Adyar Institute Unveils Impact of HPV molecular testing in cervical cancer community
screening program in South India
Chennai, July 03, 2023: Dr. Vijayalakshmi Ramshankar, Department of Preventive Oncology
(Research), Cancer Institute (WIA), today unveiled research titled “Impact of HPV molecular
testing with partial genotyping as a feasibility study in cervical cancer community
screening program in South India” in a panel discussion held at Adyar Institute. Dr.
Vijayalakshmi and her team that included Ms Soundharya Ravindran; Ms. Komathi Arun, Ms.
Kanchana Albert, Ms. Sakthi Lalitha Sri, Dr. Lalitha Ramasubramanian and Dr. Banumathy
Satyaseelan have conducted a study involving a group of 10,395 women who were
administered the HPV DNA test.
The study showed that there is a need for implementation of a high throughput technology for
cervical cancer that can be scalable. They used the Cobas 4800, a multiplexed assay based on
quantitative polymerase chain reaction technology, identifying HPV 16 and HPV 18 along with
the concurrent detection of 12 pooled other high‐risk HPV infections.
This technology was used to test 10,375 women from the South Indian community for the first
time as a feasibility program. Upon testing, high‐risk HPV was found in 5.73% women. A total
of 127 women (1.2%) were found to be infected with HPV 16, 36 women (0.34%) with HPV 18
and 382 women (3.68%) with the 12 pooled high‐risk HPV and multiple mixed infections were
found in 50 women (0.48%). It was observed that there was a high prevalence of high‐risk HPV
in younger women, 30–40 years of age and a second peak was observed at 46–50 years of
age. The second peak had higher mixed infections in the 46–50 years of age and this
association was statistically significant. The study has found that 24/50 (48%) of the multiple
mixed high‐risk HPV infections were in the age group 46–50 years.
This study showed that high negative predictive value of the Cobas HPV can help in increasing
the screening efficiency identifying only clinically relevant infections with high-risk HPV with
effective cost reduction eliminating unnecessary further intervention in nearly 94% of the
women. This study has established that the effectiveness of a single round of HPV testing is
attributable to a significant decline in the rate of advanced cervical cancers and associated
mortality compared to the unscreened group in India.
The study also highlighted that for successful implementation of HPV‐based screening, it is
important to understand the technical aspects of the assay of choice and a prudent choice of
test should be an assay that is clinically validated, in a randomised clinical trial. In a
screening programme, it is essential to diagnose cervical precursor lesions that are likely to
progress to cancer, leading to an increase in cervical cancer‐related mortality, and the
interventions offered should give an advantage over the conventional treatment after diagnosis
of cancer.
The panel included esteemed members like Dr. Lalitha Ramasubramanian, Prof and Head,
Dept of Radiotherapy, Govt Thoothukudi Medical College, Tuticorin; Dr. Jayashree Natarajan,
Assistant professor in Gynecological Oncology, Cancer Institute (WIA), Adyar, Chennai; and Dr.
Sandeep Sewlikar, Head of Medical & Scientific Affairs for India and neighboring countries
(Bangladesh, Sri Lanka, Nepal, and Bhutan) at Roche Diagnostics,
The key highlights of the study are:
● Adoption of HPV Testing: Globally, current screening guidelines for cervical cancer
uniformly recommend HPV testing as the primary and preferred method.
● Cervical Cancer Burden in India: India has a high burden of cervical cancer,
necessitating the implementation of a national government-sponsored public health
policy.
● Screening Methods: Various cervical screening methods are available, emphasizing
the importance of high-risk HPV testing and vaccination in preventing cervical cancer.
● Centralised Testing Facility: Dealing with the challenge of offering high-risk HPV tests
to a large population requires a fully automated molecular testing platform that can
serve as a centralised facility. The study explored the feasibility of such a platform
in a community-based screening setting in India for the first time.
● Value of HPV 16 and HPV 18 Differentiation: The study highlights the significance of
differentiating between HPV 16 and HPV 18 infections in population screening.
● Promising Screening Tools: Three promising tools for large-scale screening include
primary HPV DNA testing, self-sampling with low vaginal swabs, and the use of digital
platforms for monitoring. The technology used in the current study can facilitate the
execution of the first two objectives, strengthening cervical cancer screening systems
and improving health outcomes.
● Prevalence of High-Risk HPV: The study revealed the prevalence of high-risk HPV
through partial genotyping.
● Multiple Mixed Infections: Further evaluation is needed to understand the significance
of numerous mixed infections in women in the perimenopausal age group, as identified
in the study.
While speaking on the occasion, Dr. Vijayalakshmi said, “Elimination of cervical cancer in a
country like India relies on three crucial pillars: screening, treatment, and vaccination. Anything
short of these pillars will not bring about significant change. The cobas® HPV test offers
individual results for HPV 16 and HPV 18, along with a combined result for other high-risk
genotypes, all obtained from a single patient sample in a single run. By delivering
comprehensive 3-in-1 results, healthcare providers can effectively assess the risk level of
patients and make confident decisions regarding patient management.”
