World Cancer Day 2026: Why cervical cancer remains a rural health crisis in India

Cervical cancer is less of a medical challenge than a public health failure. Despite being preventable and slow to progress, it remains a major cause of cancer deaths among Indian women, with rural areas bearing the highest mortality due to gaps in access and execution.

According to national cancer estimates, cervical cancer is the second most common cancer among women in India. Every year, there are about 120,000 new cases and more than 75,000 deaths from the disease. GLOBOCAN 2008 data showed that India is responsible for almost 15.2 per cent of all cervical cancer deaths worldwide. 

This burden isn’t shared equally. According to time-trend data from the National Cancer Registry Programme (1982–2005), the number of cases has gone down in cities, but it is still very high in rural areas, where women are often diagnosed at later stages. This drives up the death rate in Indian villages because treatment of advanced cancer is more difficult, expensive, and less effective.

This gap between urban and rural areas is key to understanding why cervical cancer continues to kill people even though there have been national programs and clinical guidelines for decades.

The biology of the disease makes the situation particularly worrying. Cervical cancer usually develops slowly, progressing from precancerous changes to invasive disease over 10 to 20 years, as outlined in the World Health Organization’s (WHO) Comprehensive Cervical Cancer Control guidelines. This long, silent phase should allow ample opportunity for screening and early treatment. Yet in India, screening rates remain low, and many cases are detected only after symptoms appear, a trend reflected in population-based cancer registry data from the Indian Council of Medical Research.

Limited access to screening

India has a defined set of rules and guidelines for cervical cancer screening. According to the national portal for control of noncommunicable diseases (NCD), as of July 20, 2025, the Ayushman Arogya Mandirs (upgraded primary healthcare centres) had screened 101.8 million women aged 30 and above under the population-based NCD programme of the Union Ministry of Health and Family Welfare.

The programme targets women between 30 and 65 years and primarily uses Visual Inspection with Acetic Acid (VIA), conducted by trained health workers at sub-health centres and primary health centres.

The health ministry said that Accredited Social Health Activists find women who are at risk in the community using 'Community-Based Assessment Checklist' forms and get them to come in for screening. The National Health Mission gives States and Union territories funds to run awareness campaigns for National Cancer Awareness Day and World Cancer Day. These campaigns are supported by print, electronic and social media outreach.

But these headline numbers mask deep gaps. The national NCD portal data showed that fewer than half of the 254.2 million women eligible for screening have actually been covered.

The shortfall is not evenly spread. Rural, tribal and economically disadvantaged communities continue to be left out. Low awareness of cervical cancer, discomfort with gynaecological examinations, fear driven by misinformation, limited family support and indirect costs such as travel, lost wages, and childcare remain powerful deterrents to participation.

Implementation gaps

Although meant for preventive care, many 'Health and Wellness Centres' do not regularly offer cervical cancer screening. When services are available, screening is usually only VIA, and there is little guarantee of quality or consistency. Follow-up systems are still weak, and the paths for referrals after a positive test often don't work.

The effects are adverse. Recent national studies have shown that cervical cancer death rates have remained high since 2016. This means that VIA-based screening alone is not enough. In India, almost 60–70 per cent of cases are diagnosed at advanced stages because many women who test positive on VIA do not get a confirmatory colposcopy or treatment right away. Some of the problems are the distance to referral centers, the cost, the loss of daily wages and the lack of clear communication about what to do next.

Screening alone does not prevent death. It just puts the blame on women who are least able to deal with a broken health system.

Why rural India pays the price

The first design flaw is city-focused infrastructure. Most rural primary health centres have limited advanced diagnostic tools like human papillomavirus (HPV) testing, cytology and colposcopy.

These services are often found in district hospitals or urban tertiary facilities. For women who live in rural areas, getting a diagnosis often means traveling long distances multiple times, using unreliable transportation, and spending money out of their own pockets. Every new hurdle makes it more likely that care will be delayed or not happen at all.

Further, India’s cervical cancer response is constrained by a shortage of trained personnel at the last mile. Skills required for screening, sample handling, interpretation, counselling, and long-term follow-up are unevenly distributed and often absent in rural facilities.

ASHAs and Auxiliary Nurse Midwives remain central to outreach and mobilisation, but cancer prevention has been added to their roles without corresponding investment in training or time. National Health Mission assessments have flagged this mismatch, yet the structural overload remains unaddressed.

Assigning technically demanding cancer prevention responsibilities to frontline workers without adequate preparation or support compromises both the credibility of the programme and the sustainability of the workforce.

Cervical cancer is still a problem in rural areas because it reflects systemic unfairness instead of clinical uncertainty. Women in rural areas are more likely to get a late diagnosis, less likely to finish the diagnostic proces, and least likely to get treatment on time. The result is a lot of deaths that could have been avoided.

Public health experts and WHO have consistently called for a shift from VIA-based screening to HPV-DNA testing, including self-sampling options. While initial costs are higher, WHO has shown that HPV-DNA testing lowers long-term expenditure by reducing the need for advanced cancer treatment. Incorporating HPV-DNA testing into the National Programme for Prevention and Control of Non-Communicable Diseases could significantly improve coverage and outcomes.

Missed opportunity

India’s cervical cancer strategy continues to miss a critical preventive opportunity, which is the systematic rollout of HPV vaccination. Global evidence leaves little doubt that vaccination, combined with effective screening, reduces disease incidence. Yet in India, prevention and treatment remain poorly integrated.

The cost of this fragmentation is reflected in regional data. Southeast Asia accounts for 29.59 per cent of global cases and 34.12 per cent of deaths. In 2022, India reported 127,526 new cases and 79,906 deaths, according to a WHO-University of Sydney report. Screening coverage remains as low as 1.9 per cent in some estimates, and is further undermined by subjective VIA testing, sociocultural barriers, privacy concerns and weak follow-up mechanisms.

India’s response to the COVID-19 pandemic showed that the country could quickly expand its testing and lab capacity. Health policy studies have shown that this infrastructure can be used for HPV-DNA testing. Public-private partnerships, mobile screening units, teleconsultations with urban specialists, and investment in indigenous testing kits are all good ways to fill in the gaps that already exist.

Countries including Australia, Denmark, Finland and Bhutan have demonstrated that regular HPV-DNA screening combined with vaccination can reduce cervical cancer risk. India has the scientific understanding and institutional foundation to adopt similar measures.

Sabine Kapasi is a global health strategist and UN advisor. Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth.