Oncogenic human papillomavirus (HPV) infection and uterine cervical cancer: a screening strategy in the perspective of rural India

• Published in: European journal of cancer prevention Vol. 11; no. 5; p. 447
• Main Authors: Duttagupta, C, Sengupta, S, Roy, M, Sengupta, D, Chakraborty, S, Bhattacharya, P, Roy, S, Ghosh, S
• Format: Journal Article
• Language: English
• Published: England 01.10.2002
• Subjects: Acetic Acid - economics; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Carcinoma in Situ - diagnosis; Carcinoma in Situ - economics; Carcinoma in Situ - pathology; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - economics; Carcinoma, Squamous Cell - pathology; Cost-Benefit Analysis - economics; Female; Follow-Up Studies; Humans; India - epidemiology; Indicators and Reagents - economics; Mass Screening - economics; Middle Aged; Papillomaviridae; Papillomavirus Infections - diagnosis; Papillomavirus Infections - economics; Papillomavirus Infections - pathology; Prevalence; Rural Health; Severity of Illness Index; Statistics as Topic; Tumor Virus Infections - diagnosis; Tumor Virus Infections - economics; Tumor Virus Infections - pathology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - pathology; Uterine Neoplasms - diagnosis; Uterine Neoplasms - economics; Uterine Neoplasms - pathology; Women's Health; India
• ISSN: 0959-8278
• DOI: 10.1097/00008469-200210000-00007

The predominance of cervical cancer in India can mostly be attributed to the lack of early screening. The objective of the present study has been, therefore, to determine a cost-effective oncogenic human papillomavirus (HPV)-based cervical cancer screening plan for rural Indian women. The results showed that in normal women, highest prevalence of HPV 16/18 infection was in the age group < or =23 years and lowest in > or =44 years with an insignificant change in between. HPV 16/18 infection was significantly associated with cervical erosion at age < or =23 years, but not with cytology or visual inspection with acetic acid testing at any age. The low-grade cytological lesions, however, increased only with increase in age. Fourteen per cent of the cervical malignancy was also found to be present in the age group 24-33 years with an 87% HPV infection. Here we proposed a cost-effective screening scheme in which HPV testing must be performed in women (a) < or =23 years with cervical erosion and (b) 24-43 years, as an adjunct to Pap smears (both HPV and cytology were prevalent in this group). For women > or =44 years, HPV testing might not be useful, since abnormal cytology was more prominent over the viral infection. We infer that by not performing HPV test in the group < or =23 years, approximately 76% of the high-risk HPV-infected individuals potentially "at risk" for developing cervical cancer might be missed.