# Osmanabad cervical screening trial (HPV testing vs cytology vs VIA)

Source: https://onco.cc/trials/osmanabad-hpv-screening/  
OnCo record `osmanabad-hpv-screening` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

One round of HPV testing in rural Indian villages halved deaths from cervical cancer within eight years, while a Pap smear or a visual check did not, which is why HPV tests are now the world's preferred screen.

## Summary

131,746 women aged 30 to 59 in 52 village clusters were randomised to HPV testing (34,126), cytology (32,058), visual inspection with acetic acid (34,074) or standard care (31,488). In the HPV arm there were 39 advanced cancers versus 82 in the control group (hazard ratio 0.47; 95% CI 0.32-0.69) and 34 cervical cancer deaths versus 64 (hazard ratio 0.52; 95% CI 0.33-0.83); neither cytology nor visual inspection significantly reduced advanced cancers or deaths, and adverse events occurred in 0.1% of screened women. The result made a single round of HPV testing the evidence base for WHO's HPV-first screening recommendation and for India's own screening guidance.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-10
- Phase: 3
- Setting: Cluster-randomised trial in 52 villages of Osmanabad district, Maharashtra: one round of HPV DNA testing, cytology, visual inspection with acetic acid, or usual care in women aged 30-59
- Sponsor: IARC with Nargis Dutt Memorial Cancer Hospital, Barshi, and the Tata Memorial Centre
- Enrolled: 131746
- Result: Cervical cancer deaths HR 0.52 with one round of HPV testing; no significant effect of cytology or VIA.
- Outcomes: Cervical cancer deaths: HPV testing 34 deaths vs Control 64 deaths, HR 0.52

## Sources

- Sankaranarayanan et al., NEJM 2009: https://doi.org/10.1056/NEJMoa0808516

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/)
- technologies: [Colposcopy and excisional treatment (LEEP/LLETZ, cone)](https://onco.cc/technologies/colposcopy-excision/), [HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/), [Visual inspection with acetic acid (VIA) for cervical screening](https://onco.cc/technologies/via-cervical-screening/)
- institutions: [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/)
- people: [Rengaswamy Sankaranarayanan](https://onco.cc/people/sankaranarayanan-rengaswamy/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [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/)
- key papers: [HPV screening for cervical cancer in rural India (Osmanabad)](https://onco.cc/key-papers/paper-sankaranarayanan-hpv-screening-nejm-2009/)
- terms: [Cluster-randomised trial](https://onco.cc/terms/cluster-randomised-trial/)
- trials: [Mumbai VIA cervical screening trial (Tata Memorial)](https://onco.cc/trials/mumbai-via-screening/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/), [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/)

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