Walmer Advises Haitian OB/GYN Society on Cervical Cancer Screening

By Family Health Ministries

Family Health Ministries (FHM) founder, Duke physician and DGHI faculty member David Walmer presented new screening guidelines for cervical cancer prevention at the 2011 annual meeting of the Haitian OB/GYN Society. Walmer’s recommendations are the culmination of 18 years of FHM-supported research conducted by Haitian gynecologists in partnership with the QIAGEN Corporation and most recently with the Duke Global Health Institute.

FHM, a Durham-based nongovernmental organization (NGO) devoted to improving maternal and child health and education in Haiti, has recommended that Pap smears be replaced with CareHPV testing, and when positive, women should be examined by colposcopy.  Similar guidelines were proposed at the May annual meeting of the American Society of Clinical Oncology. The Ministry of Health, Haitian OB/GYN Society, and Groupe de Support Contre le Cancer have also endorsed these new guidelines, which could make Haiti one of the leading countries in the world to adopt this promising new approach to cervical cancer prevention.

The incidence of cervical cancer in Haiti is the highest in the Western Hemisphere, 30 times higher than in the US. Approximately one in 20 women in Haiti coming to FHM’s clinic has an advanced, untreatable cancer.  At the request of a Haitian gynecologist, Walmer formed a partnership more than 15 years ago to address these staggering statistics. 
One of the early discoveries by FHM researchers was an observation that Pap smears miss approximately 85% of treatable disease that could be visible by using a magnifying medical device called a colposcope. 

This new approach, Walmer notes, is also advantageous because there are only 10 pathologists to read Pap smears in Haiti, which is not enough to support a national screening program.  In addition, many women in Haiti cannot afford to make multiple trips to the clinic for screening and treatment.  Using this knowledge, FHM invented and refined an inexpensive, portable, battery-powered colposcope that has been named the “CerviScope” with assistance from Duke engineering students and Cary-based Applied Technologies, Inc.  FHM is now preparing the CerviScope to be manufactured inexpensively in large quantities across multiple resource-limited countries with the assistance of a grant from Goldman Sachs.

FHM’s second screening advance resulted from a partnership with QIAGEN Corporation and the knowledge that cervical cancer is caused almost exclusively by one or more of 15 cancer-causing strains of the human papillomavirus (HPV) over time.  In an effort to detect it early before the cancer becomes untreatable, QIAGEN developed CareHPV, an inexpensive laboratory test for HPV infections that is designed for use in resource-limited settings. A second benefit of FHM’s partnership with QIAGEN Corporation is the ability to evaluate the efficacy of existing HPV vaccines, which is ongoing based on the genotyping data that was provided during the development of the CareHPV assay.

FHM’s partners have been heavily involved in this research and formation of new guidelines. They include Jean Claude Fertillien (OB/GYN, Leogane, Haiti), Delson Merisier (OB/GYN, Leogane, Haiti), Junior Duliepre (OB/GYN, PaP, Haiti) Paul Eder and QIAGEN Corporation, Harry Beauvais and the Haitian NGO FOSREF, Marie Louise Baker of Port-au-Prince, and members of the Group de Support Contre le Cancer.