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Over decades of dedication to preventive healthcare, Dr Priya Ganesh Kumar, the Medical Director of SaiNiwas Health Care, has been a pioneer in preventive oncology. With her expertise in colposcopy, she has performed over 35,000+ colposcopies and prevented more than 6,000+ hysterectomies by treating precancerous lesions. She is also a certified trainer for colposcopy courses and has trained over 2,500+ gynecologists across India
In a recent interview with M R Yuvatha, Senior Correspondent at siliconindia, Dr Priya Ganesh Kumar shared her insights on the pivotal roles of colposcopy training and HPV vaccination programs in the prevention of cervical cancer.
In the ongoing battle against cervical cancer, a major public health challenge in India, stakeholders are increasingly focusing on innovative strategies for early detection and prevention. Cervical cancer remains a critical health concern, particularly in rural areas. Key solutions include colposcopy training programs and HPV vaccination initiatives, aligned with WHO’s elimination goals.
Scalable healthcare models, national guidelines, and advanced screening tools are central to improving prevention efforts, while empowering clinicians plays a crucial role in these initiatives.
The WHO Elimination Framework
The WHO has issued a call for the elimination of cervical cancer by 2030, defined as reducing incidence to less than 4 cases per 100,000 population. In India, the current rate stands at around 18 per 100,000 as of 2026, underscoring the urgent need for action. The WHO's strategy targets 90% HPV vaccination coverage for girls by age 15, 70% screening coverage for women at ages 35 and 45, and 90% treatment for precancerous and cancerous conditions. This framework presents a blueprint for investment in preventive technologies and programs.
Nearly all cervical cancers are caused by high-risk strains of HPV, a virus prevalent in India where 4 out of 5 individuals may encounter it in their lifetime. However, not all infections lead to cancer, the body's immune system often clears the virus within a year, similar to how it handles other infections like COVID-19. Persistent infections, which show no symptoms, pose the greatest risk, leading to cellular changes that can progress to precancerous conditions over 5 to 15 years if undetected.
Screening is crucial for identification, with HPV testing recommended for its high sensitivity. Traditional methods like Pap tests or Visual Inspection with Acetic Acid (VIA) have been common in India, but barriers such as cost and availability have limited HPV adoption.
Industry advancements are addressing these challenges, making HPV testing more accessible and shifting clinician mindsets toward acceptance. Positive HPV tests enable risk stratification, directing patients to colposcopy for further evaluation.
Every clinician aims to treat patients with integrity but needs science-backed confidence.
India's Current Landscape
Colposcopy involves magnifying the cervix and applying solutions like 5% acetic acid (not crude vinegar, though experiments have explored alternatives in resource-limited settings) and Lugol's iodine to reveal hidden precancerous changes. Biopsies classify these as Cervical Intraepithelial Neoplasia (CIN) stages: CIN1 (one-third affected), CIN2 (two-thirds), or CIN3/HSIL (fully affected), with CIN3 carrying a 12% risk of progressing to cancer. Treating these conditions prevents advancement, aligning with the WHO's treatment targets.
India's progress is lagging, vaccination coverage is 0.5-1%, screening 2.5-3%, and treatment around 10%. The country relies heavily on treatment rather than prevention, even in urban areas like South India where screening reaches only 6-7% in dense populations. Industry leaders see potential in scaling up through public-private partnerships, leveraging studies on clinician insights and patient perspectives to create win models.
Innovative Training and Mentorship Models in Rural India
Structured colposcopy training, combined with HPV testing, has significantly impacted the detection of cervical precancerous conditions in rural India. These programs address clinician challenges by providing fallback systems and mentorship, fostering confidence in preventive measures.
Some centers like Sainivas Healthcare, as a private sector pioneer, identified the issue in 2005, why women die from preventable cervical cancer despite India's advancements. Recognizing the global burden India accounts for one-fifth due to population and demographic challenges the focus shifted from reiterating problems to solutions. Training began as a moral responsibility, igniting knowledge transfer without ulterior motives.
Initial two-day programs evolved to seven days, incorporating hybrid online-offline models post-COVID. Books like ‘Colposcopy and Practical Gynecology’ (editions in 2015, 2017, 2023) and the 2019 ‘Colposcopy and Cytology Atlas’ co-authored with Dr Venkat Iyer from AIIMS, supported this. Over 2,500 gynecologists have been trained, emphasizing practical, live cases over bookish knowledge.
Dr Priya Ganesh Kumar highlights that one of the major challenges in the field was the institutional neglect of preventive oncology, which was considered a ‘dead science’ in 2005. Clinicians lacked confidence, fearing mistakes in a field where there were often hairline differences between safety and risk. Sainivas's approach successfully combined an understanding of HPV, testing, and colposcopy, advocating for uterus preservation instead of unnecessary hysterectomies for symptoms like leucorrhea.
Mentorship models proved to be highly effective. One-on-one discussions during training helped identify barriers and led to the creation of fallback systems. The Federation of Obstetric and Gynecological Societies of India (FOGSI) certification, introduced in 2012, helped expand the program’s reach. International recognition from Mary Stokes UK in 2016 further elevated the program, attracting global candidates, including those from Afghanistan, prompting continuous improvements to the training.
Overcoming Challenges and Scaling Industry Impact
A game-changer occurred when trainees reported difficulties implementing learnings alone, facing resistance from politicians, patients, and peers favoring hysterectomies. Dr Priya says, feedback during conferences highlighted the need for ongoing support, while charged during training, clinicians felt isolated upon return, especially in rural areas. This underscores the value of sustainable mentorship ecosystems. Sainivas responded by refining models, ensuring trainees could emulate paved paths without initial thorns. Conviction-driven efforts, starting from a state-of-the-art unit in Thane in 2005, defied criticisms.
As a researcher-clinician, Dr Priya Ganesh Kumar drew from personal cases, municipal work, and private practice to teach practical applications. Public models, like CAHPS studies, gauge perspectives, while private initiatives create structured support.
Advice to the Next Generation!
Every clinician aims to treat patients with integrity but needs science-backed confidence. Traditional workshops often fail due to hesitancy, while personalized mentorship offers more effective guidance. Industry strategies now focus on scalable models, with hybrid courses connecting clinicians globally and real-world case studies enhancing relevance.
Fallback networks help prevent setbacks. By addressing mindsets and providing essential tools, these models empower clinicians to play a crucial role in combating cervical cancer. Through collaboration, there is a strong potential to meet the WHO's elimination goals.