Khushwant Singh, Ashoo Grover, Kavitha Dhanasekaran
Cervical cancer remains a major global health issue, particularly in low- and middle-income countries (LMICs). Although human papillomavirus (HPV) vaccination and screening are proven preventive strategies, LMICs, including India, face significant implementation challenges. This observational, descriptive epidemiological study analyzes cervical cancer burden across WHO regions sourcing data from GLOBOCAN 2022, GBD, and GHO. India-specific state-level analysis was conducted using GBD data. Joinpoint regression assessed death trends, and a comparative analysis examined the impact of India's 2016 national cervical cancer screening and management policies. The Southeast Asia Region (SEARO) accounts for the second-highest cervical cancer incident (new cases) and death rate among WHO regions, with India contributing over 65 % of the burden. National screening coverage remains alarmingly low, with only 1.9 % of women aged 30–49 undergoing screening, far below developed nations. Despite the adoption of Visual Inspection with Acetic Acid (VIA) as primary screening method in 2016, India's cervical cancer death rates have continued to rise, increasing from 6.06 to 6.78 per 100,000 women (2012–2016) to 6.82–6.91 (2016–2019). However, death annual percentage change declined from 3.84 % (2012–2015) to 0.46 % (2016–2019), indicates slowdown in death acceleration but not a reversal. India's burden remains high due to low screening coverage, reliance on subjective screening test, and limited HPV vaccination. While many countries like Australia and Bhutan have successfully reduced incidence and death through HPV-based screening and vaccination, India's slow progress underscores the urgent need for policy shifts towards HPV-DNA testing with self-sampling option and national HPV-vaccination programs implementation to curb cervical cancer burden effectively. • The Southeast Asia Region ranks second, contributing 29.59 % of global cervical cancer cases and 34.12 % of deaths, with India alone reporting 127,526 new cases and 79,906 deaths in 2022. • Persistent high cervical cancer death rates in India after 2016 suggest that VIA-based screening alone is insufficient. Almost 60–70 % of cases are detected at advanced stages because many VIA screen-positive women do not undergo colposcopy for confirmation or receive timely treatment due to a variety of barriers. • Major contributing factors/barriers include inadequate screening coverage (~1.9 %), the subjectivity of the VIA test, low awareness, sociocultural barriers, privacy concerns and discomfort during the procedure, lack of follow-up after VIA testing, and delayed or absent early treatment. • To effectively reduce cervical cancer mortality, India must strengthen its screening program by transition from VIA to HPV-DNA testing with a self-sampling option, and standard treatment pathways, and implement a national HPV vaccination strategy at the earliest.