PIH ramps up cervical and breast cancer projects

This year, thousands more women living in poverty will have access to cervical and breast cancer screenings and treatment because of a recent PIH initiative.

	In Guatemala, a patient is screened for cervical cancer using Visual Inspection with Acetic Acid.

In August 2010, Dr. Paul Farmer announced that PIH would integrate cancer care across several of its sites. In partnership with Boston’s Brigham and Women’s Hospital, the Jeff Gordon Children’s Foundation, the Avon Foundation for Women and the Lance Armstrong Foundation, PIH began testing women and girls for various types of cancer in Guatemala, Haiti, Lesotho, Malawi and Rwanda. In the past 18 months, thousands of women have been screened and hundreds treated.

To ramp up these projects, PIH is training local health care workers to test for cervical and breast cancer and building the infrastructure needed to offer both prevention and treatment in places where they’ve never existed.

A simple swab to detect cervical cancer

Since 2010, PIH clinicians and nurses in Haiti, Lesotho, Malawi, and Rwanda, and at ETESC (the PIH-supported project in Guatemala) have used Visual Inspection with Acetic Acid (VIA) to test women for cervical cancer. The procedure is incredibly simple. Clinicians swab a small amount of acetic acid – common vinegar – across the cervix. Normal cervical tissue remains unaffected by the solution, but damaged tissue found in pre-cancerous or cancerous lesions turns white.

	In Haiti, young girls receive doses of Gardasil.

To treat these pre-cancerous lesions – which could develop into cervical cancer – clinicians learned how to use cryotherapy, which removes the lesions by freezing them with liquid carbon dioxide or nitrous oxide. 

"We have screened thousands of women since last year and even found some with advanced cases of cervical cancer,” said Dr. Jacklin St Fleur, PIH’s director of women's health in Rwanda. “We sent seven women for radiotherapy in Uganda and we've so far put over seventy others on treatment.”

Hundreds of women have also been tested at facilities in Guatemala, Lesotho and Haiti.

In early 2010, PIH completed a pilot project aimed at guarding young women against human papillomavirus (HPV)—the primary cause of cervical cancer – with Gardasil, the HPV vaccine. The project succeeded in vaccinating 2,884 girls between the ages of 10 and 13. More than 75 percent of the girls enrolled in the program received all three required doses of the vaccine -- a completion rate higher than those recorded in the US and other developed countries -- even though the devastating earthquake struck Haiti between their second and third doses.

Addressing breast cancer in Haiti

Since starting a weekly breast cancer clinic in June 2012, PIH staff has diagnosed some strikingly advanced cases of breast cancer – an arresting reminder of the work that remains to be done, from basic education to health care access.

	In Haiti, PIH clinicians learn how to give breast exams at a training.

With generous support from the Avon and Lance Armstrong Foundations, PIH initiated a weekly breast cancer clinic at Clinique Bon Sauveur in Cange in the Central Plateau of Haiti in June 2011. Since then, PIH’s Dr. Damuse has performed about 12 to 15 exams each week. Of the women tested, three to four women are diagnosed with cancer weekly. 

Women who have early forms of cancer are offered care at PIH’s hospital in Cange, Haiti. Women with more advanced forms of the disease are sent to the Dominican Republic for care.

Though the challenge is a big one, this is only the beginning of ZL’s cancer initiative. Beginning in late 2011, Dr. Damuse began assembling a team of nurses and a social worker to help provide psychological support to patients with cancer, organizing surgeries, and coordinating care outside of the clinic.

The broader situation

The toll of death and suffering from cancer in developing countries has increased sharply in recent decades. So has the disparity in the allocation of resources for cancer care and control between rich and poor countries.

More than 4 million of the 7.6 million cancer deaths in the world each year now occur in developing countries – and more than half are preventable. The result is a drastic "5/80 disequilibrium" in which only 5 percent of the global resources allocated for cancer go to the developing countries that bear more than 80 percent of the burden of disease.  

Read more in Paul Farmer’s call-to-action in the medical journal The Lancet.
Watch a video of Francine Tuyishime, a young woman treated for cancer at a PIH hospital in Rwanda.