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