28 November 2013

South Africa: One-Day Cervical Cancer Test Could Soon Be Available in South Africa

A low-cost, point-of-care test to detect cervical cancer may be available in South Africa by 2018.

Cervical cancer kills more South African women than any other type of cancer and one in every 39 women in the country will be diagnosed with it in her lifetime.

Cervical cancer or its precursor, abnormal cervical cells, are generally detected using a pap smear test - where cells are lifted from the cervix using a swab and sent to a laboratory for testing. If abnormal cells are detected, a biopsy has to be done in which a small tissue sample is cut from the cervix and sent back to the pathologist for further testing.

Depending on these results, the woman will receive treatment or not. This process can take up to several weeks and requires a woman to make three trips to her health care provider.

"You can lose a lot of patients through follow-up, and the best method is to do everything in one visit," said Kathleen Schmeler, an associated professor at the MD Anderson Cancer Centre at the US University of Texas.

She added that in many African countries, a lack of laboratories and pathologists has also limited women's access to pap smears.

Schmeler presented a new devise, called the high-resolution microendoscope (HRME), which could provide women with same-day pap smear results without the need for laboratories at the AORTIC International Cancer Conference in Durban last week.

"With the HRME everything can be done in one day, and you no longer need a specialist and a lab and a pathologist," said Schmeler, who was part of the team of researchers at MD Anderson's Department of Gynaecologic Oncology and Rice University's Department of Bioengineering that developed the HRME.

The device consists of a digital florescent microscope, a fibre optic probe, a cell phone and battery pack. The probe is placed on the cervix and transmits images of cells to the cell phone screen. Normally, pathologists only see these types of images beneath a microscope.

"You can easily identify irregular (cells) by their shape and how close they are together," Schmeler told Health-e. "To remove the element of human error, (the HRME) also comes with software that does the calculations and tells you if (cells are) normal or not."

Costing about R5 000, the HRME could potentially bring relief to overburdened pathology services in South Africa and other African countries. The United States has one pathologist for every 20 000 patients, but in South Africa there are only one for up to every 500 000 patients. In other African countries, there may be just one pathologist serving several million people.

The HRME has shown promising results in several small and medium pilot studies, and large studies are planned for South Africa soon.

"We are very optimistic about this new technology," said African Cancer Institute Director Vikash Sewram. "This is exactly what we need at primary health care facilities - a point of care test."

Sewram said he believes the devise may not only be useful in screening for cervical cancer, but also oesophageal cancer, for which there is currently no form of screening.

"There is a lot of benefit to this technique, we just need to validate it to ensure that in our population it can work just as well as the current gold standard, the pathological diagnosis," he added. "I see no reason that if it does stand up to the test that it will not be rolled out in the country."

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