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Dr. Ileana Hancu. Researcher at GE’s Global Research Center (GRC). Photo courtesy of GE Healthcare

GE Healthcare, February 4, 2015

Cervical cancer kills over four thousand women a year.
Staggeringly, it has been estimated that up to 93 percent of cases could be prevented by screening and vaccination against Human Papilloma Virus (HPV), the virus known to be a cause of cervical cancer.

HPV causes warts, which mostly occur on the hands and feet. However, certain strains also affect the genitals.
Although most warts are non-cancerous, some strains of HPV are strongly linked to cervical cancer.


The conference of the Radiological Association of North America (RSNA) provides a forum for showcasing the latest innovations in medical imaging. Photo courtesy of GE Healthcare

Despite advances in prevention and control, cervical cancer remains the second most common cause of death from cancer in women.
The vast majority of those deaths occur in countries that fall within the World Bank definitions of low- and middle-income countries.

Today is World Cancer Day, and it is now more important than ever to raise awareness of the issues surrounding cancer across the world, assess the progress we have made, and look at how far we have yet to go before we can declare cancer beat.


The SenoClaire mammography solution can produce 3D images using only as much X-ray radiation as a 2D scan. Photo courtesy of GE Healthcare

The Pulse spoke with Dr. Phil Castle, the Executive Director of Global Cancer Initiative, and the Executive Director of the Global Coalition against Cervical Cancer, also known as GC3.
He hopes to introduce cervical cancer prevention programs in countries where constrained resources do not allow the same level of care that benefits millions of women in higher-income countries.

“Essentially, there is not a single organization that has the manpower or the knowledge to provide a sort of ‘one-stop shop’ for a country that wants to implement a [cervical cancer screening] program,” said Dr. Castle.

Dr Phil Castle, Executive Director of Global Cancer Initiative, and Executive Director of the Global Coalition against Cervical Cancer, also known as GC3.
Photo courtesy of GE Healthcare

“The idea was to create a platform on which different groups could be called upon to work together, for those countries really committed to moving forward. So it’s a little different than the one-off activity in which a doctor might to a country and do screening, or provide services for three weeks and then go home,” he added.
“The goal here is to provide sustainable support. To basically help a country make an informed decision about what they should do, how they should do it, and provide the training and education that they need to implement it themselves.”


3D illustration of Human Papilloma Virus (HPV). HPV causes warts, which mostly occur on the hands and feet. Certain strains also infect the genitals. Although most warts are non-malignant (not cancerous), some strains of HPV have been associated with cancers, especially cervical cancer. Photo courtesy of GE Healthcare

In what appears to be a David versus Goliath scenario, there are many barriers to overcome before cervical cancer screening can be effectively implemented across lower-income countries.
These are namely cost, compliance (from governments as well as patients), and the level of expertise that may be needed to properly carry out screening procedures.
Fortunately, GC3 is making headway on the latter issue at least.

Micrograph of cervical squamous carcinoma tumor nests.
This is a section of tissue from the cervix showing small tumors (light pink, above center) beginning to form.
Magnification: x100
Photo courtesy of GE Healthcare

“The traditional method for screening was the Pap smear,” said Dr. Castle,
“which on the one hand has been incredibly successful, but only in a relatively small number of countries: those with a lot of resources.”

“The reason for that is manifold. One is that the Pap test has a very moderate, one-time sensitivity. And ‘moderate’ is being generous; in a lot of the lower income countries it’s very poor. There’s a lot of cost in setting up the lab, and doing it right. You have to invest in quality control to maintain performance and have feedback. There’s a variety of steps.”

Fluorescence micrograph of ovarian cancer cells.
Photo courtesy of GE Healthcare

Cytology and expertise in Pap smear tests is also a rather specialized skill that is expensive to teach.
Such high-level training efforts can also be high-risk.

MR Elastogram, showing different densities of liver tissue (left) and spleen tissue (right).
Photo courtesy of GE Healthcare

Dr. Castle points out,
“what we’ve typically observed over the last twenty or thirty years is that even if you were to make the effort to train up a bunch of people in cytology, what would happen is they would simply go off to the private labs and make money. And the public health programs would suffer tremendously.”

Professor Valérie Vilgrain, Professor of Radiology, Chair of the department of diagnostic and interventional radiology at the Beaujon Hospital (Assistance Publique-Hôpitaux de Paris, Paris Sorbonne Cité, France).
Photo courtesy of GE Healthcare

With new technological advances in screening methods and technology, new hope for a widely-implementable screening program emerges.

Tests are now advanced and user-friendly enough to allow someone with minimal training to determine whether a woman with an HPV infection is susceptible to developing cervical cancer.

Those who test ‘positive’ can be asked to return for further tests, and those who test ‘negative’ can be monitored.

Global Coalition against Cervical Cancer (GC3) is a large, international cooperative effort that will serve as an independent, credible source for technical support and expertise, technology transfer, training, and education to assist countries and entities that want to implement scaled-up cervical cancer prevention and control programs.

The population of women susceptible to cervical cancer becomes much clearer and more manageable as a result.

Unfortunately, simple and effective testing methods are not enough to achieve GC3’s goals.
In many lower-income countries, there is still stigma around the subject of HPV and cervical cancer, along with a sharply-felt lack of awareness.

