Regarding cervical cancer screening guidelines in India, all of the following statements are TRUE EXCEPT:

Explanation

## Cervical Cancer Screening: Evidence-Based Guidelines ### Screening Methods Hierarchy **Key Point:** In resource-rich settings, HPV-based testing (either primary HPV testing or HPV-reflex cytology) is now the preferred primary screening modality, NOT visual inspection with acetic acid (VIA). **High-Yield:** VIA is a low-cost, low-technology screening tool suitable for low-resource settings where HPV testing and cytology infrastructure are unavailable. However, it has lower sensitivity (~60–70%) and specificity (~80–90%) compared to HPV testing (sensitivity >95% for CIN2+). ### Correct Statements Explained | Screening Method | Sensitivity for CIN2+ | Specificity | Best Use | |---|---|---|---| | HPV testing (primary) | >95% | 90–95% | Resource-rich, organized programs | | Liquid-based cytology | 85–95% | 95–98% | Adjunct to HPV; reduces artifacts | | Conventional Pap smear | 80–85% | 95–98% | Historical; air-drying artifacts common | | VIA | 60–70% | 80–90% | Low-resource settings only | **Key Point:** Liquid-based cytology (LBC) reduces air-drying artifacts, improves specimen quality, and allows HPV reflex testing — all advantages over conventional smear. **Key Point:** HPV testing demonstrates superior sensitivity (>95%) compared to cytology (~85%) for detecting CIN2+ lesions, making it the gold standard in developed nations. ### Screening Age and Duration **High-Yield:** Current guidelines (NCCN, ASCCP, WHO) recommend screening initiation at age 21 years (or 25 years in some updated guidelines) and discontinuation at age 65–70 years in women with adequate prior negative screening and no history of CIN2+. ### Why Option 4 Is Wrong VIA is NOT recommended as the primary screening method in resource-rich settings. VIA is a triage tool for low-resource areas where HPV and cytology are unavailable. In developed healthcare systems, HPV-based testing is superior in sensitivity, specificity, and reproducibility. [cite:Park 26e Ch 23] [cite:NCCN Cervical Cancer Screening Guidelines 2023]