening treatment pathways for women who test positive.
Three reforms to accelerate elimination
If asked to redesign India’s national cervical cancer strategy today, Dr Bhatla said three policy priorities stands above the rest first is the transition from opportunistic to organised population-based screening. Second is establish HPV DNA testing as the national standard for primary screening. Third is to strengthen governance through workforce training, quality assurance, digital reporting, sustainable financing and measurable programme accountability.
“Eliminating cervical cancer is no longer an aspirational goal,” she said. “With evidence-based screening, strong implementation and sustained political commitment, it is an achievable public health objective for India.”
