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

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Abstract
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 ≤23 years and lowest in ≥44 years with an insignificant change in between. HPV 16/18 infection was significantly associated with cervical erosion at age ≤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) ≤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 ≥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 ≤23 years, approximately 76% of the high-risk HPV-infected individuals potentially ‘at risk’ for developing cervical cancer might be missed.