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Supported by a $ 5.1 million grant, doctors and scientists at the University of North Carolina and the Malawi College of Medicine launch a multi-pronged effort to fight cervical cancer in Malawi , a country in sub-Saharan Africa where cervical cancer is the leading cause of cancer death among women.
The US Agency for International Development (USAID), in partnership with the US Academies of Science, Engineering and Medicine, will fund a total of $ 12 million for two new cancer prevention programs in the United States. Cervical uterus in sub-Saharan Africa, including the project in Malawi and one in Mozambique.
"Through screening women, we are able to detect and treat precancerous changes before they develop into cervical cancer," said Jennifer Tang, MD, MSCR, co Principal Investigator of the Study for UNC, Associate Professor at the UNC School of Medicine, Department of the Global Women's Health Division of Obstetrics & Gynecology, and a member of the website of the UNC. UNC for Health and Infectious Diseases in Malawi. "Because women in Malawi were not screened, they were diagnosed very late." A late diagnosis of cervical cancer is usually a death sentence in Malawi, which is why we are trying to track as many women as possible with the help of an extremely sensitive test. " and treat women with precancerous lesions on the same day. This increases the number of women screened and treated and decreases follow-up losses. "
According to the World Health Organization, the majority of cervical cancer deaths occur in low- and middle-income countries. The disease is linked to the badual transmission of HPV, or human papilloma virus.
Malawi has the second highest rate of cervical cancer in the world, according to the 2018 estimates of the HPV Information Center. This is due to high rates of HPV and HIV, and low rates of screening and vaccination in the population, said Satish Gopal, MD, MPH, a member of the UNCC's Lineberger Cancer Center, Director of the Malaria Control Program of the UNC Project in Malawi and Associate. Professor at the Division of Hematology / Oncology of the UNC School of Medicine.
In 2004, the goal of the cervical cancer program in Malawi was to screen 80% of eligible women for cervical cancer. Yet less than one-third had completed this screening in 2015, according to program data.
"Progress is being made, but much remains to be done to stem the epidemic of cervical cancer," said Gopal. "We need to understand how to provide prevention services as effectively as possible to the greatest number of women and avoid unnecessary deaths from cancer."
With the new funding, UNC-Chapel Hill and the Malawi College of Medicine will badess the feasibility and cost-effectiveness of integrating self-collected HPV testing into voluntary family planning clinics and community sites in the country. Malawi. The researchers also plan to study the efficacy of treating precancerous lesions using a method called thermocoagulation as part of a "screening and treatment" strategy.
"We could not be more proud of this team of US-trained and African-trained investigators receiving such an important award to better understand the global burden of cervical cancer," said Myron Cohen. , MD, director of the UNC Institute for Global Health. Infectious diseases. "UNC faculty and staff across the campus have worked tirelessly over the past 25 years to create a self-sustaining model of clinical care, research and training at the university. Malawi for health professionals from the United States and the country, to succeed and improve the health of all.This grant is an example of this mission. "
Recent technological advances have made the project possible, said Tang. The HPV test can now be done quickly to determine if a woman has a strain of the virus at high risk for cervical cancer. With the results, providers can determine which women might need same-day treatment for precancerous cervical lesions. Thermocoagulation involves the use of a battery-powered portable device that can easily be used in environments with limited resources, she said.
"Transportation is one of the biggest barriers to treatment for women in Malawi, with the cost," she said. "We try to prevent women from having to come to the clinic several times, spending money and time that they do not have." As soon as we find a problem, we treat it immediately. "
UNC doctors and researchers have been working with health leaders in Malawi since 1990 to provide clinical care and research on HIV and other badually transmitted diseases. This partnership led to the creation of the UNC Project-Malawi site in Lilongwe. While prevention and treatment interventions have improved the survival rates of people living with HIV in Malawi, cancer has become a growing health problem in the country. In 2014, the Malawi Cancer Consortium was launched with funding from the National Cancer Institute to help fight cancer, and HIV-related cancers in particular.
Last year, Malawian leaders traveled to UNC-Chapel Hill to meet with Carolina leaders, doctors and scientists to prepare for the opening of Malawi's first dedicated cancer center. , planned for this year and under construction near the UNC-Malawi project.
The recently funded project on Cervical Cancer relies on the results of a pilot study led by Lameck Chinula, MMED, FCOG, co-principal investigator of this project and the first obstetrician and gynecologist trained by the Malawi to the UNC-Malawi project. In the pilot study, more than 400 rural women were screened for cervical cancer using a community-based screening approach and then treated with thermocoagulation if they had precancerous lesions.
Chinula, who is also a research badistant professor in the Department of Obstetrics and Gynecology of the UNC School of Medicine, was trained in South Africa through funding from the UNAIDS partnership. UNC Institute for Global Health and Infectious Diseases with the Fogarty AIDS International Training and Research Program and the Gilead Training Grant. To address another critical need, he was also trained in the surgical procedure used to treat invasive cervical cancer – radical hysterectomy – by two American specialists in gynecologic oncology. Chinula is now striving to educate other clinicians, and Malawian women in general, to stop cervical cancer before it becomes lethal.
"We would like to see providers maximize their contacts with women and use the most effective and culturally appropriate screening test to identify patients requiring treatment for pre-cervical cancer", Chinula said. "By allowing women to collect samples themselves for the HPV test, we hope to empower and increase the number of women screened in. As a clinician researcher who had to announce the bad news of an incurable diagnosis of bad cancer. cervix in Malawi, I can in the future with the hope that someday will come when these diagnoses will be rare. "
According to USAID, this is the first time that the agency is funding cervical cancer prevention programs in the broader context of women's health, other than as part of the Plan d'Or. President's Emergency to Fight AIDS (PEPFAR). These new programs in Malawi and Mozambique will ensure close coordination with PEPFAR investments in both countries.
"Women who are not screened and treated for cervical cancer have a higher risk of dying from this preventable disease," said Jennifer S. Smith, PhD, professor of epidemiology at UNC Lineberger, specializing in global public health. "We must do everything in our power to increase cervical cancer screening rates globally.We are testing a self-sampling technology that should dramatically increase screening coverage, but we have unanswered questions about implementation in existing health care systems and about the costs.Studies of the study will inform future policy and implementation, not just for testing. self-collection in Malawi, but in other countries. "
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