Project Lead(s): Patricia Garcia
Issue
There are more than half-a-million cases of cervical cancer and 270,000 deaths caused by this disease every year worldwide. A minimum of nine out of every 10 deaths caused by cervical cancer occur in developing countries like Peru, where it is the leading cause of death from cancer among women.
While the Pap test is used in Peru for screening, it has low coverage, low sensitivity, poor reproducibility and there are often delays in the delivery of results.
The human papillomavirus (HPV) has been identified as the causative agent in cervical cancer and there are several highly sensitive molecular tests that can detect the cervical infection caused by HPV, which are being considered as a replacement for cytology-based tests in the early detection process.
A majority of the infections caused by HPV go into remission spontaneously and do not progress to cervical cancer, meaning detection of the HPV infection through molecular tests would not lead to a definitive diagnosis but would instead simply be an indication that further testing (a Pap test or colposcopy) is required.
Solution
The object of this project was to evaluate the feasibility of a model of cervical cancer screening in Ventanilla, Callao, Peru, that includes the participation of female community leaders, the use of home tests with self-sampling equipment (to increase screening coverage) and the use of new tests to detect HPV.
Fifty-nine women were trained as leaders to distribute self-testing kits. These leaders received training about cervical cancer, collection of samples, recording of data and effective communication. They were trained to offer the testing to women between the ages of 25 and 59 years old, who agreed to participate and had the capacity to give informed consent to take part in the program.
In the project, 2,090 women were tested for HPV using CareHPV, marketed by Qiagen Inc.
Women would self-test at home and tests were then sent to a lab and analyzed; results were communicated by SMS and phone calls.
If the results were negative, the women were advised to have a Pap smear in a year, while all those who were positive were followed up.
Outcome
Of the 2,090 women screened, 12.8% or 266 women tested positive for HPV infection. The average time taken between the distribution of the kits to laboratory examination was 10 days.
A total of 260 women who tested positive were followed up and 252 consented to have a colposcopy, Pap test and biopsy. Additionally, a total of 179 women who tested negative were followed up with a colposcopy, Pap test and biopsy.
Of these 431 women (both HPV-positive and -negative), 49 women had either high-grade lesions, in situ cancer or other adenocarcinomas. A total of 37 were treated using cryotherapy, while 12 were treated using other procedures (LEEP, hysterectomy and/or radiotherapy).
The project received additional funding and support of $10,000 from the Weill Cornell Medical College to purchase a colposcope, to be placed at the Bahia Blanca health centre.