In this study we would like to find out whether menstrual pads/napkin can be used as a cervical cancer screening tool.  The objective of the study is to test the DNA extraction from the menstrual pads is good enough in quality and quantity for HPV testing by PCR technique. The consented women will be requested to provide the sanitary pads/clothes that will be transported to a central lab where a PCR based testing will be done for the presence of high risk HPV. These women will be screened by Hybrid Capture-2 method and the concordance of the two tests will be determined. Pilot study will be conducted in 200 women of age group 30 to 50. The HPV positive either by HC2/PCR will be further investigated or treated at NDMCH, Barshi.

After the pilot study, we will conduct a population based screening study in 1000 women in a rural community near Barshi -Jamkhed in Maharashtra state. Trained female social workers will counsel, educate and will conduct the interview of all consenting women aged 30 to 50 years. The social workers will collect the used sanitary pads or similar devices (clothes) from the women. Theses pads will be processed, packed and transported to a central facility at National Institute for Research in Reproductive Health (NIRRH), ICMR, Mumbai. After extracting the genetic material it will be tested by PCR methodology for the presence of HPV.  Based on the previus study we assume 10% of this sample will be test positive for HPV. Based on the test reports a set of cases (HPV positive based on PCR) and controls (HPV negative based on PCR) will be recalled for further investigation including VIA and or Colposcopy during which a cervical sample will be collected for HPV testing using HC2 technology. Those with precancerous lesions or cancer will be treated at Nargis Dutt Memorial Cancer Hospital, Barshi. If successful this approach can help to overcome the practical challenges in implementing a HPV based cervical cancer screening programme in our community. This will also demonstrate the feasibility of integrating this method into the public health programme such as National Rural Health Mission

The IARC monograph on HPV states that there are number of studies reporting that HPV might occasionally be transmitted through modes other than sexual activity. To evaluate this aspect, we will perform a parallel study and enroll 50 mother and unmarried daughter pair to determine the possibility of cross infection by HPV due to reuse of homemade sanitary napkins. This study will also provide information on the prevalence of HPV in the menstrual pads of adolescent girls and the role of any horizontal transmission of HPV due to poor hygiene practices such as reused sanitary pads.