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Home News and Update Year 2009 New Test could Cut Cervical Cancer Deaths by 50 per cent

New Test could Cut Cervical Cancer Deaths by 50 per cent
4 April 2009

Hailed as “from India to the world – a better way to prevent cancer”, doctors including experts from Mumbai‘s Tata Memorial Hospital prove that a new testing method called HPV, cuts cervial cancer deaths by half. Jagdeep Worah reports

A team of doctors including experts from Mumbai‘s Tata Memorial Hospital have demonstrated that a new method of screening and testing for cervical cancer, called the HPV or human papilloma virus test, is far more effective than earlier methods, and has the potential to cut deaths from the tumour by half.

A 10–year study involving 130,000 women in Osmanabad district showed that only 34 of the women who received HPV testing died of cervical cancer, against 54 who received the standard Pap smear test. This is the test that is currently used across the world.

Further, 56 women examined using the acetic acid method died, while 64 women who got no screening at all died of the disease. The mild acid test is widely used in India as it is cheap, but it requires visual screening by the doctor, and is thus limited in its accuracy.

In addition, the women who received the HPV test were found to have far fewer cases of advanced cervical cancer.

A Pap smear is a scraping of the cervix which is then examined for irregular cells that could be developing into a tumour. The acetic acid test is used to directly look at the cervix for potentially cancerous cells, while the HPV test looks for the virus in cells taken from the cervix.

The study was published in the New England Journal of Medicine on Thursday. In an editorial, the journal hailed the research as “from India to the world – a better way to prevent cancer”.

The method was developed by Qiagen NV of the Netherlands, which expects the product to be worth $1.1 billion annually. The company said it plans to donate a million units of the $30–test over the next five years to encourage its use in developing countries, and it is working on a version of the test for regions that do not have access to electricity or clean water.

Cervical cancer is the most common sexually transmitted disease in the world. It strikes about 493,000 women worldwide each year, and kills 273,000. Eighty per cent of the cases are in underdeveloped countries, including India, where access to Pap smears may be limited or follow–up treatment may be inadequate.

The disease, which has about 100 different strains, causes warts as well as mouth, penile, and anal cancer.

“India contributes 20 per cent of the global burden of cervical cancer. Moreover, 70 per cent of our patients come in at the last stage,” says Surendra Shastri of the Tata Memorial Hospital.

The research team was led by Rengaswamy Sankaranarayanan of the International Agency for Research on Cancer, which is part of the World Health Organisation. “The treatment is so safe, it may protect them from future cancer,” he said in a statement. Women who were found to have invasive cancer were referred for standard biopsy and surgery.

“The significant reduction in advanced cancers and cervical cancer deaths following a single HPV test is due to the possibility that HPV screening detects more precancerous lesions with a high potential of becoming cancer than those detected by visual screening or Pap smear,” Sankaranarayanan said. The study was funded with $2.3 million in grants by the Bill and Melinda Gates Foundation under a $56.4 million package of grants to the Alliance for Cervical Cancer Prevention, said Jan Agosti, a Gates senior program officer. Papth, a Seattle– based nonprofit that supports technology for the developing world, coordinated training of study staff, she said.

Far–Reaching Applications

“The implications of the findings of this trial are immediate and global: international experts in cervical–cancer prevention should now adapt HPV testing for widespread implementation,” wrote Mark Schiffman and Sholom Wacholder of the National Cancer Institute in Bethesda, Maryland, in their editorial.

The test could eventually replace the Pap smear as the primary method for cancer screening, and women uninfected by the virus could wait much longer between tests, they said.

Schiffman and Wacholder added that the new findings mean that “a single HPV test that is performed 15 to 20 years after the median age of first sexual intercourse will detect many easily treatable, persistent infections and precancers while limiting overtreatment.”

The Indian findings come at a time when vaccines against two strains of the virus hold the potential for dramatically lowering the cancer rate in developed countries. Both Merck and GlaxoSmithKline make vaccines against some of the strains of HPV most strongly linked with cervical cancer.

“Even when HPV vaccines are affordable and widely used, they will not substantially decrease rates of cervical cancer for decades because of the long latency between infection and cancer,” said Schiffman and Wacholder. But “the Indian findings show HPV testing “can lower the death rate from cervical cancer within 5 to 10 years,“ they said.

Test Better than ‘Education’

The project compared women who received screening for the human papilloma virus against those receiving education and referral. The results led researchers to estimate that if 80 per cent of women aged 30 to 59 worldwide had HPV test results followed by swift treatment for cancer, the number of cervical cancer malignancies and deaths would drop by almost half within 10 years.

In the study, 132,000 Indian women were divided into four groups. Three of the groups were offered treatment immediately on receiving results of screening; one by traditional PAP smears, a second group by a swab with acetic vinegar, and the third by HPV test. The fourth group was simply educated about cervical cancer, spread by a sexually transmitted HPV virus, and urged to seek screening.

Only the HPV–screened group showed a significant reduction in deaths compared with the education–and–referral group. Researchers said this is because the HPV test gives faster, more sensitive results than a Pap smear, which is slower, more subjective and dependent on skilled interpretation. The vinegar swab is a cheap way to mark damaged tissues but unspecific.

Sankaranarayanan said he would eventually like to see an HPV test priced “at $1 or less. Many countries won‘t be able to afford it otherwise”. However, he admitted that the downside of this method is that a certain number of women will be mistakenly diagnosed as having a precancerous growth and be unnecessarily treated with a ‘freezing technique’.

The new test, now undergoing regulatory review in China, will be commercially available in China in the second half of 2009, a Qiagen official said.

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