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HPV Screening for Cervical Cancer

In rural India, a single round of HPV testing was associated with substantially lower rates of advanced cervical cancer and cervical cancer death.

More than three quarters of the world’s 500,000 annual cervical cancer cases occur in developing countries, where incidence is substantially higher than in developed countries. In a cluster-randomized, controlled trial in rural India, researchers evaluated the effects of a single round of human papillomavirus (HPV) screening on rates of advanced cervical cancer and cervical cancer deaths. More than 130,000 women (age range, 30–59) were assigned to four groups: HPV testing (13 high-risk types), cytologic testing, visual cervical inspection with acetic acid (VIA), or no screening (the current standard of care in this area of India; women in the control group received information about how to obtain screening). Women with positive screening tests underwent colposcopy and treatment as needed.

At 8 years of follow-up, 34 cervical cancer deaths had occurred in the HPV-screened group and 64 cervical cancer deaths had occurred in the control group (hazard ratio, 0.52). For detection of advanced cervical cancers, HR was 0.47 in the HPV-screened group compared with the control group. Rates of advanced cervical cancer and cancer-related death also were substantially lower in the HPV-screened group than in the cytologic-screened and VIA-screened groups.

Comment: In showing that a single round of HPV screening (compared with cytologic or VIA screening) had the most marked effect on preventing cervical cancer deaths, these results have tremendous international health implications: Single rounds of HPV screening are much easier to implement than repetitive cytologic screening, particularly in resource-poor countries where cervical cancer is relatively common. Nonetheless, we should not rush to apply such findings to populations with optimal resources. Clinicians in the U.S. should continue to screen as recommended by the American Society for Colposcopy and Cervical Pathology (JW Womens Health Nov 29 2007).

— Ann J. Davis, MD

Published in Journal Watch Women's Health April 1, 2009

Citation(s):

Sankaranarayanan R et al. HPV screening for cervical cancer in rural India. N Engl J Med 2009 Apr 2; 360:1385.

• Medline abstract (Free)

Schiffman M and Wacholder S. From India to the world — A better way to prevent cervical cancer. N Engl J Med 2009 Apr 2; 360:1453.

• Medline abstract (Free)

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Review and add to remarks on this article

• HPV SCREENING FOR POOR RESOURCE COUNTRIES
  maninder ahuja, 14 Apr 2009 10:55 AM EST
  HPV screening is cost effective in the long run, but the problem is initial one time cost ,who would bear... [more]
• HPV TESTING COST
  Santosh Gupta, 17 Apr 2009 1:35 AM EST
  Auroprobe Laboratories located at New Delhi, offers cost effective Hybrid caputure assay for last five years.

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