Cervical cancer burden in India: A descriptive epidemiological study and policy insights.

Background: 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. Methods: 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. Findings: 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. Conclusion: 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.