CAPE: CAPE is BHI’s Cervical cAncer Prevention Program in El Salvador. In El Salvador, cervical cancer is the leading cause of cancer death among women. The CAPE project has been a joint effort between the Salvadoran Ministry of Health (MOH) and Basic Health International. It is the first time low-cost HPV DNA testing is being used in a national screening program. The success of BHI’s mission to eradicate cervical cancer is deeply tied to the success of the CAPE program. Each phase of the program turns more control over to the MOH and it is anticipated that by 2019, the program will be entirely run by the MOH. Until that time, BHI will continue to provide MOH clinical and technical support.
careHPV: careHPV is an HPV DNA test developed by Qiagen (a health technology company), with support from the Bill and Melinda Gates Foundation, designed specifically for use in low-resource settings. careHPV offers testing accuracy that has never been achieved before in low-resource settings.
Cervical Cancer: Cervical cancer is caused by a very widespread virus known as HPV, or Human Papillomavirus. Abnormal cells multiply first in the cervical lining and cause high-risk lesions or pathological growth. At a more advanced stage, this cancer may spread to nearby organs and eventually cause death.
Cervix: The cervix is the lower part of the uterus that connects to the vagina. This is the organ that dilates (opens) during childbirth.
Chemotherapy: Chemotherapy is the use of medicines or drugs to treat cancer. Surgery and radiation target cancer cells in a certain area, but chemotherapy can work throughout the whole body.
Cryotherapy: Cryotherapy is a gynecological treatment used to freeze and destroy abnormal cervical cells. Cryotherapy is used to treat pre-cancer and is not a treatment for cervical cancer. Cryotherapy has an overall cure rate of approximately 85-90%, similar to other treatment methods.
Eradication: The completely removal of something; in our case, we hope to completely remove cervical cancer from the world.
High-Risk HPV: High Risk HPV refers to strains of the HPV virus that can and are known to cause cancer.
HPV: Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI). HPV is so common that nearly all sexually active men and women are exposed to it at some points in their lives. There are more than 100 strains of HPV, with at least 13 high-risk strains known to cause cervical cancer. Persisting HPV infection can lead to precancerous lesions within two to five years and cervical cancer within 10 – 20 years. HPV is responsible for almost 100% of cervical cancer.
HPV Testing: The goal of HPV DNA testing is to detect the presence of genetic material from certain high-risk strains of HPV in cells from a woman’s cervix. HPV testing involves the collection of a cervical or vaginal sample using a swab. The swab is then tested for the presence of HPV DNA. Nearly all cases of cervical cancer develop from persistent, untreated HPV infection. HPV testing, linked with timely treatment, can prevent cervical cancer.
HPV Vaccine: There are currently three vaccines that protect against HPV, Gardasil-4, Gardasil-9 and Cervarix. All of these vaccines protect against HPV types 16 and 18, which together account for approximately 70% of all cervical cancer cases worldwide. Gardasil-4 also protects against HPV strains 6 & 11, which are 90% responsible for condyloma (warts). The newer Gardasil-9 adds protection of an additional 5 high risk strains of HPV, so that Gardasil-9 protects against >90% of HR HPV that cause cervical cancer. Both Gardasils and Cervarix are given in three doses over a period of 6 months, and cost approximately $500 in the U.S. To be effective, these vaccines must be administered before the exposure to HPV infection; so ideally, before sexual debut. The HPV vaccine is recommended for preteen boys and girls to protect against cervical and other cancers.
Low- and Middle-Income Countries (LMIC): World Health Organization (WHO) Member States are grouped into low and middle-income countries (LMIC) by WHO region and are based on the World Bank list of analytical income classification of economies for fiscal year 2014. In general, people in LMIC have lower life expectancy, less education, and less money, which translates into less access to basic and lifesaving health care services than those in high income countries.
Mortality Rate: A mortality rate is a death rate used to measure the number of deaths, in general or due to a specific cause, in a particular population, scaled to the size of that population, per unit of time.
OB/GYN: An obstetrician/gynecologist is a physician specialist who provides medical and surgical care to women and who has particular expertise in pregnancy, childbirth, and the female reproductive system.
Pap Test: A Pap test, also known as a Pap smear, is a test used to detect cancer of the cervix. A provider uses a device called a speculum to widen the opening of the vagina so the cervix and vagina can be examined. Cells are collected from the cervix and sent to a lab for testing.
Primary Prevention: To prevent a disease from ever occurring. In the world of cervical cancer, vaccines are considered primary prevention.
Radiation Therapy: Radiation therapy is a treatment method that uses high-energy radiation to shrink tumors and kill cancer cells. X-rays, gamma rays, and charged particles are types of radiation used, and this treatment works by damaging the DNA of cancer cells. Cancer cells with DNA damage beyond repair stop dividing or die.
Secondary Prevention: HPV typically takes 10-20 years from the time of exposure to the time of invasive disease, allowing a large window of time for women to be screened and treated before the disease becomes too advanced; this is secondary prevention. Enabling women around the world to have low-cost methods of screening and treatment is a challenge on which BHI is working.
Tertiary Prevention: Lessening the impact of a long-term disease. Women with invasive cancer should have access and be offered chemotherapy, radiation, and palliative care.
VIA: Visual Inspection with Acetic Acid is a low-tech, low-cost method of cervical cancer screening. 3-5% acetic acid (vinegar) is added to the cervix and a health care provider looks for areas that change color. Normal cervical tissue is unaffected by the application of vinegar, but tissue in cervical pre-cancer turns white with visible borders.