The challenges of cervical cancer prevention and early detection

Mortality from cervical cancer is uncommon in developed countries. In 1989 in the United States, mortality from cervical cancer was only 3.1 per 100,000 women per year. In part, the low mortality from cervical cancer can be attributed to early detection of and elimination of precancers. In developed countries this has been realized by periodic cytologic screening with Papanicolaou smears. Theoretically, periodic cytologic screening can prevent 90% of invasive squamous cancers of the cervix.

The remarkable decline in mortality from cervical cancer seen in developed countries has not been seen in underdeveloped countries. Worldwide, cervical cancer remains the third most common malignancy in both incidence and mortality, with close to a half a million cases diagnosed, and 230,000 deaths each year. It is the greatest cause of death from cancer in women in the developing world and the greatest cancer killer of young women (< age 50). It kills women at the height of their productive lives often when they still have children at home. Though periodic cytologic screening could decrease these numbers greatly, it has not been adopted worldwide because it is expensive and because a cytology based screening system requires a significant healthcare infrastructure.

To limit expense and the need for a complex healthcare infrastructure, we have been studying various screening technologies looking to find combinations or single tests that are sensitive and specific enough such that women who test positive can be treated for precancer of the cervix without resorting to histologic (biopsy) confirmation of the diagnosis.  POI is developing, testing and evaluating new methods to make cervical cancer screening  more accurate and more reliable as well as cheaper and easier to implement.  If developments continue on their current path , POI will  assist in the creation of an inexpensive self-sampling test kit so that individual women can perform a self-examination and then send the sample to a laboratory for quicker results without the need for an examination to be performed by a health care professional.

This research will lead to the development of low cost screening and treatment algorithms for cervical cancer. Importantly, it will also provide increased access to care for women in underserved parts of the United States and areas of the world where screening programs do not exist or do not reach the women most in need.

POI conducts primarily investigator initiated research.  Research questions are developed by POI and its colleagues, then funding is sought to support the research.  Funders may have related research questions they they want to investigate, and collaboratively a protocol is written to meet the objectives of POI and its funders

Objectives of Current Projects

• To develop models using community based participatory research methodologies that will allow todays screening technologies to reach the under-served.
• To provide cost and time efficient research programs that are able to provide vital clinical research data for industries with technologies related to cancer prevention and early diagnosis.
• To teach the low-cost screening and diagnostic algorithms so they may continue in these underserved areas when demonstrated to be successful.
• To provide experiences in international public health for students, residents, fellows and other interested physicians.