Greetings to everyone, both new and old followers of our work.

POI has had a great last 12-18 months with 3 large studies now winding down in China and in Mexico. We are very excited about our future, but at the same time nervous, because as one study finishes the process of generating new funding based our results begins. However this time something unanticipated has happened. First let me provide a bit of background.

Cervical cancer screening beginning more than 60 years ago was cytology based. Then with the revelation that HPV was the necessary cause of the disease the focus turned to HPV for screening. Our work and the work of many others has clearly demonstrated the strength of testing for the presence of high-risk types of HPV in a primary screening role. Unfortunately most of these new technologies have been correctly identified as too expensive for a large portion of the world’s underserved environments where the overwhelming majority of the cervical cancer occurs. Very low tech, low resource demanding technologies then became the focus, including a big effort to develop a fast, inexpensive, low tech HPV test. The focus of the problem, to reach the world’s low resource populations, a be able to screen and treat in one visit so as to not lose patients to follow-up. As you might imagine some compromises were made (such as in test sensitivity and through-put) to allow these results. All good in my opinion, and very laudable.

Over the past 14 years we have been focusing on self-sampling for HPV, which up to now has always fell 8-15% behind a direct sample (health provider obtained) in sensitivity. During our SPOCCS III trial we discovered that self-sampling with PCR based technology was as sensitive as a direct sample. Now in SHENCCAST II we have demonstrated it is possible to combine self-sampling with a very high through-put technology (5000 samples/day) at a very low per/patient cost. Suddenly we realized that if one does the math, screening massive numbers of patients quickly makes the initial cost of high-end, high through-put technology, not very expensive when viewing the entire program. We are now ready to explore making the communities the focus with strong community involvement in the planning and implementing of the screening algorithm. Using a community based participatory research model the focus will be advance education, registration, training in self-sampling and specimen transport to a central testing site. We believe by moving caregivers rather than patients, and completing the screening, triage, and treatment phases quickly, problems of lost to follow-up and sustainability will be re-defined.

So now we have our direction defined, we have of sites identified and our protocols written to provide care and advance the science. We have some identified partners for this next journey and continue to look for more. We are moving quickly now in the world of cervical cancer control, and I could not be more excited.