Human papillomavirus self-sampling for cervical cancer screening: Review on the acceptance, accuracy, feasibility and incorporation in the National Screening Programme of India

Screening along with treatment is the foremost tool for cervical cancer elimination in addition to vaccination strategies. At present, India lacks a comprehensive screening programme. There are huge issues in terms of feasibility, acceptability and implementation of the existing cervical screening programme in the country. Less than 2% (Urban-2.2% and Rural-1.7%) of women in India have been screened. The current strategy recommended by Ministry of Health and Family Welfare is Visual Inspection with Acetic Acid (VIA) every 5 years for women aged between 30 and 65 years. A significant improvement in terms of decreasing incidence and mortality of cervical cancer has been seen in two randomized controlled trials conducted in India. However, VIA lacks sensitivity, requires extensive training to be given to the medical staff for accurate diagnosis, has substantial operator variability and has less acceptability among women when compared to the newer methods of cervical cancer screening such as human papillomavirus (HPV) self-sampling. HPV self-sampling is a more sensitive, accurate and more acceptable method of cervical cancer screening for women in India and abroad. It can help the existing VIA-based strategy of cervical screening by increasing participation resulting in more population being screened in the various geographical regions and populations in India. However, VIA-based screening should also be continued because of its affordability and cost-effectiveness in India where there is a significant population belonging to low socio-economic background. There are numerous evidences such as systematic reviews, meta-analyses, randomised controlled trials of India and abroad that have been used as sources in this review article to come to the conclusion that HPV self-sampling is an acceptable, accurate and sensitive method that can be used as a primary screening tool in cervical cancer screening programmes globally and in India. It can also be used as an effective triage test for prioritising high-risk populations who require urgent and effective treatment for cervical pre-cancer and cancer. To conclude, HPV self-sampling should be integrated and implemented by the government and private sector in addition to VIA-based screening strategies for achieving the goal of cervical cancer elimination in India.