I recently took the position of Director of Clinical Research at Preciva, an Oregon registered benefit company whose mission is to see that every woman and girl has a chance to live free of cervical cancer. Our goal is to make critical preventive screening affordable for women around the world and our first product is a field-portable electronic device designed to radically reduce the cost and increase the accessibility of cervical cancer screening.
Cervical cancer kills over 288,000 women annually, nearly 85% of them in low and middle income countries (LMICs).1 According to a report by the Cervical Cancer Free Coalition, approximately 26% of all cervical cancer deaths occur in India, accounting for more than any other country.2 Despite this significant burden of disease, India has no existing national cervical cancer screening program. Screening efforts are localized, opportunistic, and in many regions limited by the lack of available pathology resources and trained healthcare providers.3
It’s a troubling fact that the single greatest determinant of cancer survival is where you live. And for decades, complex comprehensive screening programs and cancer care have been neglected in areas of the world with weaker health systems, such as parts of India or in many nations of sub-Saharan Africa.4 However, it was also once thought that antiretroviral treatment and multi drug resistant tuberculosis therapy were not cost effective and too impractical to warrant wide scale administer in LMICs. Success in the fields of TB and HIV control have come mainly from coordination of financing and procurement strategies that have helped to streamline supply chains for therapeutics and diagnostics as well as integrate these advances into national agendas.4 The Clinton Health Access Initiative, for example, substantially increased access to generic HIV drugs and the government of South Africa drastically improved TB screening efforts through massive government-led campaigns.5,6
Despite the attention and advances in HIV, TB, and malaria, more deaths occur worldwide due to cancer than in these three diseases combined.7 However, donor funding available for cancer prevention and treatment is vastly disproportional to the growing worldwide need as this public radio international infographic displays.
Barriers to the advancement of a global cancer strategy were a major focus at the Global Oncology Symposium at Fred Hutch Cancer Center in Seattle WA, “Making Cancer a Priority in Global Health.” This meeting brought together leaders and stakeholders in oncology, public health, industry, and foundations to discuss the current state of cancer prevention, screening, diagnostics, and treatment in a global context.
Through several presentations and panels, speakers worked towards defining priority areas in cancer research, advocating to build capacity in LMICs, and identifying gaps in knowledge and opportunities in funding. Much of the message was focused on looking beyond categorical programs and striving for broader system change. It’s widely acknowledged that in order to tackle global caner, we need better data systems for tracking, robust education on screening and prevention, greater investments in the healthcare workforce, and thorough program evaluation to understand what works and what does not.
The United Nations General Assembly will adopt the 2015 sustainable development agenda in September 2015 and this declaration is expected to include a strong stance on the reduction of non-communicable diseases. While this agenda is likely to result in new funding streams to combat cancer, it is critical that we build on the successes of HIV and TB and learn from what did not work well. I previously wrote about the unintended consequences of PEPFAR in Uganda, where despite its undeniable successes in improving access to anti retroviral therapy, this $15 billion investment also fostered the development of narrow disease-focused private programs and non governmental organizations that put strain on the greater public health system. The challenge to making cancer a global priority will be to invest in innovations that are reducing costs, improving access, and filling knowledge gaps while also supporting and strengthening the workforce and institutions needed to incorporate these advances into the broader health system. Further, countries must foster the political will to adopt screening and prevention initiatives as national policy and extend resources to link screening programs with treatment options.
At Preciva we hope to be part of the solution to improve access to affordable screening in areas of the world where cancer is disproportionally affecting the most vulnerable, starting with India, a country with a significant burden of cervical cancer. We strive to take a multi faceted approach through the development of better technology, the implementation and evaluation of our device, and by building partnerships with advocates and policymakers to integrate cervical cancer screening into a broader political landscape. To achieve these goals we are focused on initial clinical validation and design evaluation with partners at Apollo Institute of Medical Sciences and Research and St Johns Medical College in Hyderabad and Bangalore, India. Additionally we will work with Swasti, a Bangalore based international health resource center specializing in the social and management aspects of public health to develop an advocacy strategy for developing national and community-based cervical cancer screening programs and appropriate links to treatment opportunities. Through this research, Preciva strives to ensure that every woman has an equal chance to live free of cervical cancer.
- Singh M, Ranjan R, Das B et al. Knowledge, attitude and practice of cervical cancer screening in women visiting a tertiary care hospital of Delhi. Indian J Cancer. 2014; 51(3) 319-323.
- Nair M, Varghese C & Swaminathan R. Cancer: Current scenario, intervention strategies and projections for 2015. World Health Organization NCMH Background Papers Burden of Disease in India. 2015.
- Farmer P, Frenk J, Knaul F et al. Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 2010; 376: 1186–93.
- Waning B, Kaplan W, King A et al. Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases. Bulletin of the World Health Organization2009; 87:520-528.
- Lozano R,Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. 2012 Dec 15;380(9859):2095-128.