Cervico-uterine cancer in India: A persistent concern for the medical fraternity, policymakers, and society

In the series of publishing special issues on “Biomarkers”^[1] and “Infectious Diseases”^[2] in 2025, this is the third consecutive topic-based special issue that the Journal of Laboratory Physicians (JLP) is publishing. Now, the JLP brings the first special issue in 2026 on “Oncology.” In this special issue, we present clinical investigations across diverse Oncological topics contributed by the authors. While writing this editorial, some important aspects such as use of artificial intelligence (AI), data input and data curation, and future of oncology, are specifically considered.

Mukhopadhyay et al.,^[3] carried out a study on unvaccinated hospitalized COVID-19 patients, using various algorithmic metrics of AI and machine learning (ML) models such as logistic regression, decision trees, random forest, support vector machine, ridge classifier, AdaBoost classifier, gradient boosting, extra trees, K-nearest neighbors, Gaussian Naive Bayes, XGBoost, LightGBM, CatBoost, Linear discriminant analysis, quadratic discriminant analysis, and dummy classifier. Even though, overall, the AI models used in the study could achieve a sensitivity of 83% and specificity of 78% only, the AI shows us a path and with further refinement, better models can be developed in the future to predict the disease outcome. Irrespective of the use of AI-ML or not, age and gender of the patients, cytokine levels, and inflammatory markers such as lymphocyte to C-reactive protein were highly predictive of fatal outcome. The findings of this paper and as I mentioned in my previous editorial,^[4] we can expect that modern AI tools may soon be helping patients and doctors not only to predict the disease outcome but also the treatment success rate, especially in cancer patients with and without targeted immunotherapies.

However, whether with or without the use of AI-ML, the data input and its curation remain extremely important for logical and reproducible results. We should not be driven away by the hype that AI can resolve each and every issue in our lives. The computers can generate knowledge based on the initial input humans give to it and computers can use various models to improve the output data. Therefore, if the inaccurate data are fed and these AI-ML models are applied, the output could be disastrous when the whole of humanity will be dependent on these tools.

One study published in this issue of JLP is worth mentioning. Gupta et al.^[5] carried out a hospital-based study in central India in females of childbearing age, to evaluate knowledge about cervical cancer, Pap screening, and human papillomavirus (HPV) vaccination. Even though one can presume that Central Indian states have low literacy rates due to a significant ration of tribal populations, it was surprising to find that out of 295 women interviewed, only 11 (3.7%) were aware that cervical cancer could be detected at an early stage, and merely nine (3.0%) had knowledge of the Pap smear test. None of these women had ever undergone a Pap smear test nor were they aware of the HPV vaccine.

The projected rise of cancer cases in India is a critical public health concern. India could see its annual cancer patient load climb to nearly 2 million (20 lakh) by 2040, a significant jump from the current 1.4 to 1.5 million cases. At present, India stands as the third country globally in cancer prevalence, trailing only China and the USA.

The Indian government is actively rolling out a national HPV vaccination program, prioritizing girls aged 9–14 for cervical cancer prevention, with plans to offer the indigenous and most economic Cervavac vaccine made by Serum Institute of India Pvt. Ltd.^[6] free through schools and health centers. The program is funded by the Government of India as envisaged in the 2024 budget in which ₹200 crore was allocated only for the HPV vaccine rollout.

Although except for the Tamil Nadu state governments which spent millions of rupees on advertisement and information, education, and communication (IEC) programs in the last few years through television, radio programs, and daily newspapers, the data on the expenditure of vaccine promotion are available neither for the state of Madhya Pradesh nor for the central government. The Union Health Ministry is currently focusing on “IEC activities” to sensitize the public before the mass rollout. This rollout will take place through workshops for frontline health workers (ASHAs and Anganwadi workers), collaborative campaigns with the Ministry of Women and Child Development and the Ministry of Education, and Digital management through the newly designed U-WIN platform. However, it is difficult to presume that without proper allocation of funds by the central and state governments,^[7] awareness in the public, where not even a single woman out of 295 was interviewed, had any knowledge about Pap smear and HPV vaccine,^[5] will increase.

Provided infrastructure and optimum budget are available; in recent years, several malignant conditions are manageable and several of them are even curable. Health tourism in India is booming, attracting millions for affordable, high-quality care, from advanced surgeries such as cardiology, oncology, and orthopedics^[8] but diagnostic facilities remain suboptimal. Das et al.^[9] reviewed how biomarkers can effectively be used in the prognosis of carcinoma of the uterine cervix. After studying 381 research articles, they concluded that expression of bcl-2 can serve as a valuable prognostic factor in cervical cancer, with locally advanced disease form, especially in developing countries where treatment outcomes are poor. Using bcl-2 as a molecular marker may help to prognosticate the disease and intensify the treatment in selected populations. Higher bcl-2 expression was associated with better overall survival.

Overall, this will be an engaging issue for JLP for our readers, especially those with a keen interest in onco-research and oncology care. As editor-in-chief, I am hopeful that in the coming years, the journal will continue to progress and serve the biomedical fraternity, clinicians, and researchers alike. The JLP remains the only multi-disciplinary journal from our country, serving a specific group of specialties, such as Pathology, Clinical Microbiology, Clinical Biochemistry, Clinical Pharmacology, Immunology, and Molecular medicine to name a few. It is due to the authors in these specialties, who have consistently enriched the journal with engaging clinical content, that the journal has contributed to the dissemination of valuable clinical information to the biomedical community. It will continue to do the same going forward. In 2026, we will encourage our reviewers and editorial board members to write commentaries and opinion pieces on the original articles published in the coming issues.