Cervical cancer screening coverage and care cascade in Tamil Nadu, India, based on a community-based cross-sectional survey

Low-and middle-income countries, including India, contribute to over 80% of cervical cancer deaths in the world. Maintaining the continuum of care during screening and diagnosis is important for early detection of cervical cancer. We assessed the screening coverage and care cascade for cervical cancer in Tamil Nadu, a southern state in India with a population of over 78 million. We conducted a state-wide STEPwise approach to NCD risk factor surveillance (STEPS) survey in Tamil Nadu in 2024. We embedded a cervical cancer screening module and interviewed 4184 women aged 30–69 years with the module. We selected the participants using the multistage cluster sampling technique. We present the lifetime screening coverage and each stage of the care cascade after screening positive, as percentages, using complex survey analysis. We did a multivariable regression analysis to determine the factors associated with screening and reported the adjusted prevalence ratios (aPR) with 95% confidence intervals (CIs). Of the 4184 women, the mean (SD) age was 48 (11) years and 3230 (77%) were currently married. About 10% (n = 423, 95% CI: 9%-12%) were ever screened for cervical cancer. Among screened (N = 423), 108 (26%) were screen-positive, 62 (15%) were referred for colposcopy, 56 (13%) underwent colposcopy, 42 (10%) had abnormal findings, 38 (9%) underwent biopsy, and 1 (0.2%) was diagnosed with cancer. Screening was higher among 45–59 year-old women (13%) than 30–44 year-olds (9%) [PR-1.52, 95% CI: 1.20–1.93], among those with education above class 8 (12%) [aPR-2.01; 95% CI: 1.45–2.79] than those with no formal education (7%) and among those with a history of diabetes mellitus (13% vs. 10%) [aPR-1.35, 95% CI: 1.03–1.79]. Referral of screen-positive women for the colposcopy examination was the major bottleneck in the cascade. Training healthcare providers to improve patient-provider communication and prompt referrals can improve cancer detection.