Project Lead(s): Barry Rosen
It is predicted that within 15 years, 95% of all new cervical cancers will be diagnosed in low- and middle-income countries.
Cervical cancer is a preventable disease and efforts are underway to introduce the HPV vaccine but, even if it is accepted and provided to all, there will be at least a 15-year delay before its beneficial effects will be realized.
One treatment option for precancerous lesions of the cervix is LEEP (Loop Electrosurgical Excisional Procedure). This technology has overtaken cryotherapy in the western world as standard of care for precancerous lesions. It is easy to perform, has low morbidity, and has been shown to be more effective than cryotherapy in randomized control trials.
The objective of this project was to introduce LEEP into Western Kenya and to use it in a ‘see and treat’ protocol, due to issues relating to loss to follow-up.
This project was developed to train the front-line healthcare providers, specifically nurses doing cervical cancer screening, on how to use LEEP, so that they could provide this care to women during their first visit. This would help overcome the need for multiple visits to the clinic setting and, at the same time, provide patients with the best or highest quality of care for cervical dysplasia.
The project team trained eight nurses in western Kenya to provide LEEP as an alternative to cryotherapy.
They developed a training program that included classroom education, a wet lab to learn how to use the LEEP instrument, a period of observation, then a period of doing the procedure under observation, and finally offering the procedure independently. The complication rates seen with procedures performed by these nurses were extremely low, with no significant bleeding and no injuries.
The project team then expanded the LEEP training program to include physicians and residents. As a result of the project, there is a greater understanding of cervical cancer and its precursors by all those involved in the training.
Overall 160 patients received LEEP treatment as a result of this initiative.
Data from this work and other studies provided opportunities for additional grants and research, and the team was successful in obtaining a $4 million USD National Institutes of Health (NIH) grant to pursue their work.