237952 Cervical Cancer Screening Program using HPV Subtyping See and Treat Cryotherapy in Milot, Haiti

Monday, October 31, 2011: 12:30 PM

Sally Greenwald, MD MPH STUDENT , School of Medicine, Tufts University, Boson, MA
Mark Pearlmutter, MD, Chair & VP Network Emergency Services Steward Medical Group , Emergency Department, Tufts University School of Medicine, Boston, MA
Laura Baecher-Lind, MD MPH , Department of OB GYN, Tufts University School of Medicine, Boston, MA
Joyce Sackey, MD, Dean of Global Health and Multicultural Affairs , School of Medicine, Tufts University School of Medicine, Boston, MA
Brian Schurko Jr. , School of Medicine, Tufts University, Boston, MA
As infectious diseases have significantly decreased their impact on the lifespan of persons living in Haiti, cancer and other chronic illnesses have emerged as large contributors to morbidity and mortality. Cervical cancer incidence (93.9/100,000) and mortality rate (53.5/100,000) are considered among the highest in the developed, and developing worlds. Efforts to decrease the burden of cervical cancer have focused on early detection including PAP smear screening, see and treat models, and HPV vaccination campaigns. There is an absence, however, of convincing prevalence data on abnormal cervical pathology and HPV serotypes. The goal of this pilot project was to 1) establish an initial prevalence study of abnormal cervical pathology and HPV subtypes using PAP smears, 2) implement a see and treat model using cryotherapy and 3)evaluate the intervention. Of 250 women recruited from church, 31 of the pathology reports showed high or low grade squamous cell lesions, 16 returned for follow up care using see and treat, and 11 of the 16 tested positive for at least one strain of HPV known to be of high risk (16,18). Based on WHO guidelines, we recommend using see and treat cryotherapy in similar low resource settings. Recommendations for or against vaccination as a means to decrease the burden of disease will require further serotype investigations.

Learning Areas:
Chronic disease management and prevention
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
1. Develop a program to identify and treat women at high risk for cervical cancer in a low resource setting 2. Assess the efficacy of using a see and treat model to address cervical cancer in high risk patients 3. Compare the lowest cost alternative for cervical cancer screening, visual inspection with acetic acid (VIA), to pap tests and HPV serotyping.

Keywords: Cancer Screening, Developing Countries

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present on this project because I oversaw the project from creation, planning, implementation, and write up.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.