New Study Might Reduce Cancer in Developing World

A School of Public Health (SPH) study of cervical cancer in the developing world has shown that new strategies for the prevention and treatment of the disease could reduce mortality rates by up to 30 percent, according to an article in the Journal of the American Medical Association this summer.

The study—led by Sue Goldie of the Harvard Center for Risk Analysis and Thomas Wright of Columbia University’s College of Physicians and Surgeons—used a computer model to test new approaches to the leading cause of cancer deaths in women in developing nations.

Cervical cancer kills approximately 190,000 women a year, almost exclusively in developing nations.

In wealthier nations like the U.S., pap smear tests to detect pre-cancerous lesions are commonly available, and incidences of the disease are very low.

Although the World Health Organization recommends that women have three pap smears a year, many poorer countries lack the money, technology and trained clinicians required to perform the tests—as well as the infrastructure needed to track women whose tests are abnormal.

The SPH study suggests that alternative screening methods could save thousands of lives.

“Other screening options such as [DNA] testing for human papillomavirus (HPV), which is the virus that causes cervical cancer, or simple visual screening methods called Direct Visual Inspection (DVI) of the cervix followed by immediate treatment, could save up to one third of these women if used just once in each woman’s lifetime around the age of thirty-five,” Goldie says.

Furthermore, the study suggests that such new testing methods are cost effective.

Another major finding of the study was that cervical cancer screening is still a feasible investment in countries with high incidences of AIDS.

“Screening is most effective for women in their mid to late thirties, most of whom have survived the peak fatality years for AIDS and have an otherwise normal life expectancy,” Goldie says.

The Model

At the heart of the analysis was a computer model designed to simulate clinical trials on a hypothetical population of South African women. South Africa was chosen because of the large amount of available data and because it is a relatively advanced developing nation, according to Director of Risk Communication at the Center for Risk Analysis David Ropeik.

However, the model can be adapted to other countries as well, Ropeik says, and the team is currently awaiting grant money from the NIH to develop their model for other nations.

“The next step is to develop paradigms for different types of countries,” says Dr. Goldie. “We are hoping to have three to five countries done in the next few years.”

The model incorporates parameters from numerous studies done over the last ten years, as well as data from an ongoing study led by Wright, a world-renowned expert on HPV.

The team expects the model to improve as more information is collected.

“The great thing about the model is that it is iterative,” says Goldie. “We can keep putting information into it to make it better.”

Goldie noted the importance of clinical studies to test the results of the study.

“Because these strategies appear to offer enormous public health impact for low resource settings, clinical studies evaluating the safety and long-term effectiveness of the new cervical cancer screening approaches must now be given the highest priority,” says the ressearcher.

According to Goldie, much work remains to be done to put the analysis into terms that developing nations can understand and use.

“Our research is an additional piece of information that decision makers can use to make policy decisions and to improve health,” she says.

Ultimately, the team hopes their work will be used to inform policy decisions in developing nations.

Ropeik says that the team is sending executive summaries of the analysis to policy and health organization around the world, and to policy makers in every developing nation.

“Our goal is to inform decision makers about the effects of various choices,” Ropiek says. “These findings are theoretical, but they give us the hard numbers to move beyond the debate.”

Funding from the Bill and Melinda Gates Foundation supported the study.

Also contributing to the study were Dr. Lynette Denny of the University of Cape Town in South Africa, Dr. Louise Kuhn, of the School of Public Health at Columbia University, and Dr. Amy Pollack of the EngenderHealth program in New York.