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Dates: 2002-2005
Funding: International Agency for Research on Cancer, Lyon, France
Collaborators: International Agency for Research on Cancer
Information: Rosa Legood, London School of Hygiene and Tropical Medicine

In many developing countries, cytology based cervical screening at regular intervals to prevent cervical cancer has proved too costly and difficult to implement effectively. Visual examination of the cervix with acetic acid (VIA), cytology and testing for Human Papilloma Virus (HPV) offer alternatives to conventional cytology. The objective of this study was to assess whether a significant reduction in cervical cancer incidence and mortality could be achieved by cervical cancer screening, and to assess the cost-effectiveness of alternative interventions.

A total of 130,000 eligible women in 52 clusters of villages in rural India were randomised between three intervention groups and a control group. In the intervention groups, mobile clinics were used to screen women in the villages. In the VIA group, screen positive women were diagnosed at the same visit. In the cytology and HPV testing groups, screen positive women were recalled for diagnosis at a tertiary centre. All treatments are conducted at the tertiary centre. Researchers at HERC worked alongside IARC, collecting cost data and analysing the cost effectiveness of the alternative methods.

We found screening with VIA to be the least expensive option, but it also detected fewer cases of CIN2/3+ than other methods; its long-term cost-effectiveness will depend on the long-term benefits of early detection. Cytology was more effective at detecting cases than VIA but was also more expensive. Our findings indicate that HPV may not be a cost-effective screening strategy in India at current consumable prices.


Legood, R, Wolstenholme, J, and Gray, A (2009). From cost-effectiveness information to decision-making on liquid-based cytology: Mind the gap.

Health Policy, 89(2):193-200.

Legood, R, Gray, AM, Mahe, C, Wolstenholme, J, Jayant, K, Nene, BM, Shastri, SS, Malvi, SG, Muwonge, R, Budukh, AM, and Sankaranarayanan, R (2005). Screening for cervical cancer in India: How much will it cost? A trial based analysis of the cost per case detected. Int J Cancer 117(6):981-7.