Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, discusses cervical cancer screening techniques.

There are 3 ways in which cervical cancer is typically screened for—Pap testing, HPV DNA testing, and visual inspection with acidic acid (VIA). Although Pap tests have been very effective and have decreased the incidence and mortality of cervical cancer in numerous countries, Ginsburg explains that they require a lot of infrastructure. The availability of cytopathology and the number of visits required to complete that screening process is inhibitive, she says.

  Ginsburg says that VIA is recommended in countries that lack the infrastructure to support these more involved tests. After those skills have been perfected and qualifications are maintained, then HPV-based DNA testing can be introduced. Ginsburg says that while the price of HPV-based DNA testing is still too high, the point-of-care diagnostic capacity is in trials now to make sure the test can be done and ensure a wait time of less than 2 hours for her diagnosis.   

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Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, discusses cervical cancer screening techniques.
 

Dr. Ginsburg Discusses Cervical Cancer Screening Techniques

Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, discusses the use of visual inspection with acidic acid (VIA) in cervical cancer screening.

Although VIA is a well-known practice, Ginsburg says that in the last few years, WHO recommended it after a large project in sub-Saharan African countries showed that it was effective, acceptable, and feasible to implement by non-gynecologists and even non-physicians, such as nurses and midwifes. Ginsburg says that there are certain criteria by which health workers are trained to identify those women who have those changes and are also suitable for treatment, even during the same visit, with cryotherapy.

VIA is one of 3 strategies that WHO recommends, along with HPV DNA testing and Pap testing. This approach is considered a cost-effective intervention in global health that can be implemented in a rural setting where no physicians are available, Ginsburg says.

Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, discusses the use of visual inspection with acidic acid (VIA) in cervical cancer screening.
 

Dr. Ginsburg Discusses the Use of VIA in Cervical Cancer Screening

Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, discusses global vaccination and screening for cervical cancer.

Ten years after the introduction of the original HPV vaccines, 47 million girls had been vaccinated, says Ginsburg. Of those 47 million girls, less than 3% were living in low income country. These are countries where there is no effective population-wide cervical screening program, Ginsburg says. Of the over 250,000 women who died of cervical cancer worldwide in 2017, 90% were living in a lower-income country.

The current HPV vaccination can prevent 90% of HPV infections, but it is difficult for it to reach all countries, Ginsburg says. HPV vaccination is essential, but it must be implemented together with increased access to effective screening and treatment programs. The tools to prevent and screen for cervical cancer are available, but they must be integrated effectively in these lower income countries, Ginsburg says.

Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, discusses global vaccination and screening for cervical cancer.
 

Dr. Ginsburg Discusses Global Vaccination and Screening for Cervical Cancer

Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, discusses cervical cancer disparities in low-income countries.

Cervical cancer has been largely addressed in many high-income countries, says Ginsburg. These countries have had anywhere up to 40 years of experience in population-based screening programs with cytology through Pap tests. Additionally, these countries have better access and implementation of pre-cancer treatments. In middle- to low-income countries, there are high numbers of women dying from cervical cancer. Ginsburg says that in 2017, over 250,000 women died of cervical cancer worldwide, and 9 in 10 of those women were living in a lower-income country.

Ginsburg says that the tools to prevent cervical cancer are available, and physicians do know how to cure the disease in all settings. In conjunction with academia, civil society organizations, and oncology organizations such as AACR and ASCO, the World Health Organization is aiming to help countries address this burden by finding pragmatic tailored solutions that will fit into their specific health systems.

Dr. Ginsburg on Cervical Cancer Disparities in Low-Income Countries

Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, addresses global disparities in cervical cancer.

Until now, many countries have been understandably reluctant to allocating resources toward cancer, as it has historically been seen as an expensive disease to treat, and almost impossible to prevent, says Ginsburg.

There are many opportunities to tackle cervical cancer control in low- and middle-income countries that may not be obvious, says Ginsburg. The first option is to improve the health system for cancer care more broadly, such as teaching the importance of radiotherapy and brachytherapy. It is important to include these technologies, infrastructures, resources, and training in order to address the cancer burden as a whole in these countries. Once that is done, preventing or treating a disease such as cervical cancer, which is relatively well controlled in the first-world, will be an easier task.

Ophira Ginsburg, MD, director of the High Risk/Cancer Genetics Program at NYU Langone's Perlmutter Cancer Center, addresses global disparities in cervical cancer.
 

Ophira Ginsburg, MD

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