UICC World Cancer Congress 2006

To evaluate the outcome of modalities of screening for cervical cancer

Methods:

The impact of screening by visual inspection with acetic acid (VIA), cytology or HPV testing on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in India. 52 clusters, with a total of 142,701 women aged 30-59 years in Osmanabad District, India, were randomized into 4 arms for a single round of screening by trained midwives with either VIA, cytology or HPV testing as well as a control group. Of the eligible women, 72-74% were screened. Test positivity rates were 14.0% for VIA, 7.0% for cytology and 10.3% for HPV. The detection rate of high-grade lesions was similar in all intervention arms (0.7% for VIA, 1.0% for cytology and 0.9% for HPV testing) (p=0.06, Mann-Whitney test). Over 85% of women with high-grade lesions received treatment.Follow up for cervical cancer incidence and mortality is ongoing by linkage with Osmanabad District Population based Cancer Registry, death registration systems and by inputs from active house visits.

Results:

Our results show that a high level of participation and good-quality cytology can be achieved in low-resource settings. VIA is a useful alternative but requires careful monitoring. Detection rates obtained by HPV testing were similar to cytology, despite higher investments.

Preliminary results do show reduced incidence of cervical cancer in the intervention group in the post screening period, and a significantly reduced risk of invasive cervical cancer among the screened negative women as compared to control group.