04 April 2009

Detecting Cervical Cancer


In the paper HPV Screening for Cervical Cancer in Rural India, The New England Journal of Medicine 360 (14): 1885-1394, April 2, 2009 Rengaswamy Sankaranarayanan et al. discuss about a cheaper screening alternative for cervical cancer in resource-poor settings. This has positive implications for health care of women in developing countries.

This uses cluster-randomization. From 52 cluster villages 131,746 women in the 30-59 age-group participated. Four group were assigned 13 cluster villages each randomly. Further, the groups were randomly assigned to undergo different screening mechanisms.

One group (34,126 women) was tested through Deoxyribonucleic acid (DNA) for human papillomavirus (HPV) ; note that Harald zur Hause was one of the recipients of the 2008 Noble prize in Medicine for his discovery of HPV - he received half of the cash award and the other half was shared by Françoise Barré-Sinoussi and Luc Montagnier for their discovery of the human immunodeficiency virus. A second group (32,058 women) was subjected to cytologic testing through a pap smear test where collected tissues are analysed at the cellular structure for early detection of cancer, as is being done for women in developed countries. The third group (34,074 women) was subjected to a visual inspection of the cervix with acetic acid (VIA), another low-cost option. Finally, the fourth (control) group (31,488 women) received standard care.

The design, particularly exclusion of care to the control group, was approved by the ethics committee of the institutes involved - International Agency for Research on Cancer (IARC), Nargis Dutt Memorial Cancer Hospital and Tata Memorial Centre. This process of ethical review should be an integral part of randomization experiments by social scientists/economists.

This is a follow-up study based on the period January 2000-December 2007. The results indicate that for the HPV testing group when compared with the control group one observes significant reduction in incidences of advanced cervical cancer as also deaths. This shows promise for women in low-resource settings or developing countries like India.

Another fact about the publication is that there are 18 authors and some of them are graduates (with a Bacelor;s degree) from different backgrounds (Arts, Commerce and Science). This is an ethical lesson that users of large scale survey data in economics/social sciences need to follow.

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