Cervical cancer remains one of India’s major public health challenges. The country bears the 2nd-highest burden of this disease globally and continues to report high mortality among women. At the same time, cervical cancer presents a rare opportunity within oncology: It is preventable, curable, and can be eliminated through sustained efforts. In fact, the World Health Organisation has outlined a global strategy and roadmap for cervical cancer elimination, anchored in three pillars- vaccination, screening and treatment, providing a clear framework for national action.
In India, cervical cancer screening is already an integral part of the population-based initiative for screening, prevention, and management of the National Programme for Non-Communicable Diseases (NP NCD) under the National Health Mission. But as of 20th July 2025, only 40% of eligible women have been screened in the country, as opposed to the WHO target of 70%. Much of this gap stems not from a lack of intent but from implementation hurdles within the current screening approach.
Currently, screening under national programmes uses the visual inspection with acetic acid (VIA), a low-cost method for screening that identifies pre-cancerous or cancerous lesions in the cervix. But it has low sensitivity and can often give inconsistent results as its accuracy is dependent on the skill of healthcare providers performing the test. These practical challenges have made it difficult to achieve uniform, large-scale coverage across the country.
HPV DNA testing offers an evidence-based opportunity to strengthen screening performance within the public health system. Detecting HPV infection, the primary cause of cervical cancer, before the appearance of cervical lesions, enables intervention at an earlier stage than VIA allows.
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The World Health Organisation (WHO) recommends HPV DNA testing as the preferred screening method for cervical cancer, owing to its higher sensitivity and reliability. However, this screening approach is viewed as resource-intensive in settings such as India, where it may necessitate the establishment of advanced laboratory infrastructure. The evidence from Amethi demonstrates that this assumption need not hold true.
The demonstration project, implemented in Uttar Pradesh, showed that HPV DNA testing can be successfully integrated within the existing public health infrastructure, drawing on local capacities and resources rather than making additional investments.
Under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), State Cancer Institutes serve as technical anchors for their respective states. They build capacities and empower district-level teams, while also providing continuous guidance, mentorship, and oversight to ensure quality and consistency.
The Amethi demonstration project offers a scalable blueprint for states across India and provides an illustrative example of how HPV DNA testing can be operationalised within a low-resource public health context. It is built on three core strengths. It first leveraged existing infrastructure through a hub-and-spoke model, creating a continuum for screening, diagnosis, and management. It designated State Cancer Institutes as technical "hubs" for high-throughput testing while sample collection, counselling, and follow-up were decentralised through Ayushman Arogya Mandirs (Health and Wellness Centres) that acted as ‘spokes’.
Decentralisation referred to service delivery and sample collection, not testing itself, allowing the programme to balance quality control with accessibility. This made optimal use of existing systems, ensuring efficiency and sustainability in low-resource settings.
Next, the pilot optimised existing human resources. ANMs, ASHA workers, and mid-level providers were trained in sample collection and self-sampling, empowering them to educate and mobilise women. This approach expanded reach without adding workforce burden.
Finally, the model showed how both centralised and decentralised approaches play a crucial and complementary role in strengthening cervical cancer screening and treatment. A decentralised approach helped overcome cultural and logistical barriers. ASHA workers supported self-sampling during household visits, enabling private, stigma-free participation with over 75% of screenings completed through self-sampling. For women testing positive, referral systems ensured timely care, and portable thermal ablation devices at block-level centres enabled same-day treatment through partnerships with non-governmental organisations.
At the same time, the model showed the importance of a centralised, hub-and-spoke testing architecture, especially in the context where public health systems face severe constraints in rural areas. By placing high-throughput HPV DNA testing platforms at State Cancer Institutes (the “hubs”) and linking them to Ayushman Arogya Mandirs and Health and Wellness Centres for sample collection (the “spokes”), the pilot ensured reliable processing, uniform standards, and efficient use of scarce laboratory capacity.
The results of this pilot were significant; screening coverage in Amethi surged from 1.5% to over 45%. Importantly, around 40% of women who tested positive were able to receive thermal ablation treatment at the sub-district level, demonstrating strong follow-through and the effectiveness of the hub-and-spoke care pathway. The entire initiative was planned in such a manner that there was seamless integration with existing platforms. Ayushman Arogya Mandirs, or the health and wellness centres, were leveraged successfully for sample collection and treatment.
No additional human resources were required; instead, task-shifting and capacity-building efforts for ANMs, ASHA workers, and mid-level providers helped optimise the utilisation of existing resources.
The Amethi pilot has demonstrated how resource optimisation is possible to achieve high impact to tackle the challenge of cervical cancer. This must be supported by a detailed, well-funded plan that ensures sustainable financing and equal access for all women, regardless of where they live or what they can afford.
At the same time, efforts should be put into accelerating nationwide HPV vaccination, integrating it as a core part of the national immunisation programme to protect future generations from preventable disease. HPV vaccination complemented by the adoption of HPV DNA testing as the primary screening method in national cervical cancer screening programmes can make high-quality early detection accessible and reliable for all women. Every woman who tests positive must then be linked seamlessly to timely treatment and follow-up, ensuring that the promise of screening translates into lives saved.
If implemented with urgency and coordination, these steps can propel India toward the WHO’s cervical cancer elimination targets and can finally make cervical cancer a disease of the past.
Dr Sabuhi Qureshi is HOD, Department of Gynaecology Oncology, Kalyan Singh Super Speciality Cancer Institute, Lucknow & Dr Parag Bhamare is the Associate Director and Technical Lead for Women's Cancer, Jhpiego.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.