Background: Cervical cancer is the second most common cancer among Indian women, with low screening coverage, especially in rural areas. Persistent infection with high-risk human papillomavirus (HPV), particularly types 16 and 18, is the main cause. This study evaluated socio-demographic factors associated with visual inspection with acetic acid (VIA), Pap smear and HPV positivity and compared the diagnostic performance of these screening methods.
Methods: This retrospective study included 641 women aged 30 to 55 years screened at two preventive oncology centres in Mullanpur and Sangrur between October 2024 and April 2025. Participants underwent VIA, Pap smear and HPV DNA testing. VIA findings were interpreted according to the World Health Organization guidelines, and Pap smear results were assessed using standard criteria. HPV results were categorised as HPV 16/18 or other high-risk types. Women positive on any screening test underwent colposcopy, with cervical punch biopsy performed when indicated.
Results: Among the women screened, VIA positivity was 31.9%, HPV positivity was 18.8% and Pap smear positivity was 1.7%. VIA positivity was higher among rural women and those with lower income, whereas HPV positivity was associated with early age at marriage and higher parity. For detecting cervical intraepithelial neoplasia 2+ (CIN2+) lesions, VIA demonstrated 100% sensitivity and lower specificity, Pap smear showed high specificity (99.5%) but lower sensitivity, while HPV DNA testing demonstrated 93.3% sensitivity and 82.8% specificity, with the highest diagnostic accuracy.
Conclusion: HPV DNA testing demonstrated high diagnostic accuracy for detecting CIN II+ lesions, while VIA showed high sensitivity but lower specificity, making it a practical screening tool in low-resource settings. Pap smear remained highly specific but detected fewer high-grade lesions. Early marriage, higher parity and lower socioeconomic status were associated with increased HPV positivity. These findings support risk-based cervical cancer screening strategies that integrate HPV DNA testing and VIA to improve early detection and reduce the burden of cervical cancer in resource-limited settings.
