Study of used sanitary napkins to identify cervical cancer cases

The study that began as a pilot project in 2013 was published in the European Journal of Cancer Prevention last month.

Mumbai-based researchers had attempted a new screening method to identify cases of cervical cancer by collecting used sanitary napkins of rural women in a pilot project. The study that began in 2013 was published in the European Journal of Cancer Prevention last month. Sanitary pads and their use, that until now, women in the rural regions are shy of discussing, was first locally spoken about by the health workers before women agreed to deposit them for research purposes.

India’s rural pockets where sanitation and hygiene are marked low in the human development index, have high incidence of cervical cancer. The country has, however, seen a drop in the number of such incidences from 30 per lakh to 10 per lakh population in the last decade. The fall is higher is urban areas than in the rural regions.

Tata Memorial Hospital (TMH) and the National Institute for Research in Reproductive Health (NIRRH), a department under the Indian Council of Medical Research, teams visited villages in Jamkhed in Ahmednagar and Mulshi in Pune where field volunteers collected used pads from 529 menstruating women between 2013 and 2016.
Blood in used sanitary napkins underwent molecular tests, called papsmear, to isolate human papillomavirus (HPV). Presence of HPV shows a woman is at a greater risk of contracting cervical cancer and subsequently, colposcopy was conducted for confirmation. In total, 4.5 per cent (24) samples tested HPV positive of which, six women were diagnosed as pre-cancerous and put on treatment.

“Ninety per cent rural women use old cloth rags. We counselled them to clear the social taboo,” said researcher Atul Budukh. Women would call local health workers and give them used sanitary pads in polybags. The pads were stored in -20 degrees Celsius and transported in dry ice to laboratory for tests.

In rural areas, where women are either daily labourers and cannot afford to miss a day’s wage to undergo screening or shy away from such screening camps, testing of sanitary napkins is a great method to identify cervical patients, the study funded by the Department of Biotechnology found.

“In rural areas, organising a large-scale camp requires nurses, doctors, diagnostic equipment, which is more cumbersome,” Budukh, an epidemiologist with the TMH, who has been working on cervical cancer prevention for the past 15 years, said. The idea came because of reluctance of uneducated rural women to undergo screening.
“This is only a preliminary screening method to identify suspected cases. Presence of HPV in blood puts a woman at higher risk of cervical cancer,” said Dr Smita Mahale, director, NIRRH, adding that the risk of false positive cases is also present in such screening method and requires confirmatory tests.

India accounts for one-third of global cervical deaths with estimates showing 1.32 lakh new cases diagnosed annually, most of them in advanced stages.