Wednesday, 26 April 2017

Cervical Cancer Therapy Pioneered In Dundee Offers New Hope In Malawi

Written by Feb 28, 2017

A cervical cancer treatment pioneered in Dundee has been hailed as a low-cost alternative to tackle the disease in developing countries after the success of a three-year screening programme in Malawi.

The Scottish Government-funded project used a thermo-coagulation machine to "burn off" cancer cells in female patients instead of cryotherapy, which freezes the cells.

Thermo-coagulation was pioneered in Dundee but over time it has been gradually replaced by the more popular cryotherapy, leading to the NHS equipment to gather dust in hospitals.

However, it has been given a new lease of life as part of a groundbreaking screening project based at Nkhoma Hospital in Malawi which sought to drive up testing and detection rates for the disease.

Professor Heather Cubie, an eminent Scottish virologist and expert in human papilloma virus (HPV) - the infection which causes cervical cancer - said it offered women in Malawi access to a cheaper and easier treatment.

Prof Cubie said: "Dundee has got more experience than anywhere else in the world in using thermo-coagulation but many places would consider it old technology because it's been around for decades.

"We discovered that the NHS was not using it; it's using newer technology, so their equipment was lying in cupboards.

"The World Health Organisation recommends a treatment called cryotherapy. That's like liquid carbon dioxide which freezes the area to kill off the abnormal cells.

"But the problem with cryotherapy is that it's difficult to get hold of in Malawi - it's very expensive, breaks easily and isn't portable - whereas thermo-coagulation machine is a little instrument. You can almost hold it in your hand.

"We've taken it to tiny little clinics, we've used it in a tent, we've used it attached to a car battery instead of requiring electricity, and it's very very cheap to deliver the treatment.

"Each treatment, after you've bought the instrument, costs pennies. So it has revolutionised what can be done and although the WHO has not yet recommended this as an alternative, Malawi is saying it can be used instead as a consequence of the work we've done."

The African nation has the highest rates of cervical cancer in the world with an incidence of around 76 cases per 100,000 population - around ten times UK levels - and mortality of 50 per 100,000, according to the most recent data from the World Health Organisation. It is also the biggest killer among women of reproductive age.

Despite the high incidence of the disease, screening is not widely available unless the women can pay for it and the HPV vaccine is not offered.

Prof Cubie added: "On top of that there are some cultural issues. Quite often husbands won't allow their wives to be seen gynaecologically. In some parts [of Malawi] they use a lot of herbs which can abrade the cervix, so that can make it more likely that the HPV will cause an infection."


Comparatively high rates of HIV and cultural practices where girls as young as nine are routinely raped by paid sex worker, known as a "hyena", as part of a "cleansing" rite-of-passage, also contribute to Malawi's high incidence of cervical cancer because it can expose their cervix to the HPV virus before it is properly formed.

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