Weill Cornell Medicine, Moffitt Cancer Center in Tampa, Fla., and the University of North Carolina have received a $3.5 million, five-year grant from the National Cancer Institute (NCI), part of the National Institutes of Health, to improve screening and preventative treatment of cervical cancer for women living with HIV in low-resource countries.
Women living with HIV are more vulnerable to cervical cancer, especially in the low- and middle-income countries. Eighty-five percent of cervical cancer deaths occur in these settings, where high quality preventative services are often lacking.
As part of the NCI's HIV/Cervical Cancer Prevention 'CASCADE' Clinical Trials Network, investigators from these institutions will develop trials to be conducted at clinical sites in Kenya, Uganda and Botswana that were selected by NCI to be in the CASCADE Network.
"Cervical cancer is a preventable disease, but so often women in these parts of the world present with advanced cancer that causes hardship and dramatically raises the likelihood of death," said Principal Investigator Dr. Timothy Wilkin, a professor of medicine in the Division of Infectious Diseases at Weill Cornell Medicine and an infectious disease specialist at NewYork-Presbyterian/Weill Cornell Medical Center.
"We have the tools already to make an immediate impact for these women. The challenge is how do we deploy them optimally? How do we sustain these services and engage women to accept them?" he said.
To address these goals, Dr. Wilkin will work with PIs Dr. Anna R. Giuliano, the founding director of the Center for Immunization and Infection Research in Cancer at Moffitt Cancer Center, and Dr. Carla Chibwesha, an associate professor of obstetrics and gynecology in the University of North Carolina's Division of Global Women's Health and the Lineberger Comprehensive Cancer Center, who is based in Johannesburg, South Africa.
"Since 2018 the WHO has had elimination of cervical cancer as a global goal. The strategy to achieve this goal was approved by the World Health Assembly, a strategy that clearly highlights the importance of cervical cancer screening and treatment," Dr. Giuliano said. "As each community has unique challenges to implementing screening and treatment, adaptation and innovation is required to assure that we can meet the ambitious goal that has been set. Hence the importance of continued research."
"The CASCADE Network brings together leaders in cervical cancer prevention from the Global North and South, said Dr. Chibwesha. "Through the network, we have a unique opportunity to work towards the elimination of cervical cancer by generating critical evidence on how best to implement newer cervical screening and precancer treatment modalities at scale."
The investigators are working with providers at study sites to identify challenges to screening patients for precancerous changes to the cervix, and to treating those patients found to be at risk. The team has already identified some new approaches they hope to test.
For example, providers at these sites often screen patients using a visual examination of the cervix. Although simple and inexpensive, this test can be unreliable. To better determine who is at risk, the investigators want to increase the use of direct testing for the presence of human papillomavirus (HPV), the virus that causes cervical cancer. For an initial study, they intend to use a desktop PCR testing machine that detects the amount and type of virus to better identify those most in need of treatment. In another project, they plan to test the effectiveness of having women swab themselves to collect samples for testing.
If a screening finds precancerous cells, a provider can remove them surgically, or with freezing or heat. Women with HIV don't respond as well to either treatment, so the collaboration plans to focus on improving outcomes for them.
This new grant is the latest among efforts by Weill Cornell Medicine researchers to address cervical and other HPV-related cancers.
When women have routine access to effective preventative services, the rate of cervical cancer drops significantly, with an enormous impact on individual lives."
Dr. Timothy Wilkin, Professor of Medicine, Division of Infectious Diseases, Weill Cornell Medicine