Dr. Sandeep Sewlikar, said, In the face of a high disease burden and complex challenges, the
road to achieving WHO's vision of eliminating cervical cancer by 2030, requires a steadfast
approach. India needs a holistic programme which covers public awareness, vaccination (9-14
yrs) and screens women for cervical cancer using the WHO recommended clinically validated
HPV test. I would like to thank Dr. Vijayalakshmi and her team for working on this study.
Moreover, with WHO awarding the prequalification to Roche’s cobas HPV test for use on the
cobas 6800/8800 Systems, we are confident that we will become an active partner in eliminating
cervical cancer in India”
Dr. Lalitha Ramasubramanian, Professor and Head of the Department of Radiotherapy at Govt
Thoothukudi Medical College, stated, "We embarked on a resolute quest to eliminate cervical
cancer, commencing with robust screening methodologies. The integration of HPV testing into
our comprehensive screening programme signifies a significant leap forward. This progression
not only enhances our ability to identify individuals at high risk in the early stages but also
equips us with reliable data to combat this preventable cancer more effectively. We are ushering
in a new chapter in our fight against cervical cancer, armed with an empirical study that clearly
shows a direct correlation between HPV testing and a significant decline in the rate of advanced
cervical cancers.”
Dr. Jayashree Natarajan, Assistant Professor in Gynecological Oncology at the Cancer Institute
(WIA) in Adyar, Chennai, remarked, "Eradication of cervical cancer necessitates a
comprehensive and multifaceted strategy. It entails not only proactive screening but also a
strong emphasis on preventive measures. By incorporating comprehensive vaccination
programs alongside robust screening processes and treating the already infected, we can strive
for a holistic solution that reaches every corner of our nation. Unifying the resources and
preventive efforts delivered and maintaining registry of preventive efforts under taken will help to
reach the goals swiftly."
About Adyar Cancer Institute:
Adyar Cancer Institute is a public charitable voluntary not-for-profit institution that is dedicated to
the service of cancer patients since 1954. It is a Regional Centre for Cancer Research and
Treatment and is recognized as the State Cancer Institute, the apex body. The care is free or
heavily subsidized or paid for, as needed. The Institute is a comprehensive cancer center with a
545 inpatient beds hospital, a research division, a College of Oncological Sciences, and a
division of preventive oncology. The Preventive Oncology (Research) at Cancer Institute has a
centralised testing facility for HPV DNA as a molecular test and caters to samples sent to this
organisation for the same. This NABL accredited molecular laboratory caters to majority of
molecular and precision oncology related testing for cancer patients both treated at Cancer
Institute as well as outside patients for a nominal cost.
Chennai, July 03, 2023: Dr. Vijayalakshmi Ramshankar, Department of Preventive Oncology
(Research), Cancer Institute (WIA), today unveiled research titled “Impact of HPV molecular
testing with partial genotyping as a feasibility study in cervical cancer community
screening program in South India” in a panel discussion held at Adyar Institute. Dr.
Vijayalakshmi and her team that included Ms Soundharya Ravindran; Ms. Komathi Arun, Ms.
Kanchana Albert, Ms. Sakthi Lalitha Sri, Dr. Lalitha Ramasubramanian and Dr. Banumathy
Satyaseelan have conducted a study involving a group of 10,395 women who were
administered the HPV DNA test.
The study showed that there is a need for implementation of a high throughput technology for
cervical cancer that can be scalable. They used the Cobas 4800, a multiplexed assay based on
quantitative polymerase chain reaction technology, identifying HPV 16 and HPV 18 along with
the concurrent detection of 12 pooled other high‐risk HPV infections.
This technology was used to test 10,375 women from the South Indian community for the first
time as a feasibility program. Upon testing, high‐risk HPV was found in 5.73% women. A total
of 127 women (1.2%) were found to be infected with HPV 16, 36 women (0.34%) with HPV 18
and 382 women (3.68%) with the 12 pooled high‐risk HPV and multiple mixed infections were
found in 50 women (0.48%). It was observed that there was a high prevalence of high‐risk HPV
in younger women, 30–40 years of age and a second peak was observed at 46–50 years of
age. The second peak had higher mixed infections in the 46–50 years of age and this
association was statistically significant. The study has found that 24/50 (48%) of the multiple
mixed high‐risk HPV infections were in the age group 46–50 years.
This study showed that high negative predictive value of the Cobas HPV can help in increasing
the screening efficiency identifying only clinically relevant infections with high-risk HPV with
effective cost reduction eliminating unnecessary further intervention in nearly 94% of the
women. This study has established that the effectiveness of a single round of HPV testing is
attributable to a significant decline in the rate of advanced cervical cancers and associated
mortality compared to the unscreened group in India.
The study also highlighted that for successful implementation of HPV‐based screening, it is
important to understand the technical aspects of the assay of choice and a prudent choice of
test should be an assay that is clinically validated, in a randomised clinical trial. In a
screening programme, it is essential to diagnose cervical precursor lesions that are likely to
progress to cancer, leading to an increase in cervical cancer‐related mortality, and the
interventions offered should give an advantage over the conventional treatment after diagnosis
of cancer.
