A Viable Solution for a See-and-Treat Paradigm for Cervical Pre-cancer in Africa
There is a critical global need for a See and Treat paradigm for cervical cancer that is effective in low-and middle-income communities (LMIC). Guidelines have been written by the Alliance for Cervical Cancer Prevention (ACCP) on strategies for screening cervical cancer in resource-limited settings. Visual inspection with acetic acid (VIA) or VIA with low power magnification (VIAM) combined with cryotherapy or Loop Electrosurgical Procedure (LEEP) appears to be the most viable option for reducing the mortality associated with cervical cancer in the low and middle income countries (LMICs). The colposcope, a low magnification microscope has been historically used for (VIAM) in women with an abnormal Pap smear. Sites that display acetowhitening are biopsied and evaluated by a pathologist. The cervix is treated with LEEP if pre-cancerous lesions are found. In LMICs, this approach is not practical due to the lack of infrastructure and resources and also due to patient attrition at each level of care. Thus it is critical to develop point of care technologies that enable a see and treat paradigm in a single visit within the local communities where the women live. Our long-term goal is to leverage community-clinics as a way to bring early detection and treatment of cervical pre-cancer to as many patients as possible in LMICs particularly in places where hospitals are not easily accessible. We propose to implement a portable, point of care technology that consolidates the colposcope into a hand-held device and with an integrated visible light diffuse reflectance optical spectroscope that rapidly measures oxygen saturation, neovascularization and the morphological composition of acetowhitened sites identified by VIAM that are known to be altered with neoplastic progressions. The colpospectroscope will enable surveillance with VIAM followed by spectroscopy (in lieu histopathology on a biopsy specimen) such that cervical dysplasia can be diagnosed on the spot thereby enabling a "see and treat" paradigm for women with cervical pre-cancer with cryotherapy and/or LEEP in at the same visit.
Department & School
Pratt School of Engineering
- NIH-National Cancer Institute
- Duke University
- Duke University
- Kilimanjaro Christian Medical Centre