Cervical Cancer Screening in India

Abstract

Three clinical trials took place in India between 1998 and 2015 in urbanUrbanand ruralRuralareas of MumbaiMumbai, OsmanabadOsmanabadand Dindigul. The trials aimed to determine whether trained health care workers could conduct cervical cancer screening in a communityCommunityusing cheap methods of testing -- primarily visual inspection with acetic acid -- to reduce the incidence and mortality rate of cervical cancer. The clinical trials were conducted on approximately 374,000 womenWomen, of whom about 141,000 were placed in the control armControl arm(no screening). Although the standard of careStandard of carefor testing of the disease in India has been cytology screeningCytology screening(or Pap smear)Pap smearsince the 1970s, screening for cervical cancer was not available universally under a governmentGovernmentprogramme, and for the study purposes the standard of care was therefore misconstrued to be no screening. Known and effective methods of screening for cervical cancer were therefore withheld from 141,000 womenWomenin areas where it was known to be of high incidence and prevalence. This placed them at a known riskRisksof developing invasive cervical cancer, and dying from it, because it was not detected and treated in time. Two hundred and fifty-four women in the no-screening arm died due to cervical cancer as per the latest published reports on the three trials. A no-screening control arm would not have been allowed in the USA, but was accepted by the US funders for clinical trialsClinical trialin India. It is imperative that ethical standardsEthical standardsfor research be applied equally across nations to prevent ``ethics dumping'' Ethics dumpingand protect the rights of human research participantsResearch participantsin research, no matter where they are located on the globe.