In recent years, the Indonesian government has made various efforts to increase cervical cancer early detection through screening. According to the National Action Plan (RAN) for Cervical Cancer Elimination 2023-2030, the percentage of Indonesian women undergoing cervical cancer screening in 2020 was only 9.35%. This figure increased to 14.5% in 2023, as noted in the Ministry of Health's Indonesia Health Profile 2023 (kemkes.go.id). While this growth is a positive step, it remains far below the WHO's recommended target of at least 70% of women aged 35 undergoing screening and repeating it at age 45.

Early detection plays a crucial role in combating cervical cancer. Cervical cancer often develops slowly and shows no symptoms in its early stages, meaning many women are diagnosed only after the disease has progressed. Early detection helps prevent cancer development by identifying abnormal changes in cervical cells before they become cancerous. WHO recommends that all sexually active women, starting at age 30, undergo regular screenings. This is because cervical cancer develops slowly, and early detection offers a chance for earlier and more effective treatment.
 

Pap Smear Method: A Common Procedure, But Are There Limitations?

The Pap Smear is the most commonly used method for detecting cervical cancer. Its procedure involves the doctor collecting cervical cells to be examined in a laboratory for abnormal changes. Introduced in the 1940s by Dr. George Papanicolaou, the Pap Smear was a groundbreaking innovation that helped reduce cervical cancer mortality rates.

However, despite its widespread use, the Pap Smear is not the most accurate method. It only detects abnormal cells after changes have occurred, serving more as a “warning” than a preventative measure. The Pap Smear also has limitations in sensitivity, meaning some cases of cancer or cell changes may be missed. To ensure early detection, women often need to undergo routine Pap Smears every three years, which requires significant time and financial commitment.
 

HPV DNA: The Latest Screening Method and WHO Recommendation

One of the newest and most recommended methods for early cervical cancer detection is the HPV DNA test. This method identifies DNA from high-risk HPV types, such as HPV-16 and HPV-18, long before abnormal cells develop into cancer. The procedure is similar to a Pap Smear but is more specific and accurate in detecting HPV infections.

WHO recommends HPV DNA testing for its higher sensitivity and because it only needs to be performed every five years, unlike the more frequent Pap Smears. This reduced frequency is due to the HPV DNA test's ability to detect the virus earlier and with greater accuracy, making the results more reliable. Unfortunately, in Indonesia, this method is still not as well-known as the Pap Smear. Limited education and access to this method in various regions are key reasons, although it has been included in the National Action Plan for Cervical Cancer Elimination 2023-2030.
 

Transitioning to HPV DNA Testing

Several studies and developments related to HPV DNA testing are underway in Indonesia. One example is Nusantics, a local biotechnology company that introduced the PathoScan hrHPV qPCR Kit, designed to detect high-risk HPV with high accuracy. This kit offers advantages over conventional methods, including higher sensitivity and the ability to detect 14 high-risk HPV types, such as HPV-16 and HPV-18.
 

Comparison of Pap Smear and HPV DNA Performance Using PathoScan hrHPV qPCR Kit

References:

1. American Cancer Society. (2021). Cervical cancer facts & figures 2021. Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21139

2. American College of Obstetricians and Gynecologists. (2021). Updated cervical cancer screening guidelines. Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines

3. Jang, T. W., et al. (2012). Human papillomavirus testing as a primary cervical cancer screening method. Journal of Gynecologic Oncology, 23(4), 282-286. Retrieved from https://doi.org/10.3802/jgo.2012.23.4.282

4. Kementerian Kesehatan Republik Indonesia. (2023). Rencana aksi nasional (RAN) eliminasi kanker leher rahim di Indonesia tahun 2023-2030. Retrieved fromhttps://kemkes.go.id/id/rencana-aksi-nasional-ran-eliminasi-kanker-leher-rahim-di-indonesia-tahun-2023-2030

5. Nusantics. (n.d.). Reproductive health: Human diagnostics. Retrieved from https://nusantics.com/products/human-diagnostics/reproductive-health

6. Pankaj, S., Kumari, A., Kumari, S., Choudary, V., Kumari, J., Kumari, A., & Nazneen, S. (2018). Evaluation of sensitivity and specificity of Pap smear, LBC, and HPV in screening of cervical cancer. Indian Journal of Gynecologic Oncology, 16(49). Retrieved from https://doi.org/10.1007/s40944-018-0202-y

7. Profil Kesehatan Indonesia 2023. Kementerian Kesehatan RI. Retrieved from kemkes.go.id

8. Taha, M. (2022). The impact of cervical cancer screening on health outcomes: A systematic review. PMC. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC11435674/

9. World Health Organization. (2021). Global strategy to accelerate the elimination of cervical cancer as a public health problem. Retrieved from https://www.who.int/europe/news/item/11-09-2021-who-recommends-dna-testing-as-a-first-choice-screening-method-for-cervical-cancer-prevention

10. World Health Organization. (2021). WHO guideline: Evidence synthesis [Annex A]. Retrieved from https://www.who.int/europe/news/item/11-09-2021-who-recommends-dna-testing-as-a-first-choice-screening-method-for-cervical-cancer-prevention