HPV screening may be added in national programme

Globally, cervical cancer is the fourth most common cancer in women, claiming a life every two minutes, according to Indian government estimates

The Union health ministry is likely to incorporate HPV (human papillomavirus) testing into the National Cancer Control Programme to screen women for cervical cancer, people familiar with the matter said.

In India, the numbers are far higher, with cervical cancer being the second most form of cancer among women after breast cancer (Shutterstock)

As part of the programme, the government is stepping up efforts to test and validate indigenously developed, low-cost and point of care HPV tests to detect the cancer causing HPV genotypes in the Indian population, the people cited above said.

Globally, cervical cancer is the fourth most common cancer in women, claiming a life every two minutes, according to Indian government estimates.

In India, the numbers are far higher, with cervical cancer being the second most form of cancer among women after breast cancer. It contributes to one-fifth of the global burden.

According to GLOBOCAN 2022, on online database of global cancer statistics, an estimated 663,301 women were diagnosed with cervical cancer worldwide and about 348,874 women died from the disease in 2022.

Low-middle income countries (LMIC), like India, contributed to nearly 80% of the disease burden, the estimates show. In India, there are approximately 127,526 new cases every year, with 79,906 deaths.

As part of the government’s efforts to scale up testing, the All India Institute of Medical Sciences (AIIMS), Delhi, and the Indian Council of Medical Research (ICMR) are launching a validation study of indigenous HPV tests at three specialized centres, a statement said.

“To achieve the 2030 targets and incorporate HPV testing into the National Program, there is an urgent need to develop and validate low-cost, point of care indigenous HPV tests, which can detect the major cancer-causing HPV genotypes in the Indian population, automated, not requiring too much technical expertise or elaborate infrastructure. The evaluation of tests with fewer HPV types is a novel aspect of this study that will improve the accuracy of the test and make it more cost-effective for the programme,” the statement from AIIMS said.

India, in 2020, joined the World Health Organisation’s “Call For Elimination of Cervical Cancer” as one of the signatories with a vision for a cervical cancer free world. Under the initiative, India has set a target of screening 70% of women by 2030 and vaccinating 90% of the girls.

The government is also planning to introduce vaccination against HPV under the national immunisation programme. It is still under consideration.

Persistent infection with high-risk human papilloma virus has been found to be the necessary cause of cervical cancer, and WHO recommends HPV testing at the age of 35-45 years as part of the elimination strategy.

“With this vision, we are launching a multi-centre study with the support of DBT-BIRAC Grand Challenges India in collaboration with WHO’s International Agency for Research in Cancer (IARC). The testing will be performed at AIIMS, New Delhi, NICPR Noida and NIRRCH Mumbai,” the AIIMS statement said.

“There are several HPV tests that are now being manufactured in India, but we have taken three indigenous point of care tests for validation. The result of these tests can be expected in 1-1.5hrs,” said Dr Neerja Bhatla, head of obstetrics and gynaecology department, AIIMS.

Experts say that cervical cancer is preventable, and can be treated if detected in pre-cancerous or early stages.

A 2021 paper— Cervical Cancer Prevention Efforts in India — said, “Cervical cancer has a long pre-invasive phase that lasts for 10–15 years. This provides a window of opportunity to detect and treat the neoplasia in pre-invasive stages by simple outpatient treatment modalities, as well as early detection of cancers.”

“This landmark project will allow validation of Make in India HPV tests for cervical cancer screening by international quality standards and will benefit millions of women in India and other low and middle income countries to get rid of the scourge of cervical cancer,” read the statement from AIIMS.