Cervical cancer claims 75,000 Indian women yearly, yet screening trio—Pap, HPV, VIA—catches 90% precancers curable. Each test unique role synergizes: detect changes, virus, visuals. National program targets 30+ women 5-10yr intervals slashing mortality
Pap Smear: Cell Change Detective
Pap cytology scrapes cervix cells speculum, smears slide stain. Grades NILM normal, ASCUS unclear, LSIL/HSIL precancer. Sensitivity 55-80% CIN2+, specificity 90%. Misses half early; liquid-based improves. India labs ₹300-500.
Role: flags abnormal cells HPV-triggered. False positives inflammation.
HPV DNA Test: Virus Hunter
Self-collect swab detects high-risk types 16/18 (70% cancers) DNA PCR. Sensitivity 90-95% CIN3+, specificity 90%. Primary screen WHO preferred; negative 5yr safe. India CareHPV rural portable. ₹800-1500.
Role: predicts progression; 16/18 vaccination complements.
VIA: Visual Acetic Acid Screen
Nurse applies 5% acetic acid cervix 1min, inspects white lesions precancer. Sensitivity 80-90%, specificity 60-80%. Instant result treat cryotherapy same visit. India NPCDCS ANM-led free camps. No lab.
Role: low-resource gold; high volume rural.
Colposcopy: Magnified Inspection
Abnormal screen? Vinegar/lugol stain cervix colposcope 10-40x zoom. Aceto-white, vessels mosaic biopsy suspicious. Sensitivity 90% CIN2+. ₹1k-2k urban.
Role: confirms directs treatment cone/LEEP.
How Tests Synergize Cervical Shield
Primary HPV/Pap 30yr+ every 5yr detects virus/cells. Positive? Colposcopy biopsy. VIA frontline rural, Pap/HPV urban. Cotest HPV+Pap boosts sensitivity 99%. Negative predictive 99.9% 5yr. India guidelines 30-65yr 3-lifetime screens.
Cascade: screen-diagnose-treat “see and treat” VIA positive low-grade.
Table: Test Comparison India
| Test | Sensitivity CIN2+ | Specificity | Cost/Setting | Role |
| Pap | 55-80% | 90% | Lab urban | Cell changes |
| HPV DNA | 90-95% | 90% | Lab/rural | Virus detect |
| VIA | 80-90% | 60-80% | Field | Visual quick |
| Colpo | 90% | 70% | Clinic | Confirm bx |
India Screening Challenges Successes
NPCDCS 2017 ANM VIA subcenters; uptake 5% target 70%. HPV self-sampling emerging. Vaccination Gardasil free 9-14 girls. Rural colposcopy mobile. Early detect 5yr survival 92%. Consult gynecologist personalized.
FAQ
- Primary cervical screen India?
HPV DNA preferred sensitivity 95% CIN3+ over Pap/VIA; negative rules out 5yr, positives colposcopy—NPCDCS adopts for 30-65yr triennial reducing overdiagnosis.
- VIA vs Pap effectiveness?
VIA 85% sesitivity rural instant “see-treat,” Pap 70% lab accurate specificity; combo VIA+HPV outperforms single boosting detection 92% resource-poor like India programs.
- Colposcopy after abnormal Pap/HPV?
Yes, magnifies acetowhite lesions biopsy HSIL (90% accuracy); guides excision preventing 80% progression cancer if CIN2+ treated timely