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 the GAVI Alliance and other partners to help countries plan strategic use of vaccines against human papillomavirus, the leading cause of cervical cancer.

Precancer screening using visual methods

Early detection of cervical precancer saves lives, but very few women are screened in low-resource settings. PATH seeks to increase access to screening using an effective, simple, safe, and inexpensive method called visual inspection with acetic acid (VIA). 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 program design. PATH is also collaborating with the Uganda Cancer Institute to create an African regional training center and to support development of master trainers for Africa.

Scaling up HPV DNA testing

A new possibility for increasing the accuracy and cost-effectiveness of screening programs is the use of molecular tests to detect human papillomavirus (HPV) infection. For years HPV DNA testing has been available only in well-resourced settings, but PATH’s partnership with QIAGEN, a private company, has brought the careHPV™ DNA Test to market after several years of development and validation.

PATH’s Scale-Up project is fostering uptake of HPV testing as a primary screening method in Central America by working with the Ministries of Health of four countries to introduce routine use of careHPV™ and to update national policies and guidelines. Scale-Up is also working with the Pan American Health Organization to incorporate HPV tests in their Strategic Fund pooled procurement mechanism.

Additionally, the project is conducting a landscape analysis of the potential for introduction of HPV DNA testing in three East African countries.

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 cold coagulation. In partnership with the National Cancer Institute of Peru (INEN) and Basic Health International, PATH is comparing the clinical performance of conventional cryotherapy (which requires equipment that costs about USD $1,500 per set and regular supplies of carbon dioxide or nitrous oxide gas) with a new cryotherapy device called CryoPen (which does not require external gas), and with cold coagulation. We are also evaluating the operational feasibility, ease of use, and cost of CryoPen compared to conventional cryotherapy. In a related effort, we are analyzing the dynamics of the cryotherapy equipment market, looking at supply and demand factors that might be influenced in order to make treatment more affordable and/or accessible.

Estimating costs

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 is collaborating 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.

RHO also features PATH’s interactive Cervical Cancer Prevention Action Planner, a tool for decision-making related to screening and treatment programs for adult women and vaccination programs for girls.

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—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 for subsidized HPV vaccine.
  • Cervical cancer vaccine project results are available on the RHO Cervical Cancer website. Learn more.

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

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