With innovative screening approaches and technologies, there’s hope that cervical cancer could be the next polio — a deadly disease that is all but eliminated worldwide.
Unlike many cancers, cervical cancer is a preventable and treatable disease that, with the right funding and awareness, could be all but eliminated worldwide. Cancer of the cervix is the second most common cancer among women, according to the World Health Organization, with about 500,000 new patients diagnoses and over 250,000 deaths every year, 82 percent of which occur in developing countries.
Extensive research has been done to find ways to prevent cervical cancer. Thanks to vaccines, women and girls who are immunized between age 11 and 26 need never fear the most virulent (cancer-causing) strains of the disease. But vaccines are quite costly, and thus not accessible to millions of women around the world. And many women don’t know how easy it is to prevent and treat the disease with proper screening.
Dr. Erin Kobetz, Senior Associate Dean of Health Disparities at the University of Miami Miller School of Medicine, believes that cervical cancer is an objective marker for health disparity. “If all women had access to screening and timely follow up for detected abnormalities, there would be no cervical cancer,” she says.
In other words, women who die from this disease are often those who struggle most to access public health infrastructure. I recently witnessed the challenge of providing adequate cervical cancer screening, preventive care and treatment to the women during a visit to the CerviCusco clinic, in the rural mountains of Peru. CerviCusco, founded in 2007 by Dr. Daron Ferris, an expert gynecological oncologist at Georgia Regents University, is attempting to scale a developed-market approach to cervical cancer prevention and treatment in the Peruvian mountains.
The clinic is staffed by a local team of healthcare workers who see patients and run extensive outreach campaigns to rural towns and villages outside the city of Cusco. Women attend a free cervical cancer screening clinic in a village near their home and are instructed to return in one month to retrieve their Pap smear results, at which point abnormalities are referred back to the clinic in Cusco for treatment. Dr. Ferris flies in for a week each month to consult on abnormalities and perform necessary surgeries. Since its founding, CerviCusco has examined over 35,000 women for the disease and its markers.
Yet Dr. Kobetz believes requiring multiple trips to the clinic is not always the most effective way to contain the disease. Over the past 11 years, Dr. Kobetz has been testing a more streamlined approach through her work with Patnè en Aksyon (Partners in Action), a campus-community partnership designed to reduce the excess disability and death from cervical cancer among Haitian women. Similar to the community in the mountains of Peru, women in the Haitian community of South Florida have an unusually high incidence of cervical cancer — developing the disease at four times the rate of the average woman in the United States.
Instead of requiring women to see a clinician to get a Pap smear, Dr. Kobetz’s approach allows a woman to take a cervical sample herself. Community health workers identify women who are unscreened or underscreened, and offer those women the chance to self-sample for human papilloma virus (HPV), the principal cause of cervical cancer, and screen the sample for the virus. The health workers then navigate any women who test positive to timely and appropriate care at a local clinic.
Based on the success of this approach, Dr. Kobetz’s team has also developed a point-of-care HPV test that can eliminate notification delays caused by laboratory testing. Dr. Kobetz says the test is still in clinical trials, but hopes that it will soon be as easy to buy as a pregnancy test.
Dr. Kobetz isn’t alone in seeking to establish alternatives to the delays inherent in traditional testing and treatment protocols. Jhpiego, a global health affiliate of Johns Hopkins University, has pioneered a “single-visit approach” to cervical cancer prevention. In the traditional protocol, once a woman has received an abnormal Pap smear result, a clinician will perform additional testing and wait up to a month for the results. The new single-visit approach enables the clinician to test and immediately treat any abnormal lesions with cryotherapy. The approach has now been incorporated into standard cancer prevention protocol in more than six countries.
Innovating on this approach, Jhpiego and the Johns Hopkins Center for Bioengineering Innovation and Design are developing an even more efficient cryotherapy device called CryoPop, a low-cost, sustainable, portable cryotherapy device that uses dry ice to treat pre-cancerous cervical lesions.
With alternative testing and innovative treatment options available, traditional protocol is no longer the only way to effectively fight cervical cancer. With the right funding and implementing partners, the global health community has an opportunity to work together to put an end to cervical cancer once and for all.
(Top image: Courtesy of MagicalPhotos.com/Mitchell Zachs, photographed for the Knight Foundation)
Alicia Bonner Ness is the Editor of The New Global Citizen and the Senior Manager for Public Affairs at PYXERA Global.