By Arunima Rajan

In an interview with Arunima Rajan, Dr. Gaurav Gujarathi, Senior Consultant and Centre Head , Birla Fertility & IVF, Mangalore, says that HPV vaccination is also now recommended for males, emphasising that timely vaccination for both girls and boys is crucial in reducing the future burden of cervical and HPV-related cancers.

India still carries one of the highest burdens of cervical cancer in the world, with over 120,000 new cases and tens of thousands of deaths each year. In your practice, how often do women come in already aware of early detection options versus those who are facing advanced disease for the first time?

In this practice, oncology consultations are relatively limited as the focus is largely on fertility care. However, among women who do present, awareness has improved compared to a decade ago, though it remains inadequate. A higher proportion still present with advanced stages such as Stage 1 or Stage 2 disease, compared to premalignant or early-stage conditions where timely diagnosis and treatment are possible. This indicates that many women are still seeking care late in the disease course.

National health surveys show that barely 2 per cent of eligible women have ever had cervical screening in their lifetime. What screening rate are you seeing among women who visit your clinic, and what practical barriers, for example cost, time, or understanding of the test, do you encounter most often?

Among women visiting the clinic, only about 2–3 per cent have undergone cervical screening such as a Pap smear. The biggest barrier is lack of awareness, many women are still unaware that such tests exist to detect precancerous changes. Cost is not a major deterrent, as the test is relatively affordable. Willingness and understanding of the importance of screening remain the primary challenges.

Studies suggest that while many women have heard of cervical cancer, very few have comprehensive knowledge of its causes or prevention and only a tiny fraction have been vaccinated. From your patient interactions, what are the most common misconceptions about cervical cancer and the HPV vaccine?

Two major misconceptions are frequently observed:

Some women believe the HPV vaccine can cause cancer, whereas it is actually preventive.
Others assume the vaccine offers 100 per cent protection and that no further precautions are required.

Vaccinated individuals must still follow safety measures such as regular health check-ups and screenings.

High-risk HPV strains like types 16 and 18 are estimated to account for the vast majority of cervical cancers in India. How frequently do you incorporate HPV testing in screening compared with cytology alone, and what drives those clinical decisions at the point of care?

In current practice, we primarily uses cytology (Pap smear) and does not routinely perform HPV testing. HPV DNA testing is selectively recommended for high-risk patients — such as those with recurrent vaginal infections, repeated urinary infections, or seropositive status. Clinical decision-making is driven by patient symptoms and risk factors.

With some states now offering free HPV vaccination for girls aged 9 to 14, what conversations do you have with adult women about vaccinating their daughters or younger siblings, and what questions or concerns come up in those discussions?

When discussing vaccination with adult women, counselling focuses strongly on the importance of early immunisation, particularly during adolescence. Women are informed that the HPV vaccine is safe, covers multiple high-risk strains, and offers the greatest protection when administered at a younger age, even though it can be taken later in life as well. HPV vaccination is also now recommended for males, emphasising that timely vaccination for both girls and boys is crucial in reducing the future burden of cervical and HPV-related cancers.

Data show a steep gap between awareness and action. In your experience, what early symptoms or clinical cues do women most often overlook before seeking gynaecological care, and how can clinicians help bridge that awareness gap?

In clinical practice, many women tend to overlook early warning signs before seeking medical care. Commonly ignored symptoms include recurrent vaginal infections, excessive or abnormal discharge, bleeding after sexual intercourse, unusually heavy menstrual bleeding, and persistent backache or pelvic pain. We try our best in bridging this awareness gap by actively educating women about these symptoms and encouraging them to seek gynaecological consultation at the earliest rather than delaying care.

For hospital administrators thinking about preventive women’s health as part of quality measurement, which three measurable indicators related to cervical cancer screening and follow-up do you believe truly reflect progress in patient outcomes and service delivery?

For hospital administrators evaluating preventive women’s health services, three measurable indicators are particularly meaningful. These include the number of women undergoing routine Pap smear screening, the rate of appropriate follow-up such as colposcopy or biopsy after abnormal results, and HPV vaccination coverage, especially among girls aged 9 to 14 and adolescents. Monitoring vaccination rates in relation to local population demographics helps assess the long-term impact of prevention strategies.

Outreach campaigns have reached tens of thousands of women with awareness and screening opportunities in some regions. Based on what you see clinically, what communication strategies or patient engagement practices seem to improve both awareness and uptake of screening or vaccination?

From a clinical perspective, awareness and participation in screening improve when communication strategies are consistent and widespread. Social media campaigns that position cervical cancer as a preventable disease, provide information on symptoms, screening frequency, and risk factors, and clearly explain the safety, benefits, and affordability of vaccines tend to be most effective. Campaigns that emphasise the importance of annual health check-ups and early detection, supported by well-planned digital and community outreach initiatives, play a key role in increasing screening and vaccination uptake.

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Vaccinating Girls Isn’t Enough