Seminar 9: Women’s cancer and the lessons for NCDs

In the latest of C3’s International Breakfast Seminars, Dr Jacqueline Sherris, vice president of global programmes for PATH, described the organisation’s use of advancing technologies to help tackle non-communicable diseases in the developing world in a talk entitled Women’s cancer and the lessons learned for broader NCD prevention and management.

• Slides from the event are available here >>
• A report of the event is available here >>

Dr Sherris first described the vision of PATH, a not-for-profit organisation based in Seattle, as a world where innovation ensures that health is within reach of everyone. PATH matches advancing technologies such as vaccines, diagnostics and medical devices to the particular needs of communities in the developing world. The emphasis is on working hand-in-hand with local communities to find solutions that work both culturally and sustainably, while strengthening local systems and encouraging healthy behaviours. The other key theme in PATH’s work is achieving progress through partnerships, bringing together the private sector, governments and local people.

Dr Sherris focused on PATH’s pilot projects in Uganda, Peru, India and Vietnam to prevent cervical cancer and detect and treat precancerous cervical lesions. Estimated deaths from cervical cancer worldwide have risen from 150,000 in 1990 to 250,000 in 2010. There is no agreed programme for tackling this painful and stigmatising disease in the developing world, and PATH was approached to explore the most effective screening and treatment models in countries with minimal resources.

The first challenge was to find an effective testing technique. Pap screening and Elaborate HPV testing kits are impractical for remote areas with few skilled health workers, and PATH has worked on a simplified form of Care HPV, with more than double the sensitivity of pap screening, as well as to test and support visual screening approaches. Vaccines, traditionally too expensive for many developing countries’ health budgets, are now significantly cheaper and PATH has developed a range of evidence that countries can use to make decisions about introducing HPV vaccine in the areas where the need is greatest. For treatment of precancerous lesions, PATH and partners have found that cryotherapy is effective and feasible for the majority of lesions.

As well as the right clinical and medical solutions, Dr Sherris stressed how important it is to find the right means to deliver them. In the pilot programmes, vaccination has been provided in primary schools, treating girls in their final year of school. Culturally, it was found that men in the pilot areas were supportive of vaccinations for their daughters, but that screening and treatment (usually cryotherapy) often needed clear explanation and reassurance.

Dr Sherris explained that the approaches used with cervical cancer could equally be applied to other NCDs such as diabetes. PATH’s work in this field suggests that it is essential for diabetes screening in developing countries that the screening be low cost and minimally invasive. For gestational diabetes, long-term fasting and long clinic visits need to be avoided if at all possible.

For real health impact there has to be a strong partnership between the public and private sectors, which, Dr Sherris believes, has been enhanced by the recent UN High-level Meeting on NCDs.

A broad spectrum of questions followed, covering such issues as:

• the role of men in cervical cancer as it is a sexually transmitted disease, including the use of condoms and possible circumcision;
• educational opportunities for women and the impact on levels of cervical cancer;
• alternative low-cost treatments for cervical cancer, and their effectiveness;
• using community figures to increase awareness of cervical cancer and other NCDs, and as a means of encouraging behavioural change.