By Kristen Mitchell
A researcher in the Milken Institute School of Public Health has been awarded a $2.6 million grant to study cervical cancer prevention in Peru’s Loreto region in the Amazon Rainforest and to look for ways to engage the health providers and the community in education, screening and treatment.
Principal investigator and George Washington University Global Health Professor Patti Gravitt received the grant from the National Cancer Institute. She has spent 25 years looking for the best ways to screen for cervical cancer.
“Pap screening has been a mainstay of cervical cancer prevention for decades, but fails to translate in many parts of the world due to the high infrastructural requirements,” Dr. Gravitt said. “We hope this effort will lead to an effective and sustainable cervical cancer prevention program in this part of Peru.”
The rate of cervical cancer in developed countries has plummeted, mostly because of high screening and treatment rates. In Peru the incidence rate is twice as high as the global average. There are more than 31 cases of cervical cancer per 100,000 women in Peru compared to about 15 cases per 100,000 women worldwide. In places like the Loreto region of Peru, screenings must be simple to perform, inexpensive, accessible and followed quickly by treatment.
With simpler screening methods and treatment approaches, more women would be able to get treatment without delays that can allow a small pre-cancer to grow into a potentially deadly tumor. One size does not fit all when it comes to effective screening programs, Dr. Gravitt said. The best solutions have to fit the requirements and resources of each region. One of the researcher’s primary goals is to develop processes and tools that health systems can use to identify which screening strategy is right for them, Dr. Gravitt said.
During the course of the five-year project, Dr. Gravitt and her colleagues will ask women in the Amazonian region ages 18 to 64 to be placed on a cervical cancer screening registry to better evaluate who is being screened and why. Researchers also will engage local stakeholders to review the barriers to screening and treatment. The team aims to find out how to decrease the number of cervical cancer cases by selecting screening and treatment strategies that best address the barriers to this region.
Studies have shown that self-collected samples can be used to detect human papillomavirus (HPV) and identify the 10 to 15 percent of women at highest risk that need either further diagnosis or immediate treatment. Such a strategy may be important to ensure that the majority of women have access to a good screening test.
Dr. Gravitt said a critical goal is to work with care providers to ensure that all women have access to a good screening test and treatment. This may require more flexibility in defining best medical practices.
“As a clinician, you want to do best for the patient sitting in front of you, but on the other hand you have to consider the hundreds or thousands of women who will never reach your office,” she said. “A really good test that only 10 percent of the population gets doesn’t impact the cervical cancer problem in the community.”
Dr. Gravitt and her team hope to put a new strategy in place to prevent cervical cancer in Loreto and compare it to the current system in Peru. Her team will have to find solutions that are acceptable to patients and care providers alike and are within the financial constraints of the region. Without stakeholder investment, prevention efforts will not be successful long term, Dr. Gravitt said.
Young girls in Peru are being given the cervical cancer vaccine, so Dr. Gravitt considers her screening research to be largely temporary. If vaccination programs are maintained, women in future generations should have a significantly reduced rate of cervical cancer.
“At some point, screenings might not be needed,” Dr. Gravitt said. “But we’ve got these generations of women who will not benefit from vaccination and we want to find practical solutions to reduce the burden of cervical cancer now.”
Dr. Gravitt’s research team includes co-principal investigator Valerie Paz-Soldan at Tulane University and Johns Hopkins University investigators Margaret Kosek, Pablo Yori and Anne Rositch.