Striving to Eradicate Cervical Cancer in Underserved Countries

By Miriam Cremer, MD, MPH

Cervical cancer prevention strategies in high-resource settings are models of success. In the past 50 years, the United States and other developed nations have seen more than a 75 percent reduction in their cervical cancer rates.

Yet cervical cancer remains the third most-diagnosed female cancer worldwide, and nearly 90 percent of new cervical cancer cases are diagnosed in poor countries.

Two large research projects at Basic Health International (BHI), a nonprofit organization founded to eradicate cervical cancer, and Cleveland Clinic’s Ob/Gyn & Women’s Health Institute seek to combat this disparity.

In 2012, BHI launched the Cervical Cancer Prevention in El Salvador (CAPE) program in partnership with the Salvadoran Ministry of Health. It is the first program of its kind to use a low-cost HPV DNA test (careHPV®) in a public-sector screening program.

The CAPE project will screen 30,000 women for HPV by the end of 2015 and generate data on the most effective methods of integrating HPV testing into a national screening program.

Nested within the CAPE study are multiple projects focused on increasing access and patient acceptance of new screening and treatment methods. By successfully integrating a cost-effective and comprehensive cervical cancer screening and treatment program in El Salvador, the CAPE project can serve as a paradigm to be replicated in other resource-poor countries worldwide.

Testing a portable tool

The second project, CryoPen® An Innovative Treatment for Cervical Precancer in Low-Resource Settings, is supported by a $4 million grant from the National Institutes of Health and the National Cancer Institute. The project involves developing and testing a practical, low-cost cervical cancer treatment tool in Peru and Colombia.

The project’s goal is to develop a cryotherapy system that does not rely on gas-based cryogen for testing in low- and middle-income countries.

Gas-based cryotherapy systems are limited by their expense and the need to continually refill tanks. Furthermore, they are bulky and difficult to transport. Our device, adapted from the electrically powered tabletop CryoPen, is inexpensive and easily transported. Specifically designed to overcome barriers to use of gas-based cryotherapy in underserved countries, it will be resilient under extreme conditions, compatible with unstable electrical systems and operable from a car battery when traditional electrical sources are unavailable.

Early data encouraging

Preliminary data already show that tip temperatures for a prototype of the adapted device are equivalent to those of the original CryoPen and of the more standard carbon dioxide-based cryotherapy.

Our study will investigate how effectively the adapted CryoPen can treat cervical intraepithelial neoplasia grade 2 and higher (CIN2+).

The study’s results have the potential to create treatment paradigm alternatives that could be used in low- and middle-income countries around the world, extending treatment to the most vulnerable, underserved and unscreened populations. N

Dr. Cremer is Director of Global Health Research for Cleveland Clinic’s Ob/Gyn & Women’s Health Institute and is the President and Founder of Basic Health International. She can be reached at 216.312.0618 or at cremerm@ccf.org.