OG33.3-4 | Cervical Cancer Screening and Prevention — Summary & Reflection

KEY TAKEAWAYS

Cervical cancer is preventable through two complementary strategies. Primary prevention: HPV vaccination with quadrivalent (HPV 6/11/16/18) or 9-valent (adds 31/33/45/52/58) vaccines — two doses at 0 and 6 months for age 9–14, three doses for ≥15 or immunocompromised; India's Cervavac (quadrivalent) has been introduced in the UIP. Secondary prevention: screening women aged 30–65. Four methods are used: VIA (3–5% acetic acid, 1 minute wait, sharply demarcated acetowhite in TZ = positive; ~60–80% sensitivity), VILI (Lugol's iodine, mustard-yellow non-staining = positive), Pap smear (Bethesda 2014: NILM/ASCUS/LSIL/HSIL/carcinoma; ~55% sensitivity), and HPV DNA testing (~95% sensitivity, WHO-preferred primary test). Abnormal results are followed by colposcopy — Grade 2 major changes (dense acetowhite, coarse punctation/mosaic) indicate high-grade CIN requiring directed biopsy. The NHM India screen-and-treat strategy allows same-visit cryotherapy for eligible VIA-positive women, eliminating referral attrition. Vaccinated women must still undergo regular screening.

REFLECT

Recall the woman at the start of this module — a 38-year-old who had never heard of cervical screening or HPV vaccination before a community health camp. She represents the majority of Indian women at highest risk. Now consider: what would it take to ensure that her 14-year-old daughter is vaccinated before she completes school, and that the woman herself is screened every 5 years at her local primary health centre? Think about the role of the doctor not just as a clinician performing VIA but as an advocate — for scaling up the national vaccination programme, for training health workers, and for reducing the stigma that prevents women from accepting gynaecological screening. What one systemic change, in your opinion, would have the greatest impact on cervical cancer mortality in India?