Fighting HPV and Cervical Cancer

By Jennie Saia, Communications Specialist for the UNC Gillings School of Global Public Health, and Courtney Mitchell, Director of Communications for UNC Women’s Care

So far, the world has eradicated only one human disease: smallpox.

Three UNC researchers want to add cervical cancer to that list.

Death from cervical cancer is largely preventable, but death rates from the disease remain higher than they should be, especially in countries where the basic measures needed to prevent the disease are scarce. We already know that a combination of vaccination against human papillomavirus (HPV), routine screenings and the use of standard treatments work – but only if women have access to them.

With three different, interweaving approaches, these UNC researchers hope to eliminate HPV within a few specific populations. After that? They’ll share their lessons learned and inform future interventions around the globe, taking great strides toward worldwide eradication.

Jennifer Smith, PhD, directs Cervical Cancer-Free America.

Jennifer Smith, PhD, directs Cervical Cancer-Free America.
Photo courtesy of Brian Strickland

Access to Screening
Jennifer Smith, PhD, is a professor of epidemiology in the UNC Gillings School of Global Public Health. She also is affiliated with the University’s Lineberger Comprehensive Cancer Center, the Center for Aids Research (CFAR) and the Center for Women’s Health Research.

Smith, who has researched cervical cancer since the mid-1990s, says she cannot stand by while women suffer needlessly from a preventable disease. HPV causes the vast majority of cervical cancer cases around the world – leading to the deaths of more than 266,000 women annually – despite the fact that a highly effective HPV vaccine has existed for years.

Her fight against HPV has led to her involvement with the Cervical Cancer Free Coalition, which promotes vaccination, screening and education as the core tools to prevent cervical cancer. The coalition has state-, country- and global-level goals. As director of the sub-program “Cervical Cancer-Free America,” Smith has helped eight states, including North Carolina, to implement programs, research and policy activities tailored to their unique settings and populations.

Now, she is bringing local and global research together as she works to reach underscreened women in N.C. through the use of at-home, self-collection testing kits – the exact same kits she is field testing at three sites in Kenya.

“This is part of a larger push to improve diagnostic access around the globe,” Smith says. “If a woman can simply gather her own sample with a brush and mail that in for testing – and the results are just as valid as if she’d traveled to a clinic for a full pelvic exam – that changes everything, especially in developing countries.”

“UNC is leading the charge around this idea of cervical cancer elimination,” she adds. “Maybe when we get to a one-dose HPV vaccine, we can start to think about true eradication. Meanwhile, it’s incredibly motivating to imagine that future, one in which women have freedom from this preventable disease.”

Jeff Stringer, MD, works to improve cervical cancer prevention and care in Zambia. Photo courtesy of Jon Gardiner/UNC-Chapel Hill

Jeff Stringer, MD, works to improve cervical cancer prevention and care in Zambia.
Photo courtesy of Jon Gardiner/UNC-Chapel Hill

Access to Coordinated Care
Is getting rid of cervical cancer an ambitious goal? Yes, says Jeffrey Stringer, MD, professor of obstetrics and gynecology and director of the UNC Global Women’s Health division.

“But – it’s not insurmountable,” adds Stringer, who also holds a position as adjunct professor of epidemiology in the Gillings School. “We absolutely can eliminate cervical cancer.”

A coordinated effort is needed to make such widespread change, and this is what Global Women’s Health faculty work toward in countries where they aim to change the landscape of health care for women.

“In Zambia, we need the screenings and we need the surgeries. We also need enough providers,” Stringer says.

For more than 20 years, Global Women’s Health faculty have been working with Zambian partners to do exactly that: improve maternal health by building better care models and training more providers. Based on the success of the team’s previous projects to treat HIV, Stringer has identified two viral next steps:

1) working with local governments to launch public health campaigns about routine screenings and
2) widespread dissemination of the HPV vaccine.

To save more women’s lives sooner, however, what Zambia really needs is a new women’s hospital. The Global Women’s Health team currently is partnering with University Teaching Hospital in Lusaka, Zambia, and the Zambian government to build a new center for women’s health care. The hospital not only will increase capacity for treating women with complex gynecologic cancers and help facilitate safe childbirth, but also will serve as the launching station for the next generation of OB-GYN doctors in Zambia by offering specialized training opportunities.

Showcasing the interdisciplinary work found at the heart of most UNC research, a team of students from UNC’s Kenan-Flagler Business School traveled to Zambia in 2016 to study the area’s infrastructure and current health-care models. Their trip resulted in a 150-page project plan for the hospital that considered everything from high-tech lab space and pharmacy needs to construction specifics.

“At UNC, we’re not afraid to go after big problems – big problems have solutions,” declares Stringer. “Those solutions are only possible, though, when we work side-by-side with our African partners to amplify our strengths as one coordinated team that is dedicated to improving the health of all women.”

Noel Brewer, PhD, works to increase the rates of HPV vaccination. Photo courtesy of Brian Strickland

Noel Brewer, PhD, works to increase the rates of HPV vaccination.
Photo courtesy of Brian Strickland

Access to Vaccination
Noel Brewer, PhD, professor of health behavior in the Gillings School, studies how to increase HPV vaccination rates by improving how providers recommend the vaccine.

In a recent study, he found that training physicians to use presumptive announcements with parents who are considering the HPV vaccine for their children increased uptake, while holding open-ended conversations with parents was less effective.

“Providers have a lot to talk about during routine visits,” Brewer says. “Brief statements that the child is due for the HPV vaccine can improve parental uptake. Parents who have follow-up questions can then ask them.”

In 2016, in the United States, 60 percent of teens aged 13 to 17 years received at least one dose of the cancer-preventing HPV vaccine. Despite national guidelines, however, not all these teens completed the vaccination series. Brewer not only wants to improve these numbers, but also help to bolster global roll-out of the vaccine.

“In the U.S., we provide HPV vaccines mostly in medical clinics. The challenge has been getting providers to recommend the vaccine clearly at every visit,” Brewer explains. “Other developed countries quickly reached high rates of vaccination through giving away HPV vaccine for free in schools. But for developing countries, the main challenge has been not having any vaccine at all. Building the infrastructure (such as the vaccine being available and free) is a key first step.”