Prevalence, Screening and Determinants of Cervical Cancer Among Women in India : A Systematic Review

Abstract

Introduction : Cervical cancer remains a predominant cause of morbidity and mortality among Indian women, with substantial disparities in prevalence and detection across regions, socioeconomic strata, and high-risk groups. This systematic review synthesises data from 20 population-based and focused studies representing over 300,000 Indian women, appraising prevalence, determinants, screening modalities, and late-stage presentation. Methodology : Systematic searches were executed in major databases adhering to PRISMA protocols. Inclusion criteria incorporated population-based and high-risk studies (HIV, urban slum, rural) published from 2000-2024, reporting numeric prevalence of histopathological, cytology, or VIA-confirmed cervical cancer or precancerous lesions. Data extraction followed standardized forms and risk of bias was assessed via a modified Newcastle-Ottawa Scale. Results : The pooled prevalence of cervical cancer or high-grade precursor lesions ranged from 0.2% to over 2.4%, with the highest rates in HIV-infected and rural low-literacy populations. Less than 15% of eligible women had ever undergone screening in most communities. VIA/VILI was predominant in field screening due to feasibility, but HPV DNA testing yielded the highest sensitivity. Late-stage presentation often exceeded 60%, largely influenced by low education and rural residence. Conclusions : India's cervical cancer burden, characterized by a significant prevalence of advanced-stage diagnoses and suboptimal screening engagement, highlights the urgent need for the enhanced implementation of HPV vaccination initiatives, the development of context-appropriate screening programs, and the execution of targeted awareness campaigns.