Diagnostic Performance of Pap Smear and HPV DNA Co-testing in Cervical Cancer Screening: Experience from a Tertiary Care Hospital in North India

Background: Cervical cancer remains one of the leading causes of cancer-related morbidity and mortality among women in developing countries, including India. Due to the long preinvasive phase of the disease, early detection through screening offers an effective opportunity for prevention. The Papanicolaou (Pap) smear has long been the cornerstone of cervical cancer screening; however, the addition of human papillomavirus (HPV) DNA testing has significantly improved detection of high-grade lesions.

Objective: To evaluate the utilization, cytological findings, and diagnostic performance of Pap smear combined with HPV DNA testing (co-testing) among women attending a tertiary care hospital in North India, and to assess demographic and clinical factors associated with abnormal screening results.

Materials and Methods: This prospective observational study was conducted between March 2021 and August 2022 in a tertiary care hospital in North India. A total of 50 women fulfilling inclusion criteria underwent cervical cancer screening using both Pap smear and HPV DNA testing. Women with abnormal results were further evaluated using colposcopy-guided cervical biopsy. Demographic and clinical variables were compared between screening-positive and screening-negative groups using Chi-square/Fisher’s exact test and Mann–Whitney U test. Statistical analysis was performed using SPSS version 23.

Results: Among the 50 women screened, 7 (14%) were identified as positive on co-testing. The mean age of participants was 42.56 ± 8.78 years. Screening positivity was significantly associated with higher age (median 48 vs 41 years, p = 0.047) and postmenopausal status (40% vs 7.5%, p = 0.008). Histopathological confirmation revealed one case of squamous cell carcinoma and one case of cervical intraepithelial neoplasia grade 2 (CIN-2). HPV DNA positivity was strongly correlated with abnormal cytology (p < 0.001).

Conclusion: Co-testing with Pap smear and HPV DNA improves detection of cervical premalignant and malignant lesions. Increasing age and postmenopausal status were significant predictors of screening positivity. Implementation of combined screening strategies may enhance early detection of cervical cancer in tertiary care settings.