FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 360:1385-1394 April 2, 2009 Number 14 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Schiffman, M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background In October 1999, we began to measure the effect of a single round of screening by testing for human papillomavirus (HPV), cytologic testing, or visual inspection of the cervix with acetic acid (VIA) on the incidence of cervical cancer and the associated rates of death in the Osmanabad district in India.

Methods In this cluster-randomized trial, 52 clusters of villages, with a total of 131,746 healthy women between the ages of 30 and 59 years, were randomly assigned to four groups of 13 clusters each. The groups were randomly assigned to undergo screening by HPV testing (34,126 women), cytologic testing (32,058), or VIA (34,074) or to receive standard care (31,488, control group). Women who had positive results on screening underwent colposcopy and directed biopsies, and those with cervical precancerous lesions or cancer received appropriate treatment.

Results In the HPV-testing group, cervical cancer was diagnosed in 127 subjects (of whom 39 had stage II or higher), as compared with 118 subjects (of whom 82 had advanced disease) in the control group (hazard ratio for the detection of advanced cancer in the HPV-testing group, 0.47; 95% confidence interval [CI], 0.32 to 0.69). There were 34 deaths from cancer in the HPV-testing group, as compared with 64 in the control group (hazard ratio, 0.52; 95% CI, 0.33 to 0.83). No significant reductions in the numbers of advanced cancers or deaths were observed in the cytologic-testing group or in the VIA group, as compared with the control group. Mild adverse events were reported in 0.1% of screened women.

Conclusions In a low-resource setting, a single round of HPV testing was associated with a significant reduction in the numbers of advanced cervical cancers and deaths from cervical cancer.

Source Information

From the International Agency for Research on Cancer, Lyon, France (R.S., R.M.); and the Nargis Dutt Memorial Cancer Hospital, Tata Memorial Centre Rural Cancer Project, Barshi (B.M.N., K.J., A.M.B., S.H., S.G.M., R.T., A.K., V.R.K., R.R., N.P.), and the Tata Memorial Centre, Mumbai (S.S.S., R.C., R.K., S.K., S.D., K.A.D.) — both in India.

Address reprint requests to Dr. Sankaranarayanan at the International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France, or at sankar{at}iarc.fr.

Full Text of this Article

Related Letters:

HPV Screening for Cervical Cancer in Rural India
Suba E. J., Cibas E. S., Raab S. S., Ankit J., Prakriti J., Lakshmaiah K.C., Cremer M. L., Conlisk E., Felix J. C., Mwanahamuntu M. H., Sahasrabuddhe V. V., Parham G. P., Weinberg C. R., Sankaranarayanan R., Jayant K., Shastri S. S.
Extract | Full Text | PDF  
N Engl J Med 2009; 361:304-306, Jul 16, 2009. Correspondence

This article has been cited by other articles:

• Munoz, N., Kjaer, S. K., Sigurdsson, K., Iversen, O.-E., Hernandez-Avila, M., Wheeler, C. M., Perez, G., Brown, D. R., Koutsky, L. A., Tay, E. H., Garcia, P. J., Ault, K. A., Garland, S. M., Leodolter, S., Olsson, S.-E., Tang, G. W. K., Ferris, D. G., Paavonen, J., Steben, M., Bosch, F. X., Dillner, J., Huh, W. K., Joura, E. A., Kurman, R. J., Majewski, S., Myers, E. R., Villa, L. L., Taddeo, F. J., Roberts, C., Tadesse, A., Bryan, J. T., Lupinacci, L. C., Giacoletti, K. E. D., Sings, H. L., James, M. K., Hesley, T. M., Barr, E., Haupt, R. M. (2010). Impact of Human Papillomavirus (HPV)-6/11/16/18 Vaccine on All HPV-Associated Genital Diseases in Young Women. JNCI J Natl Cancer Inst 0: djp534v1-15 [Abstract] [Full Text]  
• Franco, E. L., Tota, J. (2010). Invited Commentary: Human Papillomavirus Infection and Risk of Cervical Precancer--Using the Right Methods to Answer the Right Questions. Am J Epidemiol 171: 164-168 [Abstract] [Full Text]  
• McGregor, D., Olaitan, A. (2010). Fighting cervical cancer in under-resourced countries. The Obstetrician and Gynaecologist 12: 49-52 [Abstract] [Full Text]  
• Franco, E. L. (2009). A New Generation of Studies of Human Papillomavirus DNA Testing in Cervical Cancer Screening. JNCI J Natl Cancer Inst 101: 1600-1601 [Full Text]  
• Schiffman, M., Solomon, D. (2009). Screening and Prevention Methods for Cervical Cancer. JAMA 302: 1809-1810 [Full Text]  
• Tong, H., Shen, R., Wang, Z., Kan, Y., Wang, Y., Li, F., Wang, F., Yang, J., Guo, X., for the Mass Cervical Cancer Screening Regimen Gro, (2009). DNA Ploidy Cytometry Testing for Cervical Cancer Screening in China (DNACIC Trial): a Prospective Randomized, Controlled Trial. Clin. Cancer Res. 15: 6438-6445 [Abstract] [Full Text]  
• Shi, J.-F., Belinson, J. L., Zhao, F.-H., Pretorius, R. G., Li, J., Ma, J.-F., Chen, F., Xiang, W., Pan, Q.-J., Zhang, X., Zhang, W.-H., Qiao, Y.-L., Smith, J. S. (2009). Human Papillomavirus Testing for Cervical Cancer Screening: Results From a 6-Year Prospective Study in Rural China. Am J Epidemiol 170: 708-716 [Abstract] [Full Text]  
• Suba, E. J., Cibas, E. S., Raab, S. S., Ankit, J., Prakriti, J., Lakshmaiah, K.C., Cremer, M. L., Conlisk, E., Felix, J. C., Mwanahamuntu, M. H., Sahasrabuddhe, V. V., Parham, G. P., Weinberg, C. R., Sankaranarayanan, R., Jayant, K., Shastri, S. S. (2009). HPV Screening for Cervical Cancer in Rural India. NEJM 361: 304-306 [Full Text]  
• (2009). All you need to read in the other general journals. BMJ 338: b1423-b1423 [Full Text]  
• Schiffman, M., Wacholder, S. (2009). From India to the World -- A Better Way to Prevent Cervical Cancer. NEJM 360: 1453-1455 [Full Text]  
• (2009). HPV Screening for Cervical Cancer. JWatch Women's Health 2009: 1-1 [Full Text]