Screening is not optional anymore: Understanding risks of delayed cervical checkups

Cervical cancer continues to pose a major public health challenge in India, not because it is hard to detect, but because screening is frequently delayed or skipped. Medical experts highlighted that late diagnosis remains common despite the availability of effective screening tools and preventive measures.

Basically, Cervical cancer starts in the cells of the cervix, which is located at the lower, narrow end of the uterus (womb), which connects the uterus to the vagina (birth canal). Cervical cancer typically progresses over time, and before cancer forms in the cervix, the cells of the cervix undergo changes called dysplasia, during which abnormal cells begin to develop in the tissue. If these abnormal cells are not detected or treated, they can eventually turn cancerous and begin to grow, spreading deeper into the cervix and nearby tissues over time.

Highlighting the delayed or skipped screening, Dr Manish Sahni, Consultant Surgical Oncologist at Kailash Hospital, Noida, said that cervical cancer often develops without noticeable early symptoms, leading to delayed diagnosis. He pointed out that limited awareness about the HPV vaccine among young girls and women, along with poor understanding of early warning signs, remains a key concern.

“Cervical cancer continues to be a significant public health concern, not because it is difficult to detect, but because it often develops without noticeable early symptoms. Despite the availability of effective screening tools and preventive measures, late-stage diagnosis remains common due to limited awareness. This is largely driven by a lack of education around the HPV vaccine among young girls and women, as well as poor awareness of early warning signs. Cervical cancer screening tests, such as Pap smears and HPV testing, aim to monitor precancerous changes in cervical cells, enabling early detection and timely intervention before symptoms appear,” he said.

The Consequences of Postponed Screening

Dr Manish Sahni added that if the time for regular screening is delayed, abnormal cellular changes may remain unseen and progress unobserved. Even in the early stages of cervical cancer, a patient may not show symptoms. This means that the condition might progress for years before the onset of abnormal vaginal bleeding, pain in the lower abdomen or pelvis, or an unusual discharge. By the time symptoms are felt, the cervical cancer may have reached an advanced stage.

Impact on Survival and Treatment Outcomes

He also said the stage at which cervical cancer is diagnosed has a direct impact on survival, with early-stage detection associated with survival rates exceeding 90 per cent. Survival rates decline significantly when the disease is detected at later stages. In many cases, when diagnosed in the late stage, patients are required to undergo multimodal treatment involving chemoradiation. On the contrary, when diagnosed at an early stage, patients can opt for less intensive treatment options such as surgery, loop electrosurgical excision procedures, or cryotherapy, which are associated with better outcomes and reduced treatment-related burden.

Misconceptions Regarding Risk and at-Risk Groups

A false sense of security often leads women to delay or avoid cervical cancer screening. Many women believe they are not at risk due to factors such as age, monogamous relationships, or menopause. However, HPV can remain dormant for many years, leaving women vulnerable to cervical cancer even without recent exposure. Women who have never been screened, those who undergo impulse or irregular screening, and women with compromised immune systems or multiple sexual partners have an increased risk of developing cervical cancer, Dr Manish Sahni added.

The Key Importance of Routine Screening

The severest outcome resulting from the late implementation of cervical screening is death from preventable disease. Adherence to guidelines for proper screening is still the best way to detect and cure this ailment and to maintain a healthy cervix. In today’s world, one cannot opt not to screen the cervix, and this process is needed for health and survival, Dr Manish Sahni further added.

Echoing similar concerns, Dr Abhilasha Narayan, Consultant Gynaecological Oncologist at HCG Cancer Hospital, Bangalore, said cervical cancer is largely preventable but continues to affect thousands of women annually due to low participation in screening programmes. She said women who skip regular screening are more likely to be diagnosed at an advanced stage with poorer outcomes. Factors contributing to low screening rates include lack of awareness, limited access to facilities, social stigma, cost concerns and fear of abnormal findings.

