HPV Screening for Cervical Cancer in Rural India
HPV Screening for Cervical Cancer in Rural India
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DOI：
10.1056/nejmoa0808516
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发表时间：
2009-04-02
影响因子：
158.5
通讯作者：
Dinshaw, Ketayun A.
中科院分区：
文献类型：
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作者：
Sankaranarayanan, Rengaswamy;Nene, Bhagwan M.;Dinshaw, Ketayun A.
背景在1999年10月，我们开始在印度的奥斯马纳巴德地区测量通过检测人乳头瘤病毒（HPV）、细胞学检测或用醋酸对宫颈进行目视检查（VIA）的单轮筛查对宫颈癌发病率和相关死亡率的影响。746名年龄在30岁至59岁之间的健康女性被随机分配到四组，每组13组。这些组被随机分配接受HPV检测（34，126名女性），细胞学检测（32，058名）或VIA（34，074名）或接受标准护理（31，488名，对照组）。筛查结果呈阳性的妇女接受阴道镜检查和直接活检，宫颈癌前病变或宫颈癌的妇女接受适当的治疗。（其中39人为II期或以上），与118名受试者相比，（其中82人患有晚期疾病）在对照组（HPV检测组中晚期癌症检测的风险比为0.47; 95%置信区间[CI]为0.32至0.69）。HPV检测组有34人死于癌症，而对照组有64人（风险比，0.52; 95%CI，0.33至0.83）。与对照组相比，在细胞学检测组或VIA组中未观察到晚期癌症或死亡人数的显著减少。在0.1%的筛选women.ConclusionsIn一个低资源的环境中，一轮HPV检测与晚期宫颈癌和宫颈癌死亡人数的显着减少。
BackgroundIn 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.MethodsIn 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.ResultsIn 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.ConclusionsIn 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.