Indonesia to push DNA screening for cervical cancer nationwide

The government is planning to implement DNA-based testing as the primary cervical cancer screening method for women between 30 and 69 years old as a measure to achieve its target to eliminate the disease by 2030.

Until now, most health facilities primarily use acetate acid (IVA) to detect human papillomavirus (HPV) and diagnose cervical cancer. The new plan would combine the IVA and DNA testing, which is deemed more accurate and effective in detecting and preventing the disease.

“We will begin to roll out HPV DNA co-testing with IVA nationwide starting in 2025,” the Health Ministry’s noncommunicable diseases prevention and control director Siti Nadia Tarmizi said in a press briefing in Jakarta on Friday.

Following a successful trial in Greater Jakarta, the ministry expanded the HPV DNA co-testing with IVA to 25 regencies and cities across 16 provinces in 2024. Around 2.5 percent of people screened with the co-testing in the regions were detected as having HPV infections.

“The risk of HPV infections among women between 30 and 69 years old is notably high,” Siti said, adding the DNA-based screening will be included in President Prabowo Subianto’s flagship free birthday checkups.

The press briefing on Friday was held ahead of the 2nd Global Cervical Cancer Elimination Forum hosted by Indonesia in Bali from Tuesday to Thursday. The meeting is a follow-up to the first forum held in Cartagena, Colombia, in March 2024 that produced key commitments to combat cervical cancer.

Indonesia’s efforts to reduce cervical cancer are in line with the country’s third sustainable development goal of cutting cancer rates by a third by 2030, said Harditya Suryawanto, who heads the Health Ministry’s global health management and strategic policy center.

It also aligns with the World Health Organization’s 90-70-90 target by 2030: 90 percent of girls older than 15 fully vaccinated against HPV, 70 percent of women older than 35 screened for the cancer, and 90 percent of women with pre-cancer treated and those with invasive cancer managed.

Indonesia has the third-highest incidence and mortality rates for cancer in Southeast Asia, with around 408,661 new cases and 242,988 deaths, according to the International Agency for Research on Cancer (IARC) in 2022. Without effective intervention, cancer cases are predicted to increase by 77 percent by 2050.

Cervical cancer is the second most common cancer among Indonesian women after breast cancer. Out of all new cases detected in 2022, cervical cancer accounted for nearly 37,000 cases and 20,000 deaths.

The death rate for cervical cancer is high due to low screening rates, with about 70 percent of cases being detected late when the disease is already advanced. In 2020, less than 10 percent of women aged 30-50 underwent the IVA and cytology screenings available free of charge at community health centers (Puskesmas).

Barriers to screening include low awareness, taboos surrounding internal examinations, fear or feeling uncomfortable with the procedures, as well as lack of support from family members, especially husbands.

Pre-cancerous lesions often develop inside the cervix and are invisible to the naked eye, making screenings important for early detection despite the swabbing being uncomfortable for most patients, said Siti.

“We hope Indonesian women don’t feel embarrassed about the screening procedure,” she said. “Family support, especially from husbands, can make a significant change in encouraging women to undergo screenings.”

Screenings, along with HPV vaccinations and treatment, makes up three key strategies outlined in Indonesia’s National Action Plan for Cervical Cancer Elimination 2023-2030.

First introduced in 2016, HPV immunization was rolled out nationally in 2023 for girls aged 11 to 12 in fifth and sixth grade of elementary school under the School Children Immunization Month (BIAS) program. The two-dose vaccination coverage has reached over 90 percent, with about 1.94 million out of 2.15 million targeted girls inoculated.

Starting this year, the government also plans to administer a single-dose HPV vaccine to girls in fifth grade, with catch-up immunization provided for those younger than 15 who missed the immunization. Studies suggest that a single-dose vaccine is effective in safeguarding children against HPV infections.

To reach the 2030 goal, the Health Ministry is targeting to vaccinate 90 percent of girls and boys against HPV.

“Initially, we plan to introduce HPV immunization for boys in 2027,” said Gertrudis Tandy of the ministry’s immunization department. “But with the results of the girls’ program, we might bring it forward to 2026 to accelerate our progress toward the 2030 elimination goal.”