Culturally Appropriate Screening and Diagnosis of Cervical Cancer in East Africa
Cervical cancer affects the lives of 500,000 women worldwide each year, and results in more than 270,000 deaths. More than 75% of cervical cancer incidence occurs in Africa, of which East Africa has the highest. In East Africa, and in particular, Tanzania Human Papilloma Virus (HPV) testing (highly sensitive) or the Papanicolaou (Pap) smear (highly specific) screening is not available. Thus, visual inspection with acetic acid (VIA) is used to screen the general female population at a primary health care setting, and VIA followed by cryotherapy or Loop Electrosurgical Procedure (LEEP) is performed at secondary (district and regional hospitals) and tertiary hospitals, VIA does not require specimen collection or processing like the Pap smear or HPV test, which makes it particularly appealing for use in this setting. In the U.S., VIA with magnification (VIAM) is performed using a low power microscope, called the colposcope, in women who have already been screened and found to have positive Pap smears. Magnification (4-7X) is used to visualize subtle features on the cervix, which is exposed with the aid of a speculum. However, the cost of the colposcope (U.S. $10K-$20K) makes its use in Tanzania prohibitive. VIA therefore is performed without magnification at the primary and secondary health settings and the interpretation of VIA is subjective. The problem with implementing VIA at the primary health setting is that health worker density in Tanzania is dire at 1 physician per 45,000 persons and 1 community health worker per 2,800 persons. Further, the training required for the community health worker to do a speculum based exam and interpretation of what he/she sees requires as much as $30 per woman with uneven results, leading to greater number of women that are overcalled as VIA positive. Further, there are well-documented studies that show that women in Tanzania fear the speculum and loss of privacy in a cervical exam. The goal of this Academic-Industry Partnership is for PI, Dr. Nimmi Ramanujam to work in partnership with Zenalux Biomedical to bring a two-pronged cervical cancer culturally relevant screening program that will facilitate scaling of population wide screening and sustainability of see and treat programs in East Africa.