Cervical Cancer Elimination in Emerging Economies – Learnings from India

This is a verbatim transcript of an interview conducted with Dr Abhishek Shankar in October 2025. The transcript has been lightly edited for clarity.

Introduction

I am Dr. Abhishek Shankar. I am a professional radiation oncologist by training, then I get further training in cancer control and prevention from NCI US.

I work on many preventable cancers apart from my radiation oncology responsibility. From a very humble background, I have always seen the suffering related to women’s health. If you see the situation in LMICs (Low-to-Middle Income Countries) including India, women still have to be dependent. Even if they have a problem, they have to go to the doctor, they have to take their, you know, spouse into account.

And in my whole journey, this has been important – how to make women empowered to take care of themselves. And coming to cervical cancer, which is a focus, and this is a preventable cancer.

And as a doctor, I know that once you get the infection, it takes many, many years, 15 to 20 years, for that infection to convert into cancer. So you have this much time for action.

What is the situation for cervical cancer in India? Can you share the context of elimination programs in India?

India, we have 1.45 billion population. The Indian population is very diverse. If you go from one state to another state, every 50 kilometers, we say with so much pride, that it changes the dialects, it changes the languages.

When you come to counter the cancer care efforts, this all thing is going to give you a big headache, because you have to modify your strategy. So coming to cervical cancer in India, unfortunately, every year we see an increase in the number of cases and in terms of mortality.

Again, in terms of 90-70-90, two important domains: 90% vaccination and 70% screening. In screening, I’m not sure that we have even reached the 2% mark in India for the eligible population. In vaccination, we are still waiting to reach the 1% mark. Close to 4 crore (40 million) people have been screened so far. So this is all with the VIA (visual inspection with acetic acid).

Now many states have started realizing that VIA is a method that we are using, but we are not seeing the response in terms of incidence and mortality. So now many states have now adopted the pilot to use HPV DNA-based screening. Rajasthan is one of them. If they see the difference in terms of VIA and HPV DNA, what is the positivity rate, what is the compliance, probably in the coming few years we can see that only methods which will be used at every level will be HPV DNA.

How do you see the role of public-private partnerships in implementation of cervical cancer programs in India?

Public-private partnership has been a very important concept. And if you just see, the success of one program that every Indian cherishes is, you know, the National Tuberculosis Control Program.

The access was very, very difficult. People with the symptoms were not getting the X-ray done, but with the implementation of public-private partnership, they have solved the access issue. They don’t have to go to only government institutions, they can go to private institutions.

One of the financial schemes is using the private network also to—to get this service delivered for cancer treatment. We call it Pradhan Mantri Jan Arogya Yojana, Ayushman Bharat. So they have coverage for the family.

So in India, cervical cancer elimination is an important goal for the government. The government has now adopted the practice, you know, to go for the pilot. So that they can see the change and over the period of time when they think that it is a cost-effective method. Coming to the public-private partnership, there is probably so much to learn from the National Tuberculosis Control Program.

What are the top challenges and possible opportunities from the elimination programme in India? Any advice which physicians from other countries in Asia Pacific should consider?

I see most of the patients come in the advanced stages, and I see that even when the patient comes in the advanced stages, the chances of survival are very very less. At the same time when I see the efforts in terms of vaccination and screening at my institute level, it is not so encouraging.

Because in India or any LMICs, the focus is on diagnosis and treatment. Most of the oncologists think that people who are already diagnosed with the disease are coming with a high disease burden. Because when you treat the advanced stages, ultimately your survival is going to be compromised.

Why not invest some time, try to convince people for the vaccination and screening, so that I can improve the survival outcomes in those patients who are diagnosed with the disease, but with the early disease. That is one of the aims related to my work in this, because I work in ANCCA (Asian National Cancer Centers Alliance)which is a consortium of 21 countries NCCs (National Cancer Centers). So we made some efforts to know what the practice is in terms of cervical cancer vaccination and screening in 21 countries.

And we found that there is a major gap. India and other LMICs, where I think there is so much stigma, cultural stigma around cervical cancer. We have been very, very poor in reaching out to people using all the resources.

Cervical cancer is a disease of poor women, and you know, all the social media reach is maximum to the people who are—if I use LinkedIn, if I use Twitter, if I use Facebook, who’s using it?

Probably if I use these methods to reach out, I will probably not reach the right population. So we need to have a mix of methods by which we can have the maximum coverage.

We have to motivate people for vaccination, motivate the eligible population for screening, and motivate people who are diagnosed with cancer or having symptoms to go to the doctor and check themselves, so that they can get it either diagnosed or excluded from the diagnosis and start the treatment on time.

So in all those areas, one thing is very common: communication. It has to be 24-into-7 affairs, because cancer doesn’t see the day, it doesn’t see the month. It goes 24-into-7. If you see the patient, please be sensitive and try to do something to prevent women from this preventable disease.

The views and opinions expressed by Dr Abhishek Shankar are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.

After this interview was filmed, on February 28, 2026, India Prime Minister Shri Narendra Modi launched the nationwide Human Papillomavirus (HPV) Vaccination Campaign from Ajmer, Rajasthan.

The initiative aims to prevent cervical cancer by protecting girls before potential exposure to HPV infection, targeting an estimated annual cohort of approximately 1.2 crore (or 12 million) 14-year-old girls. This campaign marks a historic milestone in India’s fight against cervical cancer and a big step forward in achieving the World Health Organisation’s 90-70-90 target.