A Viable Solution for a See and Treat Paradigm for Cervical Pre-cancer in Africa

非洲宫颈癌前病变“即见即治”模式的可行解决方案

• 批准号: 9302705
• 负责人: Nirmala Ramanujam
• 金额: $ 20.22万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9302705
• 关键词: Academic Medical Centers; Acetic Acids; Acids; Adoption; Affect; Africa; Algorithms; Biopsy; Biopsy Specimen; Calibration; Capital; Care Technology Points; Caring; Cervical; Cervical Cancer Screening; Cervical dysplasia; Cervix Neoplasms; Cervix Uteri; Cessation of life; Clinic; Clinical; Clinical Research; Cold Therapy; Collaborations; Colposcopes; Colposcopy; Columnar Epithelium; Communities; Consumption; Country; Data; Devices; Diagnosis; Diffuse; Disease; Early Diagnosis; Early treatment; Ensure; Eye; Goals; Gold; Guidelines; Hand; Health; Hemoglobin; Histopathology; Hospitals; Human Papillomavirus; Human Resources; Image; Incidence; Income; Lesion; Link; Loop electrosurgical excision procedure; Maintenance; Malignant neoplasm of cervix uteri; Measurement; Measures; Medical center; Methods; Microscope; Modeling; Morphology; Optics; Oxygen; Pap smear; Pathologist; Pathology; Patients; Performance; Persons; Phase; Physicians; Physiology; Pilot Projects; Premalignant; Primary Health Care; Procedures; Public Health; Qualitative Methods; Recording of previous events; Regulation; Reproducibility; Research; Research Infrastructure; Resources; Sensitivity and Specificity; Site; Specificity; Spectrum Analysis; Spottings; Stratification; Stratified Squamous Epithelium; System; Tanzania; Technology; Testing; Time; Tissues; Training; Visible Radiation; Vision; Visit; Visual; Woman; absorption; arm; base; cervical cancer prevention; clinical investigation; cost; density; digital; experience; global health; improved; in vivo; low and middle-income countries; mortality; neovascularization; portability; pressure; public health relevance; screening; sensor; spectroscopic data; standard of care; success; temporal measurement; tumor progression

 DESCRIPTION (provided by applicant): There is a critical global need for a See and Treat paradigm for cervical cancer that is effective in low-and middle-income communities (LMIC). Guidelines have been written by the Alliance for Cervical Cancer Prevention (ACCP) on strategies for screening cervical cancer in resource-limited settings. Visual inspection with aceti acid (VIA) or VIA with low power magnification (VIAM) combined with cryotherapy or Loop Electrosurgical Procedure (LEEP) appears to be the most viable option for reducing the mortality associated with cervical cancer in the low and middle income countries (LMICs). The colposcope, a low magnification microscope has been historically used for (VIAM) in women with an abnormal Pap smear. Sites that display acetowhitening are biopsied and evaluated by a pathologist. The cervix is treated with LEEP if pre-cancerous lesions are found. In LMICs, this approach is not practical due to the lack of infrastructure and resources and also due to patient attrition at each level of care. Thus it is critical to develop point of care technologies that enale a see and treat paradigm in a single visit within the local communities where the women live. Our long-term goal is to leverage community-clinics as a way to bring early detection and treatment of cervical pre-cancer to as many patients as possible in LMICs particularly in places where hospitals are not easily accessible. We propose to implement a portable, point of care technology that consolidates the colposcope into a hand-held device and with an integrated visible light diffuse reflectance optical spectroscope that rapidly measures oxygen saturation, neovascularization and the morphological composition of acetowhitened sites identified by VIAM that are known to be altered with neoplastic progressions. The colpospectroscope will enable surveillance with VIAM followed by spectroscopy (in lieu histopathology on a biopsy specimen) such that cervical dysplasia can be diagnosed "on the spot" thereby enabling a see and treat paradigm for women with cervical pre-cancer with cryotherapy and/or LEEP in at the same visit.