Two-stage screening refers to a strategy where a cheap, sensitive test is followed by a specific confirmatory test in screen-positives. Which combination correctly applies this principle in the context of India's cervical cancer screening programme?
- A Stage 1: Pap smear (sensitive) → Stage 2: HPV DNA test (specific confirmatory)
- B Stage 1: Colposcopy (sensitive) → Stage 2: Cervical biopsy (confirmatory)
- C Stage 1: HPV DNA test (highly sensitive) → Stage 2: VIA or colposcopy (specific, to triage HPV-positive women) ✓
- D Stage 1: CA-125 serum (sensitive) → Stage 2: TVS (specific) — applied to cervical cancer
Correct answer: C. Stage 1: HPV DNA test (highly sensitive) → Stage 2: VIA or colposcopy (specific, to triage HPV-positive women)
Explanation
The WHO 2021 'screen-and-triage' strategy and India's National Cancer Grid guideline recommend HPV DNA testing as the primary (highly sensitive, 90–95%) screening test, with positive women then triaged by VIA or colposcopy (more specific) before treatment. This two-stage approach maximises sensitivity at population level (minimising missed cases) while using specificity at the second stage to minimise unnecessary treatment. Pap smear has lower sensitivity (50–60%) and would not serve as a sensitive first-stage test in low-resource settings.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.