"HPV testing is more sensitive and less specific than Pap testing," said Philip E. Castle, executive director of the Global Cancer Initiative and CEO of the Global Coalition Against Cervical Cancer.
Photo courtesy of GE Healthcare / VNS Photo

“[Education] is a huge factor. The truth is, you’re not going to go into a country and say, ‘hey, we’re going to prevent cervical cancer here!’ because they’re going to say, ‘Well what’s cervical cancer and why should I care?’ And perhaps there are places that can’t decide, or won’t decide, whether to do cervical cancer prevention because it’s not deemed important enough.”

Courtesy of GE Healthcare

While the future for GC3’s ambitions is bright, its success depends on a vast number of factors and elements coming together.

Courtesy of GE Healthcare

“The real barrier to this cost,” Dr. Castle adds.
“If we can drive the cost down by volume-purchasing, if we can get [funding groups] to not only understand that this is good for women’s health, but that it’s good for health in general, then I think we can get some countries moving forward. I’d like to see one or two countries really doing this on a national level, that fall within the World Bank definitions of middle- or lower-income countries. That would be terrific, and it would be a model for others to replicate.”

Courtesy of GE Healthcare

Dr. Castle’s hopes for GC3 are best summed up by a quote by Goethe that appears on the front page of the GC3 website:
“Knowing is not enough; we must apply. Willing is not enough; we must do.”


Courtesy of GE Healthcare

Dr. Philip Castle, PhD, MPH

Philip Castle is an independent consultant, the Executive Director of Global Cancer Initiative (Chestertown, MD), and the Executive Director of the Global Coalition against Cervical Cancer.


Dr Philip Castle Photo courtesy of GE Healthcare

Previously, Dr. Castle was the Chief Scientific Officer of the American Society for Clinical Pathology (ASCP) (2011-2).

He was a Senior, Tenured Investigator (2010-11) and Tenure-Track Investigator (2003-10) in the Division of Cancer Epidemiology and Genetics (DCEG) at the U.S. National Cancer Institute (NCI).

He received his Ph.D. in Biophysics in 1995 and M.P.H. in Epidemiology in 2000 from the Johns Hopkins University.

Dr. Castle’s professional interests are
(1) epidemiology of human papillomaviruses (HPV) and cervical/anogenital cancer;
(2) science and translation of cancer prevention strategies;
(3) evidence-based medicine; and
(4) international health.

Dr. Castle has published over 200 papers on HPV and cervical cancer, including in such prestigious journals as the New England Journal of Medicine, Lancet, Lancet Oncology, Journal of the National Cancer Institute, British Medical Journal, JAMA, Archives for Internal Medicine, and Cancer Research.

He currently serves on the editorial boards of the Journal of Infectious Diseases and Journal of Lower Genital Tract Disease.

Dr. Castle has served as an invited speaker or session chair in many forums, including for the American Association for Cancer Research, International Papillomavirus Society, and the European Union on Genital Infection and Neoplasia (EUROGIN).

He regularly participates in the development of national and international guidelines for cervical cancer prevention.

Dr. Castle serves a consultant for several countries on the development of national cervical cancer prevention programs, including pilot/demonstration projects in El Salvador and Vietnam.

He is currently a member of the Centers for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection and Prevention (NBCCEDP) Advisory Committee.

For his work in cervical cancer prevention, Dr. Castle has received
(1) An EUROGIN Distinguished Service Award (2006);
(2) a NIH Merit Award for introduction of HPV testing into low-resource settings in the U.S. (2007);
(3) a Distinguished Scientific Achievement Award by American Society For Colposcopy and Cervical Pathology (2010), its highest honor; and
(4) The Arthur S. Flemming Award for Exceptional Achievement in Federal Government Service for Applied Science, Engineering and Mathematics (2010).

More Information:

CG3

http://solvecervicalcancer.org/

Dr Phil Castle

http://solvecervicalcancer.org/gc3-steering-committee/philip-castle/

Cervical Cancer Factsheet

http://solvecervicalcancer.org/wp-content/uploads/2014/11/FACT-SHEETVS_NOV_FS_Cervical-cancer_FINAL.pdf

Self-Collection Could Be the Key to Beating Cervical Cancer

http://newsroom.gehealthcare.com/self-collection-could-be-the-key-to-beating-cervical-cancer/

Self-Collection HPV Tests the Future for Cervical Cancer Screening?

http://newsroom.gehealthcare.com/qa-ulf-gyllensten-self-collection-hpv-tests-future-cervical-cancer-screening/

What You Should Know About Cancer, with Dr Robert Smith

http://newsroom.gehealthcare.com/what-you-should-know-about-cancer-with-dr-robert-smith/

Cancer Research Month: A Physicist’s Determination to Improve Breast Cancer Screenings & Diagnostics

http://newsroom.gehealthcare.com/cancer-research-month-physicists-determination-improve-breast-cancer-screenings/

A New Era in Breast Cancer Screening

http://newsroom.gehealthcare.com/a-new-era-in-breast-cancer-screening/

Liver Cancer is on the Rise, But Doctors are Getting Better at Beating It

http://newsroom.gehealthcare.com/liver-cancer-is-on-the-rise-but-doctors-are-getting-better-at-beating-it/

Source: GE Healthcare

http://newsroom.gehealthcare.com/

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