# HPV screening for cervical cancer in rural India (Osmanabad)

Source: https://onco.cc/key-papers/paper-sankaranarayanan-hpv-screening-nejm-2009/  
OnCo record `paper-sankaranarayanan-hpv-screening-nejm-2009` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In 131,746 rural Indian women, a single round of HPV testing roughly halved deaths from cervical cancer within eight years, while Pap smears and visual inspection did not.

## Summary

Cluster-randomised trial in 52 villages of Osmanabad district, Maharashtra, comparing one round of HPV DNA testing, cytology, visual inspection with acetic acid and usual care in women aged 30 to 59. In the HPV arm there were 39 advanced cancers versus 82 in controls (hazard ratio 0.47; 95% CI 0.32-0.69) and 34 deaths versus 64 (hazard ratio 0.52; 95% CI 0.33-0.83); the cytology and visual inspection arms showed no significant reduction. Adverse events occurred in 0.1% of screened women.

## Fields

- Kind: Key paper
- Last checked: 2026-09-10
- Journal: New England Journal of Medicine
- Year: 2009
- DOI: 10.1056/NEJMoa0808516
- Authors: Sankaranarayanan R, Nene BM, Shastri SS, et al.
- Findings: Cervical cancer deaths: 34 with HPV testing versus 64 with usual care; hazard ratio 0.52.; Advanced cervical cancers: 39 versus 82; hazard ratio 0.47.; Neither cytology nor visual inspection with acetic acid significantly reduced advanced cancers or deaths in this trial.; Total cervical cancers detected were similar (127 versus 118), so the gain came from earlier stage and treatment.
- What it means: HPV DNA testing is the screening test that saves lives in low-resource settings, even when done once. The result underpins WHO's HPV-first screening guidance and India's operational guidelines, and gives the rationale for self-sampled HPV tests as the route to cervical cancer elimination.
- Caveats: One round of screening with eight years of follow-up; long-term programme effects were not measured.; The visual inspection arm's null result differs from the later Mumbai trial, which used repeated rounds and health workers with intensive training.; Treatment access after a positive test was provided by the trial, which programmes must replicate.

## Sources

- NEJM 2009: https://doi.org/10.1056/NEJMoa0808516

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/)
- technologies: [HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/)
- institutions: [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/)
- trials: [Osmanabad cervical screening trial (HPV testing vs cytology vs VIA)](https://onco.cc/trials/osmanabad-hpv-screening/)
- people: [Rengaswamy Sankaranarayanan](https://onco.cc/people/sankaranarayanan-rengaswamy/), [Surendra Shastri](https://onco.cc/people/shastri-surendra/)
- bottlenecks: [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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