O Re-iniciado com Cervical Cancer

Peço a descuple de todos, mas ninguém escreveu neste blog desde Janeiro 2009.  Não sei o que aconteceu com Jubei, mas para mi, tenho ficado nos últimos nove meses aqui em Moçambique..

...learning Portuguese and working on a PEPFAR funded rural HIV project.  Perhaps we'll deconstruct the process and experience as we go along.  There's a lot to praise and criticize, both within the PEPFAR world, the international NGO context and with the country of Moçambique itself. 

But for now, perhaps it's better to just jump into the world of 'articles-i'm-stunned-by'.  This week the New England Journal of Medicine published a Gates Foundation funded study of the best way to screen for cervical cancer in low-resource settings.  They followed about 130,000 women in villages in India and tried to find out which of three methods of screening would save lives.  In the end, they found that a one time screening for HPV, the causative virus of the vast majority of cervical cancers, after the age of 30 worked best amongst the three methods (the other two being normal pap smears and a simple staining method called VIA). 
 
A related editorial from two National Cancer Institute physicians argues that this study is so persuasive, the international community should 'now adapt HPV testing for widespread implementation.'  That seems premature.  This is still only one study.  And we're not sure what modifications or errors will soon be unearthed.

That being said, there's a few of impressive aspects to this study we should note while we await further confirmation and validation.  First, the study studied 131,746 women over 8 years in India.  That's stunning.  Over 130,000 women!  In India...in villages.  Most uneducated (70% without formal education) and most working at home (60%).  The logistic achievement of following, screening and treating 130,000 is almost incomprehensible. 

Secondly, they took a very basic question - what's the best screening tool for a serious cancer in women?...and studied the hell out of it.  They found a huge cohort of women and screened each of them with one of the three types (with a fourth placebo group).  Then, any positive women were given the appropriate treatment.  And finally they followed these women for over 8 years to get good outcome results.  In the end, they got the main endpoint they were looking at - lives saved or lost with each method. 

Finally, as a consequence of a wealthy donor (i.e. the Gates Foundation), they have remarkably few conflicts-of-interests amongst the authors.  No one here, as far as they report, owns the HPV testing machines.   

The results of this study should be closely evaluated and perhaps with more confirmation, quickly implemented.  Nonetheless, this study at the very least demonstrates how a proper, large-scale clinical trial can be done in even hard-to-reach-communities. 

Comments

[grrljock]

Have not looked at the article yet, but agree with you on the stunning accomplishments of the study staff.

Also, I know very little Spanish, no Portuguese, but I think you opened this post by apologizing for not writing since Jan 2009 because you've been Mozambique - is that the gist of it?

[kolahun]

Madam/Sir grrljock,

well, i haven't actually written since about july because i've been in moçambique. jubei (the co-blogger) has written most of the posts since then. i hope to return to more regular posting.

cheers,

kolahun