The cervical cancer gap: We have vaccines and screening, so why are women still dying?

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 2026 ASCO (American Society of Clinical Oncology) 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 just 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's asymptomatic, who has no idea anything's 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.

Cervical cancer is often described as one of the most preventable cancers, why are so many women in India still dying from it?

Dr. Sonia Mathai: Cervical cancer is a significant problem around the world and especially in India. It is the second most common cancer among women in India and accounts for a quarter of deaths globally.

Infection with Human Papillomavirus (HPV), a common virus transmitted sexually, is the main cause for almost all cases of cervical cancer.

We generally approach cervical cancer prevention with two strategies: 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 of the disease, 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 this is why I see great value in engaging in cross-region dialogue amongst researchers, so that we can learn from the latest science and develop real-world applications in clinical practice that can address India’s unique challenges.

Why do so many cases in India get diagnosed at a late stage, and what are the biggest barriers to early detection?

Dr. Sonia Mathai: Late-stage diagnosis of cervical cancer is due to multiple challenges at both community and health-system levels, both of which hinder effective early detection. Lack of awareness about HPV infection and its link to cervical cancer, compounded by sociocultural stigma around women’s reproductive health, limits health-seeking behaviour 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 centres. Limited access causes delays in diagnosis, in the continuity of care, and results in a higher percentage of advanced-stage presentations.

From a global perspective, we are making some progress in increasing vaccination uptake, and researchers in India and globally are exploring innovative solutions to increase screenings for cervical cancer. A recent study published at the 2025 American Society of Clinical Oncology’s (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 in finding innovative new ways to increase early detection.

To detect HPV early and increase prevention, coordinated efforts are essential in making both vaccination and testing, available and accessible. We must build the infrastructure and resources to ensure patients receive vaccines, and improve their health outcomes.

What are some of the biggest myths surrounding cervical cancer and the HPV vaccine that doctors wish people would stop believing?

Dr. Sonia Mathai: Many myths and misconceptions need to be addressed in the community, arising from a lack of awareness and misinformation, or both. The most common myth is that cervical cancer is hereditary or bad luck, when the fact is that it is caused by HPV infections that are highly preventable. Another major misconception is that only women who have menstrual problems or symptoms need to come for 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 to undergo regular screening after the age of 30 years till 65 years.

The misinformation regarding the HPV vaccine is largely about 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 and causes infertility.

At what age should girls and women receive the HPV vaccine, and is it still effective later in life?

Dr. Sonia Mathai: We recommended the HPV vaccine for adolescent girls aged nine 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 15–26 years. Research shows sustained immune response for more than 10 years without the need for booster doses. The World Health Organization (WHO) recommends a one- or two-dose schedule for girls aged nine to 20 years, and two doses administered six months apart for women aged 21–26 years.

Vaccination may also benefit women aged over 26 years, up to 45 years, and should be combined with regular cervical cancer screening. The vaccine does not treat existing infections, emphasising the importance of early vaccination. Routine screening remains essential even after vaccination to ensure comprehensive prevention. We have the Quadrivalent and Nonavalent Gardasil vaccines, and Cervavac (Serum Institute of India), available in India.

What women should know about Pap smears, HPV DNA tests?

Dr. Sonia Mathai: All women should undergo cervical cancer screening between the ages of 30 and 65 years. 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.

How cervical cancer research has evolved over the years and the breakthroughs shaping treatment and prevention today?

Dr. Sonia Mathai: 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 (VIA) 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 organisations like the American Society of Clinical Oncology (ASCO) are also important in sharing the best 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.

You have a meaningful association with ASCO through recognitions, moderations and research presentations. Could you tell us what ASCO means to you personally, and why a platform like ASCO is so vital for advancing oncology research, particularly in countries like India?

Dr. Sonia Mathai: ASCO is one of the largest oncology societies. Oncologists, health professionals, researchers, patient advocates, and philanthropists are members and are invested in advancing cancer care. I 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 in cancer care.

Through ASCO, I engage with leading oncology professionals, build long-term relationships, and foster mentor–mentee relationships, all of which ha enhanced my expertise and helped me contribute more effectively to the field of cancer care.

I look 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. They enable the delivery of evidence-based, contextually relevant cancer care. Importantly, they also empowering Indian clinicians and researchers to contribute to and shape the future of global oncology.