Reproductive Health Global Program

Protecting women from cervical cancer

Cervical cancer is a largely preventable disease, yet it kills about 270,000 women each year, mostly in low- and middle-income countries. As part of a comprehensive approach to protecting women from the disease PATH is working on cancer screening methods that are rapid, affordable, and easy-to-use—even in rural areas without sophisticated laboratory facilities—and feasible precancer treatment methods. We’re also working with Gavi, the Vaccine Alliance, and other partners to help countries plan strategic use of vaccines against human papillomavirus (HPV), the primary cause of cervical cancer.

Scaling up HPV DNA testing

Early detection of cervical precancer saves lives, but in low-resource settings only a tiny percentage of eligible women are screened. Molecular tests to detect HPV infection offer the opportunity to screen many more women with increased accuracy and cost-effectiveness, as compared with traditional Pap tests or visual inspection methods. For years, HPV DNA testing was available only in well-resourced settings, but PATH’s collaboration with the private company QIAGEN led to the development, validation, and commercialization of the careHPV™ test, a low-cost molecular test designed specifically for limited-resource settings. The careHPV test allows women to collect samples themselves, resulting in considerable programmatic advantages.

In partnership with the ministries of health of four Central American countries, PATH’s Scale-Up project is introducing routine use of careHPV and updating national policies and guidelines to include HPV testing as a primary screening test. Scale-Up is also working to incorporate HPV tests into regional pooled procurement mechanisms to facilitate government procurement at the right price. The project also assessed the feasibility of introduction in three East African countries.

Precancer screening using visual methods

If a woman screens positive for HPV, her clinician must then examine her cervix to determine the best treatment option. One low-cost way to do that is with an effective, simple, and safe method called visual inspection with acetic acid (VIA). Where HPV testing is not yet available, VIA can be a sensible primary screening method as well.

Through our Cervical Cancer Prevention Project, we offer targeted technical assistance to countries to develop national strategies and design effective and efficient programs, disseminate up-to-date information, and use decision modeling to answer critical questions about screening-program design. PATH also collaborated with the Uganda Cancer Institute to create a cadre of VIA master trainers for Africa.

Effective, appropriate treatment of precancerous lesions

Even the best screening programs are meaningless unless women who need treatment receive it in a timely fashion. Fortunately, two low-cost and simple treatments are available: cryotherapy (freezing affected tissue) and thermal ablation, which uses high temperatures to destroy the affected tissue (formally called cold coagulation or thermal coagulation). While cryotherapy is an effective treatment method, access to the gas required for treatment can limit access.

To address the need for non-gas treatment methods, PATH has collaborated with medical device manufacturers to develop new technologies. Under the Cervical Cancer Prevention Project, PATH worked with Liger Medical, LLC, to help develop a portable, battery-powered thermal ablation device. This device received FDA clearance for marketing in the United States and has CE marking, which certifies that a product has met European Union consumer safety, health, and environmental requirements. In partnership with the Ministry of Health of Honduras, PATH is carrying out a study to determine the acceptability, short-term safety, and effectiveness of thermal ablation in the country.

In a related effort, we have analyzed the dynamics of the cryotherapy equipment market, looking at supply and demand factors that might make treatment more affordable and/or accessible. The PATH Market Dynamics team recently launched a tool to help ministries of health determine the best scenarios for deployment of treatment equipment for optimal treatment coverage.

Estimating costs and cost-effectiveness

Costing studies comparing different screening tests and algorithms, or assessing various strategies to vaccinate young adolescents, are also a critical part of PATH’s work to help decision-makers. PATH collaborates with the decision-modeling team at Harvard University to evaluate different screening and management options. PATH also collaborated with Cervical Cancer Action and the American Cancer Society on a modeling study to estimate the total investment required to offer both vaccination and screening/treatment to all the girls and women who need it in low- and middle-income countries.

RHO Cervical Cancer website

RHO Cervical Cancer website

RHO Cervical Cancer offers up-to-date information and a library of cervical cancer resources.

The RHO Cervical Cancer website offers users a vast, searchable library of cervical cancer information.

RHO makes it easy to access background papers, training materials, films, PowerPoint presentations, and a host of other documents and tools published by the world’s leading HPV experts and organizations, including the World Health Organization, US Centers for Disease Control and Prevention, US National Cancer Institute, International Union Against Cancer, PATH, and many others.

PATH leadership—the Cervical Cancer Prevention Initiative

Since 2007 PATH has played an important leadership role in two global coalitions: Cervical Cancer Action, an advocacy partnership, and the Cervical Cancer Prevention Initiative (CCPI). As a co-chair of both groups, PATH has supported their growth in many ways, including supporting Secretariat functions, managing working groups, taking the lead on publications, maintaining websites, and broadcasting email news briefs.

The four goals of the CCPI are to:

1. Scale up prevention services for all women and girls
Build political commitment for developing appropriate policies and integrating vaccination and screening/preventive treatment into school health, women’s health and HIV/AIDS prevention and treatment programs. For partners currently operating limited prevention programs, seek to cover all girls and women.

2. Expand the stakeholder base globally and within countries
Strengthen and expand national- and global-level commitment and investment in cervical cancer prevention, and support collaboration for more effective implementation.

3. Encourage innovation and shared learning
Support efforts to spur the next generation of vaccines; screening and preventive treatment technologies; programmatic innovations and scalable approaches; and to share new learning broadly.

4. Track progress and encourage accountability
Establish systems to track global progress in expanding coverage, monitor resource investments, and compare levels of investment against global commitments and need.

Past PATH cervical cancer prevention projects

Screening Technologies to Advance Rapid Testing for Cervical Cancer Prevention—Utility and Program Planning

A precursor to Scale-Up, PATH’s Screening Technologies to Advance Rapid Testing for Cervical Cancer Prevention—Utility and Program Planning (START-UP), introduced low-cost, easy-to-use, and culturally acceptable screening and treatment strategies for cervical cancer in low-resource countries. The project (2009–2013) aimed to make rapid, accurate precancer screening feasible and accessible at lower levels of the public health care system, and to increase the number and types of staff able to provide effective and efficient screening and treatment services.

Cervical Cancer Vaccine project

From 2006 to 2012, PATH conducted demonstration projects in four low- to middle-income countries—India, Peru, Uganda, and Vietnam. These projects aimed to provide evidence for decision-making about public-sector introduction of human papillomavirus (HPV) vaccines.

The work was implemented in three phases:

  • Formative research to explore the knowledge, attitudes, and beliefs of diverse audiences, and to better understand health system and policy factors.
  • Demonstration vaccination programs, informed by the formative research data, to evaluate strategies for reaching girls with HPV vaccine.
  • Rapid dissemination of lessons learned and technical assistance to governments and nongovernmental organizations that wish to develop or scale up HPV vaccination programs, including assistance with completing applications to Gavi, the Vaccine Alliance, for the subsidized HPV vaccine.

Cervical cancer vaccine project results are available on the RHO Cervical Cancer website.

More information

careHPV is a trademark of QIAGEN