Menstrual pad, a cervical cancer screening tool, a population-based study in rural India Atul Budukh a , Vrushali Palayekar b , Amita Maheshwari a , Kedar Deodhar a , Pallavi Purwar a , Sonali Bagal a , Ashok Vadigoppula b , Manoj Lokhande c , Nandkumar Panse c , Rajesh Dikshit a and Rajendra Badwe a In the rural areas of India, women generally use a piece of old cloth as a menstrual device. The aim of this study was to detect human papilloma virus (HPV) from menstrual blood on the menstrual pad and assess whether this could be a useful screening tool for cervical cancer. In Jamkhed area of rural Maharashtra, (population A), we collected menstrual pads from women who provided consent in the 30–50 year age group. The women who had provided menstrual pads underwent HC2 testing. We standardized the method for extracting DNA by PCR from the menstrual pad. The women who tested HPV positive, on the basis of HC2/PCR testing, underwent colposcopy. In the rural population of Pune area of Maharashtra state (population B), menstrual pads were collected. HPV was tested using the PCR method. HPV-positive women and a few HPV-negative women, selected randomly, underwent colposcopy and HC2 testing. In population A, 164 women provided their used menstrual pads and also underwent an HC2 screening test. Of these, six (3.2%) cases were reported as HPV positive. In population B, 365 women provided their used menstrual pads for HPV testing, of which 18 (4.9%) cases were diagnosed as HPV positive. The women who tested HPV positive, on the basis of PCR testing, and 10% randomly selected HPV-negative cases (37) and 18 women who voluntary requested testing underwent colposcopy and HC2 testing. The sensitivity of menstrual pad HPV testing compared with gold standard HC2 testing was 83% [95% confidence interval (CI): 0.47–0.97], 67% (95% CI: 0.30–0.91) and specificity was 99% (95% CI: 0.96–0.99), 88% (95% CI: 0.77–0.94) in population A and population B, respectively. The sensitivity of diagnosing CIN lesion was 83% (95% CI: 0.44–0.97) and specificity was 95% (95% CI: 0.91–0.97). On the basis of the sensitivity and specificity results, and the completely noninvasive, simple and convenient method of detecting HPV, menstrual pad might be considered a cervical cancer screening tool in rural Indian women. European Journal of Cancer Prevention 00:000–000 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. European Journal of Cancer Prevention 2017, 00:000–000 Keywords: HPV testing feasibility, HPV testing for rural Indian women, simple HPV testing a Tata Memorial Centre, b National Institute for Research and Reproductive Health (NIRRH), Mumbai and c Nargis Dutt Memorial Cancer Hospital, Barshi, India Correspondence to Atul Budukh, PhD, Tata Memorial Centre, Mumbai, Sector 22, Ustav Chowk, CISF Road, Kharghar, Maharashtra 410210, India Tel: + 91 222 740 5000 x5848; e-mails:atul.budukh@gmail.com, budukham@tmc.gov.in Received 8 December 2016 Accepted 26 May 2017 Introduction India accounts for a quarter of the world’s cervical cancer burden; 122 844 new cases and 67 477 deaths occurred in 2012 (Ferlay et al., 2013). Most cervical cancer patients visit a hospital when they are at the regional or the distant meta- static stage (National Cancer Registry Programme, 2016). Almost all cervical cancer cases are caused by human papilloma virus (HPV) infection (Jemal et al., 2015) and are amenable to primary and secondary prevention. A large population-based randomized-controlled trial in rural India had shown that a single lifetime testing for HPV infection by hybrid capture technology and subsequent treatment could reduce mortality from cervical cancer (Sankaranarayanan et al., 2009). At present, there are no organized screening programmes in the country. The major roadblock to large- scale implementation of the cervical cancer screening pro- gramme is the low participation by the women at risk. Rural women are shy, fear the test and consider screening for cervical cancer unnecessary, although they are at high risk (Budukh, 2007). The women, who are mostly daily wage earners, also do not want to lose their daily earnings by taking out time to visit the screening clinic. A simple HPV detection method could help overcome some of these issues. Self-sampling is a very good method of HPV detec- tion that has been shown to increase the participation in screening programmes (Gök et al., 2010; Schmeink et al., 2011). A recent study has suggested the possibility of detecting HPV on a menstrual pad (Wong et al., 2010). In view of the problems faced by rural women in undergoing a cervical cancer screening examination, this study was carried out to assess whether we can detect HPV on the menstrual pad and its feasibility as a cervical cancer screening tool. Rural Indian women generally use a piece of old cloth as a menstrual device (Singh, 2006). In India, only 12% of women and girls use commercial sanitary products (Water Supply and Sanitation Collaborative Council, Government of India, 2013). Research paper 1 0959-8278 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/CEJ.0000000000000387 Copyright r 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.