The panel included esteemed members like Dr. Lalitha Ramasubramanian, Prof and Head,
Dept of Radiotherapy, Govt Thoothukudi Medical College, Tuticorin; Dr. Jayashree Natarajan,
Assistant professor in Gynecological Oncology, Cancer Institute (WIA), Adyar, Chennai; and Dr.
Sandeep Sewlikar, Head of Medical & Scientific Affairs for India and neighboring countries
(Bangladesh, Sri Lanka, Nepal, and Bhutan) at Roche Diagnostics,
The key highlights of the study are:
● Adoption of HPV Testing: Globally, current screening guidelines for cervical cancer
uniformly recommend HPV testing as the primary and preferred method.
● Cervical Cancer Burden in India: India has a high burden of cervical cancer,
necessitating the implementation of a national government-sponsored public health
policy.
● Screening Methods: Various cervical screening methods are available, emphasizing
the importance of high-risk HPV testing and vaccination in preventing cervical cancer.
● Centralised Testing Facility: Dealing with the challenge of offering high-risk HPV tests
to a large population requires a fully automated molecular testing platform that can
serve as a centralised facility. The study explored the feasibility of such a platform
in a community-based screening setting in India for the first time.
● Value of HPV 16 and HPV 18 Differentiation: The study highlights the significance of
differentiating between HPV 16 and HPV 18 infections in population screening.
● Promising Screening Tools: Three promising tools for large-scale screening include
primary HPV DNA testing, self-sampling with low vaginal swabs, and the use of digital
platforms for monitoring. The technology used in the current study can facilitate the
execution of the first two objectives, strengthening cervical cancer screening systems
and improving health outcomes.
● Prevalence of High-Risk HPV: The study revealed the prevalence of high-risk HPV
through partial genotyping.
● Multiple Mixed Infections: Further evaluation is needed to understand the significance
of numerous mixed infections in women in the perimenopausal age group, as identified
in the study.
While speaking on the occasion, Dr. Vijayalakshmi said, “Elimination of cervical cancer in a
country like India relies on three crucial pillars: screening, treatment, and vaccination. Anything
short of these pillars will not bring about significant change. The cobas® HPV test offers
individual results for HPV 16 and HPV 18, along with a combined result for other high-risk
genotypes, all obtained from a single patient sample in a single run. By delivering
comprehensive 3-in-1 results, healthcare providers can effectively assess the risk level of
patients and make confident decisions regarding patient management.”
Dr. Sandeep Sewlikar, said, In the face of a high disease burden and complex challenges, the
road to achieving WHO's vision of eliminating cervical cancer by 2030, requires a steadfast
approach. India needs a holistic programme which covers public awareness, vaccination (9-14
yrs) and screens women for cervical cancer using the WHO recommended clinically validated
HPV test. I would like to thank Dr. Vijayalakshmi and her team for working on this study.
Moreover, with WHO awarding the prequalification to Roche’s cobas HPV test for use on the
cobas 6800/8800 Systems, we are confident that we will become an active partner in eliminating
cervical cancer in India”
Dr. Lalitha Ramasubramanian, Professor and Head of the Department of Radiotherapy at Govt
Thoothukudi Medical College, stated, "We embarked on a resolute quest to eliminate cervical
cancer, commencing with robust screening methodologies. The integration of HPV testing into
our comprehensive screening programme signifies a significant leap forward. This progression
not only enhances our ability to identify individuals at high risk in the early stages but also
equips us with reliable data to combat this preventable cancer more effectively. We are ushering
in a new chapter in our fight against cervical cancer, armed with an empirical study that clearly
shows a direct correlation between HPV testing and a significant decline in the rate of advanced
cervical cancers.”
Dr. Jayashree Natarajan, Assistant Professor in Gynecological Oncology at the Cancer Institute
(WIA) in Adyar, Chennai, remarked, "Eradication of cervical cancer necessitates a
comprehensive and multifaceted strategy. It entails not only proactive screening but also a
strong emphasis on preventive measures. By incorporating comprehensive vaccination
programs alongside robust screening processes and treating the already infected, we can strive
for a holistic solution that reaches every corner of our nation. Unifying the resources and
preventive efforts delivered and maintaining registry of preventive efforts under taken will help to
reach the goals swiftly."
About Adyar Cancer Institute:
Adyar Cancer Institute is a public charitable voluntary not-for-profit institution that is dedicated to
the service of cancer patients since 1954. It is a Regional Centre for Cancer Research and
Treatment and is recognized as the State Cancer Institute, the apex body. The care is free or
heavily subsidized or paid for, as needed. The Institute is a comprehensive cancer center with a
545 inpatient beds hospital, a research division, a College of Oncological Sciences, and a
division of preventive oncology. The Preventive Oncology (Research) at Cancer Institute has a
centralised testing facility for HPV DNA as a molecular test and caters to samples sent to this
organisation for the same. This NABL accredited molecular laboratory caters to majority of
molecular and precision oncology related testing for cancer patients both treated at Cancer
Institute as well as outside patients for a nominal cost.