"Cervical cancer is a largely preventable disease, yet it continues to affect thousands of women in India every year, largely because screening is delayed or skipped altogether. Low participation rates in screening programs have a detrimental impact on women's health outcomes. Women who do not receive regular screening are at higher risk of developing cervical cancer, and when diagnosed, they are more likely to have advanced disease and poorer outcomes. It is recognised that there are a large number of women who are consistently under-screened due to a wide range of factors." Dr Narayan said.

Several factors contribute to low screening rates:

● Lack of awareness
● Limited access to facilities
● Social stigma around gynecological screening
● Concerns about the high cost and fear if any abnormalities are found within the body

Dr Narayan added that these challenges are compounded by a widespread misconception that screening is only necessary when symptoms appear. Early cervical cancer and precancerous changes are usually silent. Screening is for all women. One should not wait for any symptoms to undergo screening.

Why does screening matters?

● Early detection helps to diagnose the abnormal cell changes before they turn cancerous.
● Early detection helps to identify and treat precancerous lesions
● It also helps to reduce the anxiety which escalates when diagnosed at the later stage
● Cervical Cancer tends to affect younger women, which is why screening needs to begin early. Pap smear screening should start at 21 years or 25 years of age (once sexually active) and repeat it once in every three years until the age of 65 years. HPV DNA testing is recommended after 30 years. If both the HPV DNA test and Pap test are negative, screening frequency can be adjusted to once in every five years.

"Don’t let fear or stigma hold you back – women should prioritize their health and schedule cervical screening on an immediate basis," Dr Narayan further added.

Similarly, Dr Vijay Kumar Srinivasalu, Senior Consultant in Medical Oncology at Sakra World Hospital, Bengaluru, stated that most of the women consult doctors only after they develop symptoms such as abnormal vaginal bleeding, pelvic pain or unexplained weight loss appear, often indicating advanced disease. Nearly two-thirds of cases present at this stage, despite cervical cancer being one of the most preventable and treatable cancers when detected early through routine screening.

"Women presenting with cervical cancer consult us only after symptoms such as abnormal vaginal bleeding, pelvic pain, or unexplained weight loss have appeared. Unfortunately, these symptoms often signal advanced disease which accounts to nearly two-thirds of our practice. What makes this particularly tragic is that cervical cancer is one of the most preventable and most treatable cancers when detected early through routine screening. It does not develop overnight, evolves slowly over many years, beginning with precancerous changes in the cervix caused by persistent infection with high-risk types of Human Papillomavirus (HPV). This long pre-cancer phase is precisely why screening works so well. Tests such as the Pap smear and HPV test are designed to identify these early changes, long before cancer develops and any symptoms appear," Dr Srinivasalu said.

"Yet, many women delay or avoid screening due to lack of awareness, fear or embarrassment about pelvic examinations, social stigma, or the false belief that screening is unnecessary in the absence of symptoms which is dangerous. By the time symptoms appear, cervical cancer is often already advanced, requiring aggressive treatment such as radical surgery, chemotherapy, and radiation. These treatments can significantly affect fertility, sexual health, and overall quality of life," he added.

He said that treatment is often simple and effective when cervical abnormalities are detected early, as it can be treated by a minor outpatient procedure. Detecting it early not only saves lives but also saves fertility and long-term well-being of the women. Emphasising the need to avoid postponed screening, he added that they are currently experiencing an increasing diagnosis of cervical cancer in younger women, ranging in age group between 30s and 40s.

According to widely accepted international and national guidelines:

● Screening should begin at 25 years of age. Women between the age group of 25–29 should go for Pap smear test every 3 years.
● And, women with 30-65, should opt for HPV testing every 5 years or Pap smear every 3 years or Co-testing (Pap + HPV) every 5 years. Remember, screening should be continued until at least 65 years, provided previous tests have been adequate and normal.

Dr Vijay Kumar Srinivasalu further emphasised that screening is recommended even if you have no symptoms, are married, and received the HPV vaccine. HPV vaccination is a powerful preventive tool and has significantly reduced the risk of cervical cancer. However, it does not eliminate the risk completely. Vaccination and screening work best together, not as substitutes for one another. Cervical cancer is preventable and treatable. Lives can be saved, if timely action is taken.