MPH MCH Course: Assessment Task One

Post-Course written assignment

Read the attached case study “Multi-Pronged Attack on Cervical Cancer Detection Seeks to Speed Detection and Treatment in Resource-Constrained Countries”.

1.Update the global burden of disease due to cervical cancer using appropriate metrics. The data shown in the cases study is from 2002. (4 marks)Answer:Cancer is the leading cause of death in the world with more than 14 million new cases reported in 2012. In 2015 cancer was responsible for 8.8 million deaths globally. Approximately 1 in 6 deaths in the world are related to cancer. Low and middle income countries experience around 70% deaths from cancer. One third of deaths from cancer are due to dietary and behavioral risks. In the US the death rate from cervical cancer is higher than before. In 2017, 77% black women died from cervical cancer while 47% white women died from the same condition. Estimates indicate that more than 12, 820 new cases of cervical cancer were diagnosed and more than 4,210 deaths reported in the US in 2017.
2.What is the “gold standard” cervical screening method in high resource settings? (3 marks)Answer:Routine cytology screening of women is the gold standard cervical screening method in high resource settings. The method commonly known as Pap Smear has led to reduced cases of cervical cancer related deaths over time in wealthier regions. A precancer screening program that is affordable and of high quality has enabled people in wealthier regions to access earlier treatment which reduces deaths associated with cancer. The most effective way of reducing cancer deaths is regular screening associated with an early diagnosis that makes treatment easy. Women in wealthier regions access the regular screenings and earlier treatment reduces cases of cancer deaths.
What alternatives are there in low-resource settings? (3 marks)List three conditions for the effective use of new cervical screening technologies. (3 marks)List three challenges faced by the three “initiatives” described in this case study. (3 marks)Answer:Routine cytology screening is accessible to women in wealthier regions but not to women in low-resource regions. This explains the higher cancer deaths in such regions. In response the PATH, ACCP, CCA and other partners conducted various studies to compare a number of screening techniques that would be accessible and affordable for low-resource regions. The alternatives include cytology, HPV DNA test, and visual inspection methods with acetic acid (VIA) or Lugol’s iodine. The alternative screening methods aim at providing cost-effective, quality, and not too technical pre-cancer screening programs to reduce the high mortality rate related to cancer in developing the region.
4.How were these alternatives evaluated and what advantages are mentioned? (3 marks)Answer:The alternatives were tested in more than 20 low-resource settings around the globe. HPV DNA and VIA testing proved to be of special interest. The test found that VIA compares well to cytology in terms of disease detection sensitivity. The alternative has some advantages over others as it requires less training, equipment, and infrastructure. It also requires specialized personnel. Cervical cancer screening through VIA can be offered in developing regions with less equipped clinics thus reaching more people. Again Via provides immediate results meaning that women are screened and treated without having to visit another day for treatment reducing the number of people who miss the treatment. Alternatively, a new – low cost HPV test such as biochemical HPV screening methods designed for low-resource settings would be more effective than VIA or cytology. The most important part is that the methods must be simple to use, accurate, and affordable.
5.What were the requirements for the use of the new HPV-DNA test and how were these addressed? (3 marks)Answer:The new, low cost HPV DNA test had to be specifically designed for low-resource settings. The tests had to be accepted by women and by the providers, be relatively simple to use, be accurate, and affordable. Cultural sensitivities towards medical tests performed during the screening on the genitals or by male practitioners were of concern to women and therefore the testing methods had been accepted by the target population. Another condition is that diagnosis and treatment had to be possible during a screening visit. To achieve this, PATH developed partnerships with Digene, a commercial medical diagnostic company, and with World Health Organization to develop a technology that would be effective in bringing pre-cancer screening to women in the developing world. The partners developed a new highly sensitive HPV DNA test that is portable and yielded results in less than 2 and a half hours facilitating immediate treatment.
Answer:For effective use of the new cervical screening technologies there is a need for strong scientific and public health leadership through leading international organizations and health agencies. There is a need for sustainable political leadership and financial commitment for a comprehensive approach for appropriate vaccination and treatment of women. Third, there is a need for adequate partnership from diverse constituents of civil society, medical associations, governments, health professional, and donors to support a wider spread of access to the new tools reducing deaths related to cervical cancer in the developing world. These conditions among others will ensure that the new prevention technologies became available and effectively used in developing regions.
Answer:The three initiatives in the case study faced several challenges. For the case of the Alliance for Cervical Cancer Protection, the groups were brought together by the interest of prevention of cervical cancer in the developing countries. However, lack of attention to the coordinated work for a stronger alliance led to frictions. For the START program initiative, and its sequel, QIAGEN faced a challenge to developbusiness model that allows the marketing of two types of HPV DNA tests. Medical communities also brought up a challenge. Many clinicians and researchers consider Pap Smear a gold standard and consider making a living from cytology. Many of them have not seen results of the alternative strategies forcing them to remain skeptical about the alternatives.
8.This case study was written in 2009. Provide an update for 2016. (3 marks)Answer:In 2016, cervical cancer still remained to be the most common cancer for women across the globe. Most diagnoses still occur in the developing world where cases are detected at late stages with poorer prognoses. Most women in low-resource regions still have difficulties accessing cancer screenings. Visual inspection methods of cervical cancer screening emerged as cost effective, safe, and effective alternative to cytology screening and can be administered to many women in the developing world. VIA and VILI were performed by nurses, paramedic staff, and midwives after a short competency based training program. Additionally, the visual screening provided immediate results supporting real tome treatment. This acted as an effective strategy for overcoming issues of non-adherence to follow-up visits.