Doctors warn that anal cancer in men often goes undetected due to lack of screening and misdiagnosis as piles.
By Shobha Shukla
Despite being one of the most preventable forms of cancer, cervical cancer continues to claim the lives of over 350,000 women globally every year. A staggering number of these deaths occur in developing countries, with India bearing a disproportionately high burden. Yet, medical science has provided us with effective tools — vaccines, DNA screening, and timely treatment — to eliminate this cancer within a generation. The real challenge lies not in science, but in ensuring that science reaches everyone, regardless of gender or geography.
What is HPV and Why Does It Matter?
Human Papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. While most HPV infections clear on their own without causing health problems, persistent infection with certain high-risk HPV genotypes can lead to various cancers — including cervical, anal, penile, vulvar, vaginal, and oropharyngeal (mouth/throat) cancers.
The World Health Organization (WHO) has confirmed that nearly all cervical cancer cases are caused by HPV. Cervical cancer is the fourth most common cancer among women globally, and tragically, a woman dies of it every eight minutes in India — despite the fact that it is entirely preventable through vaccination and screening.
In 2022 alone, over 660,000 women were diagnosed with cervical cancer, and more than 350,000 lost their lives. Alarmingly, HPV also caused over 70,000 cancer cases in men in 2019, a number that remains underreported and poorly addressed.
DNA Screening: The Scientific Gold Standard
Experts are unanimous in their recommendation: HPV screening must be conducted using DNA-based molecular tests, not outdated methods like pap smears or VIA (Visual Inspection with Acetic Acid).
“We have a massive burden of cervical cancer in India,” says Dr Smita Joshi, a renowned preventive oncologist and a key figure in HPV research for over two decades. “All women above the age of 30 must undergo HPV DNA screening. The use of pap smears or VIA is no longer scientifically justifiable.”
India’s National Family Health Survey (2019–2021) paints a grim picture — only 1.2% of women aged 15–49 have ever undergone cervical cancer screening. WHO’s global goal is to screen at least 70% of eligible women. Clearly, we have a long way to go.
HPV and HIV: A Dangerous Intersection
The risk of HPV-related cancers increases sharply among people living with HIV. Women with HIV are six times more likely to develop cervical cancer. Men who have sex with men, especially those with HIV, are also at higher risk of anal HPV infection.
A new study presented at the 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025) in Japan by Mumbai-based microbiologist Dr Prapti Gilada-Toshinwal highlights this concern. Conducted at the Unison Medicare and Research Centre in Mumbai, the study screened 105 men who have sex with men between August 2022 and December 2024.
“Anal HPV infection was found in 62% of participants,” said Dr Gilada. “The rate was even higher — 68.5% — among those living with HIV. HPV genotypes 16, 18, and 45 were the most common.”
Dr Gilada emphasized that many of these men were also living with other sexually transmitted infections like syphilis, gonorrhea, and chlamydia, making the case for a more integrated health response. Her centre continues to monitor participants, one of whom has cleared the HPV infection during the study.
Call to Expand HPV Vaccination for All Genders
India’s HPV prevention efforts have largely focused on women. But experts and activists argue that this must change.
“We need HPV vaccination and screening for boys and men too,” insists Vijay Nair, Chairperson of Udaan Trust, a community health NGO. “There are many cases where people have suffered or died due to undiagnosed anal cancers — often misdiagnosed as piles or fissures. Without proper anoscopy centres and awareness, men are being left out of the prevention net.”
He was speaking at a recent National Dialogue on Non-Communicable Diseases among people living with HIV, organized by the National Coalition of People Living with HIV in India (NCPI Plus).
India’s Indigenous Breakthrough: Truenat HPV DNA Test
A beacon of hope emerged in April 2025 when India validated its first indigenous point-of-care HPV DNA test — Truenat HPV-HR Plus. Developed by Molbio Diagnostics, this test screens for eight high-risk HPV genotypes responsible for over 96% of cervical cancers.
Validated by India’s top research institutions including AIIMS Delhi, ICMR’s NICPR Noida, and NIRRCH Mumbai, in collaboration with WHO’s International Agency for Research on Cancer (IARC), Truenat is a low-cost, rapid, and scalable solution for expanding access to HPV screening, especially in rural and under-resourced areas.
The Power of the HPV Vaccine — One Dose Can Do It
Dr Smita Joshi was a lead investigator in WHO-IARC’s long-term HPV vaccine study initiated in 2009. Though government orders halted vaccination mid-study, it unintentionally created a cohort that received varied dosages — one, two, or three. The follow-up studies now provide robust evidence that even a single dose provides strong protection, influencing WHO’s recommendation of single-dose vaccination for young girls.
India’s indigenous HPV vaccine, Ceravac, developed by Serum Institute of India, is also approved for boys — a critical step toward gender-inclusive vaccination. However, it is yet to be rolled out in the national immunization program, despite pilot state-level efforts in Sikkim, Punjab, and Delhi.
Are We Ambitious Enough?
WHO’s Cervical Cancer Elimination Initiative aims to bring the global incidence below 4 cases per 100,000 women by the end of this century. But are we moving fast enough?
The 90-70-90 targets by 2030 require:
- 90% of girls fully vaccinated by age 15
- 70% of women screened by age 35 and again at 45
- 90% of those with pre-cancer or cancer treated
As Dr Joshi rightly says, “We have the tools, the science, and the solutions. What we need now is political will, public funding, and societal commitment to deploy them.”
A Global Appeal Ahead of UNHLM on NCDs
As world leaders gear up for the UN High-Level Meeting on Non-Communicable Diseases (UNHLM on NCDs) in September 2025, researchers and activists are urging bold commitments to end HPV-related suffering.
“HPV may be a virus,” says Dr Gilada, “but its outcomes are cancers that we can prevent. We need global solidarity to make vaccines and diagnostics accessible in every corner of the Global South.”
The question is not whether we can eliminate HPV-related cancers — but whether we will act quickly and inclusively enough to do it.