CHAPEL HILL, NC — Backed by a $5.1-million grant, University of North Carolina and University of Malawi College of Medicine physicians and scientists will launch a multi-pronged effort to combat cervical cancer in Malawi, a country in sub-Saharan Africa where cervical cancer is the leading cause of cancer death among women.
The United States Agency for International Development (USAID) and the U.S. National Academies of Science, Engineering, and Medicine are funding a total of $12 million for two new programs to prevent cervical cancer in sub-Saharan Africa, including the project in Malawi and one in Mozambique.
鈥淏y screening women, we are able to detect and treat precancerous changes before they develop into cervical cancer,鈥� said Jennifer Tang, MD, MSCR, co-principal investigator of the study for 黑料网, associate professor in the 黑料网 Department of Obstetrics & Gynecology鈥檚 Division of Global Women鈥檚 Health and a member of the 黑料网 Institute for Global Health & Infectious Diseases Malawi site. 鈥淏ecause women in Malawi weren鈥檛 getting screened, they were getting diagnosed very late. A late cervical cancer diagnosis is usually a death sentence in Malawi. That is why we鈥檙e trying to screen as many women as possible using a highly sensitive test, and to treat the women with evidence of precancerous lesions the same day. This increases the number of women screened and treated, and decreases loss to follow up.鈥�
Globally, the majority of cervical cancer deaths occur in low- and middle-income countries, . The disease is linked to the sexual transmission of HPV, or human papillomavirus.
Malawi has the second-highest cervical cancer rate of any country in the world, according to 2018 estimates from the HPV Information Centre. That is due to high rates of HPV as well as HIV, and low population-level screening and vaccination, said Satish Gopal, MD, MPH, member of the 黑料网 Lineberger Comprehensive Cancer Center, cancer program director for 黑料网 Project-Malawi and an associate professor in the 黑料网 Division of Hematology/Oncology.
In 2004, the Malawi Cervical Cancer Control Program set a target of screening 80 percent of eligible women for cervical cancer. Yet, less than a third had completed this screening as of 2015, according to data from the program.
鈥淧rogress is being made, but there is a tremendous amount still to do to stem the cervical cancer epidemic,鈥� said Gopal. 鈥淲e need to understand how to most efficiently deliver the preventive services to the highest number of women, and avert these unnecessary cancer deaths.鈥�
With the new funds, 黑料网-Chapel Hill and the Malawi College of Medicine will evaluate the feasibility and cost-effectiveness of integrating self-collection HPV testing into voluntary family planning clinics and community-based sites in Malawi. The researchers also are planning to investigate the effectiveness of treating precancerous lesions using a method known as thermocoagulation in a 鈥渟creen-and-treat鈥� strategy.
- Malawi family part of 黑料网 Project-Malawi
鈥淲e couldn’t be more proud of this team of U.S.- and African-trained investigators receiving such a large award to better understand the global burden of cervical cancer,鈥� said Myron Cohen, MD, director of the . 鈥満诹贤� faculty and staff from across the campus have worked hard over the past 25 years to build a self-sustaining model of clinical care, research and training in Malawi for health professionals from the United States and in-country to succeed and improve health for all. This grant exemplifies this mission.鈥漅ecent technological advances have made the project possible, Tang said. HPV testing can now be completed rapidly to determine if a woman has a strain of the virus that is high-risk for causing cervical cancer. With the results, providers can determine which women might need same-day treatment of precancerous cervical lesions. Thermocoagulation involves using a portable, battery-operated device that can easily be used in settings with limited resources, she said.
鈥淭ransportation is one of the biggest barriers to treatment for women in Malawi, along with cost,鈥� she said. 鈥淲e鈥檙e trying to save women from having to come to the clinic multiple times, spending money and time they don鈥檛 have. As soon as we find a problem, we are treating it immediately.鈥�
- 黑料网 physicians and researchers have been collaborating with Malawian health leaders since 1990 to provide clinical care and research for HIV and other sexually transmitted diseases. This partnership led to the establishment of the 黑料网 Project-Malawi site in Lilongwe. As prevention and treatment interventions have improved the survival rates of people living with HIV in Malawi, cancer has emerged as 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-associated cancers in particular.
Last year, Malawian leaders traveled to 黑料网-Chapel Hill to meet with Carolina leadership, physicians and scientists to prepare for the opening of Malawi鈥檚 first dedicated cancer center, which is expected this year and is being built adjacent to 黑料网 Project-Malawi.
The newly funded cervical cancer project builds on the results of a pilot study led by Lameck Chinula, MMED, FCOG, who is co-principal investigator for this project and the first Malawian-trained obstetrician and gynecologist at 黑料网 Project-Malawi. During 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 were found to have precancerous lesions.
Chinula, who is also a research assistant professor in the 黑料网鈥檚 Department of Obstetrics and Gynecology, was trained in South Africa through funding from the 黑料网 Institute for Global Health & Infectious Diseases partnership with the Fogarty AIDS International Training and Research Program and the Gilead Training Fellowship. To address another critical need, he was also trained to perform the surgical procedure used to treat invasive cervical cancer – radical hysterectomy 鈥� by two U.S. gynecologic oncology specialists. Chinula now strives to educate other clinicians, and Malawian women in general, to stop cervical cancer before it becomes deadly.
鈥淲e would like to see providers maximize any contacts they have with women and use the most efficient, culturally-sensitive screening test available to identify patients needing treatment for cervical pre-cancer,鈥� Chinula said. 鈥淏y allowing women to self-collect specimens for HPV testing, we hope to empower and increase the number of women screened. As a clinician-researcher who has had to deliver the bad news of an incurable cervical cancer diagnosis in Malawi, I can look to the future with hope that a day will come when these diagnoses will be a rare occurrence.鈥�
According to the USAID, this is the first time the agency has funded programs to prevent cervical cancer in the context of broader women’s health, other than under the President’s Emergency Plan for AIDS Relief (PEPFAR). These new programs in Malawi and Mozambique will coordinate closely with PEPFAR investments in both countries.
“Women who aren鈥檛 screened and treated for cervical cancer have a higher risk of dying of this preventable disease,鈥� said 黑料网 Lineberger鈥檚 Jennifer S. Smith, PhD, professor of epidemiology at the 黑料网 Gillings School of Global Public Health. 鈥淲e need to do all that we can to increase cervical screening rates globally. We鈥檙e testing a self-sampling technology that should increase screening coverage dramatically, but we do have unanswered questions about implementation within existing health care systems and cost. Study findings will inform future policy and implementation, not only for self-collection tests in Malawi, but other countries.鈥