India has one of the highest cervical cancer death tolls in the world, accounting for 25% of global cervical cancer deaths. That's not a statistical quirk, it's a tragedy playing out across the country, largely preventable, yet claiming thousands of lives every year. We know how HPV causes the disease. Yet women keep dying.
Dr. Sonia Mathai, a consultant in the Department of Preventive Oncology at Tata Medical Center in Kolkata and member of the 2026 ASCO Breakthrough Program Committee, has spent her career staring at this gap between what we can do and what we actually do.
The virus, Human Papillomavirus, or HPV, is the culprit in 99% of cervical cancer cases. It's sexually transmitted, incredibly common, and in most women, their immune system clears it naturally within a year or two. But when that doesn't happen, when the infection persists, that's when cervical cells start changing, when precancerous lesions form, when a woman who is asymptomatic, who has no idea anything is wrong, is slowly developing cancer that will take 15 to 20 years to fully emerge.
The timeline is actually the problem's silver lining. You have years to catch this if you screen. Years to find those precancerous cells and treat them before they turn into cancer. Dr. Sonia Mathai is bringing all of this to the table in this conversation: the science, the barriers, the myths that are killing women, and what actually needs to happen to make cervical cancer prevention real for Indian women instead of just theoretical.
Why Are So Many Women in India Still Dying from Cervical Cancer?
Cervical cancer is often described as one of the most preventable cancers. Dr. Sonia Mathai explains that it is the second most common cancer among women in India and accounts for a quarter of deaths globally. Infection with HPV, a common virus transmitted sexually, is the main cause for almost all cases. Prevention strategies include prophylactic HPV vaccination and secondary prevention via screening for HPV infection.
India has limited resources and healthcare infrastructure to implement these preventive strategies. As a result, HPV vaccination coverage and cervical cancer screening rates among women are low. Roughly a quarter of patients are diagnosed at advanced stages, leading to poor survival outcomes.
Every country's demographics result in varied challenges in screening, treatment efficacy, and hurdles across care pathways. There is no one-size-fits-all for addressing cancer gaps, and Dr. Mathai sees great value in engaging in cross-region dialogue among researchers to learn from the latest science and develop real-world applications that address India's unique challenges.
Barriers to Early Detection
Late-stage diagnosis of cervical cancer is due to multiple challenges at both community and health-system levels. Lack of awareness about HPV infection and its link to cervical cancer, compounded by sociocultural stigma around women's reproductive health, limits health-seeking behavior and participation in screening programs. The screening uptake has historically been less than 2.5% of the eligible population.
The HPV vaccine's cost and exclusion from the national immunisation programme create challenges. Cervical cancer screening in women is opportunistic because of the lack of resources, diagnostic infrastructure, and programme delivery. As a result, there are gaps in referral systems, reducing access to timely treatment centers. Limited access causes delays in diagnosis, continuity of care, and results in a higher percentage of advanced-stage presentations.
From a global perspective, progress is being made in increasing vaccination uptake. Researchers in India and globally are exploring innovative solutions to increase screenings. A recent study published at the 2025 ASCO Annual Meeting showed strong evidence for the feasibility and acceptability of hr-HPV DNA testing from menstrual blood as a promising alternative to cervical cancer screening, with the potential to increase screening uptake and reduce the burden of cervical cancer. This type of research and conversations among researchers on new applications, like those happening at 2026 ASCO Breakthrough, are key to finding innovative ways to increase early detection.
Coordinated efforts are essential to make both vaccination and testing available and accessible. Building infrastructure and resources to ensure patients receive vaccines and improve health outcomes is critical.
Myths Surrounding Cervical Cancer and the HPV Vaccine
Dr. Mathai addresses common myths. The most common is that cervical cancer is hereditary or bad luck, when in fact it is caused by HPV infections that are highly preventable. Another major misconception is that only women with menstrual problems or symptoms need cervical screening, and postmenopausal women do not need screening at all. Women need to understand that HPV infection is asymptomatic in more than 95% of women, and all women who have ever been sexually active need regular screening after age 30 until 65.
Misinformation regarding the HPV vaccine largely concerns its safety and effect on future fertility. The HPV vaccine has proven to be very safe and effective, with millions vaccinated worldwide. There has been no proven scientific evidence that HPV vaccination affects ovarian function or causes infertility.
Recommended Age for HPV Vaccination
The HPV vaccine is recommended for adolescent girls aged 9 to 14. At these ages it is most effective due to stronger immunogenicity and lower likelihood of past HPV exposure. Vaccination is also extended to older adolescents and young women aged 15 to 26. Research shows sustained immune response for more than 10 years without the need for booster doses.
The World Health Organization recommends a one- or two-dose schedule for girls aged 9 to 20, and two doses administered six months apart for women aged 21 to 26. Vaccination may also benefit women aged over 26, up to 45 years, and should be combined with regular cervical cancer screening. The vaccine does not treat existing infections, emphasizing the importance of early vaccination. Routine screening remains essential even after vaccination to ensure comprehensive prevention. Available vaccines in India include Quadrivalent and Nonavalent Gardasil and Cervavac from the Serum Institute of India.
What Women Should Know About Pap Smears and HPV DNA Tests
All women should undergo cervical cancer screening between ages 30 and 65. The HPV DNA test is recommended as the primary screening method because it detects high-risk HPV infections with high sensitivity and a high negative predictive value, allowing a 5-year screening interval when results are normal.
Evolution of Cervical Cancer Research
Over the past few years, research around cervical cancer has progressed rapidly. The shift to the nonavalent HPV vaccine, alongside the development of India's own vaccine Cervavac, has strengthened prevention efforts. Screening is moving from simpler, low-cost options like Visual Inspection with Acetic Acid to more effective methods like HPV DNA-based testing, with self-sampling emerging as a promising primary screening method. Diagnostics are also evolving, with AI-assisted tools complementing traditional approaches.
In treatment, conventional chemoradiotherapy is now being augmented by precision medicine, immunotherapy, and biomarker-driven strategies aimed at improving early detection and survival. Global efforts focus on the WHO's cervical cancer goals. Scalable screening and vaccination programs and equitable treatment delivery are key. Professional organizations like ASCO are important in sharing evidence-based practices and guidelines for vaccination, screening, and treatment. ASCO also connects clinicians, researchers, and industry leaders to share and drive collaborative solutions relevant to India.
The Role of ASCO in Advancing Oncology Research
Dr. Mathai explains that ASCO is one of the largest oncology societies, with members including oncologists, health professionals, researchers, patient advocates, and philanthropists invested in advancing cancer care. She was a recipient of the ASCO International Development and Education Award in 2020, which provides opportunities for early-career oncologists from low- and middle-income countries to learn and share knowledge with leading oncologists and researchers.
Through ASCO, she engages with leading oncology professionals, builds long-term relationships, and fosters mentor-mentee relationships, all of which have enhanced her expertise and helped her contribute more effectively to cancer care. She looks forward to meeting fellow researchers at ASCO's upcoming Asia-Pacific meeting, 2026 ASCO Breakthrough, which will be held in Singapore for the first time. Platforms like ASCO Breakthrough are critical for oncologists in India. They bridge global expertise and local practice, enabling delivery of evidence-based, contextually relevant cancer care. Importantly, they also empower Indian clinicians and researchers to contribute to and shape the future of global oncology.
