Lab technician adding solution to a test kit.

A laboratory technician in Shanxi, China, works with the careHPV™ test. Photo: Cancer Institute Chinese Academy of Medical Sciences.

Advancing new tools to prevent cervical cancer

What does it mean to save a woman from cancer? It means saving a teacher, a nurse, a farmer, a community leader, a businesswoman, a mother.

A mother like Aisha’s. Eleven-year-old Aisha quietly described her mother’s terrible suffering and passing in a film PATH helped produce in Uganda. Aisha was looking for answers from the health workers who’d come to protect her and her fellow students from the same fate. Why, she wanted to know, had cervical cancer taken her mother?

The vast majority of women who die from cervical cancer—close to 275,000 every year—are like Aisha’s mom. They live in developing countries where access to cervical cancer screening and vaccination is rare. By the time symptoms develop and women realize they are ill, it’s usually too late. As a result, in many developing countries cervical cancer is the leading cause of cancer deaths for women.

But it doesn’t have to be that way. Cervical cancer is easily preventable through vaccination and by identifying and treating the precancer stage.

A small team and an idea

When PATH started work in cervical cancer in the early 1990s, the disease wasn’t perceived as a significant problem in the developing world, in part because few people realized how prevalent it was. Cervical cancer rates had been dramatically reduced in the United States and other industrialized countries through widespread use of the Pap test.

Pap testing has proven difficult to establish in the developing world due to the need for sophisticated laboratories and highly trained technical staff. Without a screening test, women in Uganda and many other countries don’t know they need treatment.

Since those early days—when we had only three staff, an idea, and a tiny budget for this work—PATH has partnered with other global health leaders to advance affordable, effective, and appropriate screening alternatives to Pap. We have also generated significant findings related to the introduction of new vaccines against the human papillomavirus (HPV)—the sexually transmitted virus that causes cervical cancer.

Early screening means lives saved

Our first breakthrough was identifying a simple and affordable screening method—visual inspection using acetic acid (vinegar)—that can be performed by many different kinds of health workers. We then partnered with private companies to develop more sensitive molecular and biochemical tests that can be used in low-resource settings.

Jenny Perez Flores

Jenny Perez Flores survived cervical cancer and hopes other women can get early detection and treatment. Read her story. Photo: Miguel Alvarez.

One of our new tests signals if a woman is infected with one of the cancer-causing types of HPV. For women 30 and older, current infection means higher risk of future disease. Working together with QIAGEN, the manufacturer of an expensive, hospital-based test, we created an easier-to-use, faster, and much less expensive version that performs well in basic labs. The test, called careHPV™, is considerably more sensitive than Pap. With the careHPV test, women can take their own vaginal samples, greatly reducing the number who need a pelvic exam conducted by a doctor or nurse.

Another test, still in development with Arbor Vita Corporation, detects actual precancerous cells, not just HPV infection. This test would allow resource-strapped health care systems to focus medical treatment on women who are at highest risk of cancer, increasing the efficiency of their programs.

These two tests have the potential to reduce the cost, training burden, and need for repeat testing that puts Pap smear screening programs out of reach for millions of women. And they could significantly increase the numbers of women who are screened and treated each year.

Stopping infection with HPV vaccines

In 2006, when new vaccines became available to protect women against the types of HPV that cause most cervical cancer, PATH recognized them as an important line of defense. Widespread HPV vaccination could reduce the number of cases of cervical cancer by at least half over the next 50 years.

Aisha was among the very first girls in Africa to be vaccinated against HPV. Local health workers and PATH staff worked with Aisha’s school to prepare the way for cervical cancer vaccines in low-resource settings. When Aisha got the vaccine, she smiled.

Clinical trials have proven that HPV vaccines are safe and nearly 100 percent effective against the most important cancer-causing types of HPV, as long as girls and young women are vaccinated before they’ve been exposed to the virus—in other words before they become sexually active.

PATH worked with ministries of health in India, Peru, Uganda, and Vietnam to lay the groundwork for effective vaccine introduction. Our goal was to help countries learn how to reach young girls with the vaccine. For example, should the ministries take the vaccine to girls in school or ask the girls to come to the clinic? Or is a combination approach needed?

With low levels of knowledge about cervical cancer and the HPV vaccine, even among health care providers, we made special efforts to support training and community education. We educated teachers, women’s groups, community leaders, and even health staff who were not directly responsible for vaccination so they could accurately respond to parents’ questions and concerns.

Results from PATH’s HPV vaccine project paved the way for Uganda and Peru to launch national immunization programs against HPV and contributed to the GAVI Alliance’s decision to subsidize HPV vaccines for the world’s poorest countries.

Vaccination + screening = good public health policy

The vaccines alone won’t wipe out cervical cancer, since they don’t cover all types of cancer-causing HPV and because many women are already infected. For those reasons, bringing screening and treatment to women in the developing world remains essential and a core part of PATH’s ongoing work.

Ultimately, our efforts mean that more women will receive the screening services they need and that HPV vaccines will be available in developing countries sooner—so that women won’t have to die simply because of where they live.