Abstract
Purpose
A demonstration project was conducted to assess feasibility of implementing HPV detection-based cervical cancer screening in primary care settings in India and to generate local evidence on feasibility and effectiveness of HPV detection in primary screening.
Methods
The project was implemented by setting up screening clinics at primary health centers. Eligible women were screened by HPV DNA test (Hybrid capture 2). All samples were processed and tested in a single laboratory. Colposcopy services were provided to screen-positive women at the same community clinics. Project utilized services of community health workers for community mobilization, recall of screen-positive and disease-positive women. Women with ≥CIN2 diagnosis were treated at tertiary hospital.
Results
Totally, 44,110 women were screened and HPV positivity was 4.7 %. Compliance to recall of HC2-positive women for colposcopy was 78 %. Detection rate of CIN3+ by HPV test was 3.9/1,000 women. Compliance of women to treatment was 80.1 %. However, compliance of HPV-positive women for follow-up at 1 year was poor (23.2 %). Concurrent use of VIA to screen the women did not have any advantage but increased number of unnecessary colposcopies and biopsies.
Conclusions
Our project demonstrated that it was possible to implement HPV detection-based screening using existing primary healthcare infrastructure. Performing colposcopy at primary setting is feasible, improves compliance and reduces over-treatment. In settings with low to moderately high HPV prevalence, direct referral of HPV-positive women is advisable. Community health workers can be effectively used for recalling the positive women.
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References
IARC Working Group on Cervical Cancer Screening (1986) Screening for squamous cervical cancer—the duration of low risk following negative results in cervical cytology tests: introduction. In: Hakama M, Miller AB, Day NE (eds) Screening for cancer of the uterine cervix (IARC Scientific Publications No. 76). International Agency for Research on Cancer, Lyon, pp 15–24
Sankaranarayanan R (2014) Screening for cancer in low- and middle-income countries. Ann Glob Health 80(5):412–417
Basu P, Chowdhury D (2009) Cervical cancer screening & HPV vaccination: a comprehensive approach to cervical cancer control. Indian J Med Res 130:241–246
Saxena U, Sauvaget C, Sankaranarayanan R (2012) Evidence-based screening, early diagnosis and treatment strategy of cervical cancer for national policy in low-resource countries: example of India. Asian Pac J Cancer Prev 13(4):1699–1703
World Health Organization (2013) WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. WHO Press, Geneva
Sankaranarayanan R, Chatterji R, Shastri SS et al (2004) Accuracy of human papillomavirus testing in primary screening of cervical neoplasia: results from a multicenter study in India. Int J Cancer 112(2):341–347
Sankaranarayanan R, Nene BM, Shastri SS et al (2009) HPV screening for cervical cancer in rural India. N Engl J Med 360(14):1385–1394
Sankaranarayanan R, Wesley RS (2003) A practical manual on visual screening for cervical neoplasia. IARC Press, Lyon
Basu P, Mittal S, Banerjee D, Singh P, Panda C, Dutta S et al (2015) Diagnostic accuracy of VIA and HPV detection as primary and sequential screening tests in a cervical cancer screening demonstration project in India. Int J Cancer 137(4):859–867
Sauvaget C, Fayette JM, Muwonge R, Wesley R, Sankaranarayanan R (2011) Accuracy of visual inspection with acetic acid for cervical cancer screening. Int J Gynecol Obstet 113(1):14–24
Arbyn M, Sankaranarayanan R, Muwonge R et al (2008) Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. Int J Cancer 123(1):153–160
Ghosh I, Mittal S, Banerjee D et al (2014) Study of accuracy of colposcopy in VIA and HPV detection-based cervical cancer screening program. Aust N Z J Obstet Gynaecol 54(6):570–575
World Health Organization (2014) Comprehensive cervical cancer control: a guide to essential practice, 2nd edn. WHO press, Geneva
Jeronimo J, Bansil P, Lim J et al (2014) A multicountry evaluation of careHPV testing, visual inspection with acetic acid, and papanicolaou testing for the detection of cervical cancer. Int J Gynecol Cancer 24(3):576–585
Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, de Sanjosé S (2010) Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis 202(12):1789–1799
Acknowledgments
We acknowledge the support of the following voluntary organizations to the project: Aalor Pathe; Amarlata Foundation; Ashurali Gramonnayan Parishad; Charaibeti; Institute for Indian Mother & Child; Indranarayanpur Nazrul Smriti Sangha; Kalpana Dutta Foundation for Cancer Care; People Rural Development Society; Prem Pariwar; Ramnagar Unnayan Sanstha; Ramakrishna Mission Lokasiksha Parishad; Sarishadaha Nabin Sangha; Southern Health Improvement Society; Sushama Mission; Tagore Society for Rural Development; West Bengal Voluntary Health Association. The demonstration project was partially supported by funds provided by QIAGEN, India, to the Chittaranjan National Cancer Institute, Kolkata, India. The funding agency did not have any role in the conduct of the study, data analysis and preparation of the manuscript. The authors acknowledge the contribution of West Bengal University of Health Sciences, Kolkata, for assisting with external protocol review.
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Mittal, S., Mandal, R., Banerjee, D. et al. HPV detection-based cervical cancer screening program in low-resource setting: lessons learnt from a community-based demonstration project in India. Cancer Causes Control 27, 351–358 (2016). https://doi.org/10.1007/s10552-015-0708-z
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DOI: https://doi.org/10.1007/s10552-015-0708-z