Extending cervical cancer prevention around the world

While U.S. cervical cancer rates have fallen by 70% since the 1950s thanks to the Pap test and national screening programs, the disease remains a leading killer of women in low- and middle-income countries for lack of access to screening and trained providers.

Kathleen Schmeler, M.D., professor of Gynecologic Oncology and Reproductive Medicine, is working change this. Her work to prevent and treat cervical cancer has taken her to underserved communities in Texas, Latin America and, most recently, to Mozambique, where cervical cancer rates are among the highest in the world.

She recently spoke with Cancer Frontline about her work.

Why is cervical cancer prevention so important?

There are so many cancers that we can’t prevent, but cervical cancer is one of the cancers we’ve figured out. We know that the human papillomavirus (HPV) causes almost all cervical cancer and that we have ways to prevent it. It’s much cheaper and easier to prevent cervical cancer than to treat it.

The HPV vaccine is very effective and safe. If we can get women access to screening and treat it at the precancerous phase, then they never go on to get cancer. That’s been a huge success story in the U.S., where we’ve really decreased cervical cancer rates.

Unfortunately, other countries where the resources are lower haven’t been able to implement cervical cancer prevention programs in the same way.

What are you doing to change that?

Over the last several years, I’ve been working with Rice University to develop new technologies that are very affordable and can essentially replace the current screening and diagnosis process for cervical cancer. These point-of-care technologies are easy to implement in low-resource settings because the device can essentially tell you right then and there if it’s pre-cancer or cancer. You don’t need a biopsy or a lab to read the biopsy. I’m currently leading a study to test this technology in Brazil.

On the other side, I also do a lot of teaching and education of providers in these regions, both on the ground and virtually through Project ECHO. By providers, I mean doctors, midwives, physician assistants and nurse practitioners because there aren’t enough doctors in these areas. In the last few years, we’ve also started to work with the ministries of health in other countries to try and change policy related to screening and get more resources toward cancer prevention.

You recently started working in Africa. What’s the current status of your project in Mozambique?

In January, we enrolled the first individuals in a study to screen 14,000 women over three years through HPV testing. We’ll also test the cervical cancer screening technology developed by Rice. We’re working closely with a group that does family planning in Africa, so that the women in our study get “one-stop shopping” to take care of all of those needs. 

By putting the systems in place and increasing access to care, we want to ensure that cervical cancer is no longer the No. 1 cancer among women in Mozambique. Our ultimate goal is that no woman dies of cervical cancer since it’s preventable.

Why do you feel personally compelled to help women in low-resource settings across the world?

If you’re fortunate enough to come to MD Anderson, you have access to all of the latest knowledge, skills, equipment, tests and everything else. But if you live in the Rio Grande Valley or in Mozambique, you don’t necessarily. It's devastating to see women at the peak of their lives being diagnosed with cervical cancer and to see the impact that it has on their families and on society.

I think a lot of my personal interest is that I feel a responsibility to take what we know and share it with people around the world to prevent cervical cancer. I want to be able to give women around the world the same access to care and the same chance to survive that people in higher-resource settings have.

How can other physicians help?

We’re always looking for volunteer physicians to help with our educational programs. In your practice, encourage women to get screened and help navigate them to the appropriate follow-up care if the screening is abnormal. One of the biggest things any physician can do is recommend the HPV vaccine for their patients, families and the general public.

Refer a patient to MD Anderson online or by calling 1-877-632-6789.