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A Review Article
Cervical

Cancer

Screening in Resource
Limited High-Burden Settings

The Northeast Indian Perspective on
HPV DNA Testing, Pap Cytology, and
the Pivotal Role of Colposcopy

Dr Shruti Kannan
Associate Consultant
State Cancer Institute, Guwahati

Abstract Conclusion: A phased shift from VIA to HPV
DNA-based primary screening, supported by
Background: Cervical cancer remains a self-sampling for remote and tribal populations,
major public health concern in India, with a must be matched with investment in colposcopy
disproportionate burden in the Northeast. training, equipment and see-and-treat referral
Although India introduced an operational systems if the region is to move meaningfully
screening framework in 2016, national screening towards the WHO 90-70-90 elimination targets.
coverage remains low and many women continue
to present late. Keywords: Cervical cancer; Carcinoma cervix;
Screening; HPV DNA testing; Pap smear;
Objective: This review summarises the cervical Colposcopy; Northeast India
cancer burden in Northeast India, compares VIA,
Pap cytology and HPV DNA testing, and highlights Introduction
the need to strengthen colposcopy as a diagnostic
link after a positive screening test. Cervical cancer is one of the few cancers where
Discussion: HPV DNA testing offers higher early detection and prevention can substantially
change outcomes. Its natural history is well
sensitivity than VIA and conventional cytology, understood, the precursor lesion is identifiable,
but it requires reliable triage. Standardised and high-risk human papillomavirus (HPV) is an
colposcopy connects a positive screening result established cause. Globally and in India, the burden
to confirmation and treatment. In the Northeast, remains highest where organised screening and
limited trained providers, inadequate equipment HPV vaccination coverage are incomplete.
and weak referral completion continue to affect
this pathway. National figures, however, conceal sharp

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