Hi, my name is Meredith and I am helping to raise funds to assist Dr. Susan Aycock further her medical ministry eliminating cervical cancer in underdeveloped countries. Each of these thermocoagulators, a thermal ablation device to treat cervical cancer, are $1600, any and all donations would greatly benefit those who otherwise could not receive treatment.
In August 2020, the WHO passed a resolution calling for the elimination of cervical cancer as a public health problem by 2030. The low-medium income countries (LMIC) represent 90% of the cervical cancer deaths worldwide, where it is the number one cause of cancer death. Strategies to achieve this aggressive target include cervical screening of 70% of all women twice by ages 35 and 45 as well as 90% treatment of precancerous cervical disease. Several screen-and-treat or screen-triage-treat models exist which are appropriate for LMIC. In each of these models, the technique of Visual Inspection with Acetic Acid (VIA) is essential to reach measurable outcomes.
The technique of VIA involves application of 5% acetic acid in the form of common table vinegar to the exposed cervix with the plan to ablate the tissue if an abnormal pattern develops that is appropriate for such local treatment. To be eligible for immediate ablation, a lesion must be visible in its entirety, cover less than 75% of the cervix, have the squamoclumnar junction fully visible, and lack signs of adenocarcinoma.
When VIA is used as the initial screen, it is found to be well tolerated by the patient and provider, low cost, and provides the opportunity for same-day treatment, which avoids loss to follow-up. The downside of VIA screen is that as a technique, it has a low sensitivity between 55-80% but even with this carries a 38% reduction of CIN3+ over a 3-year period.
When VIA is used as a triage, it is best coupled with a high sensitivity test such as high-risk Human Papilloma Virus (hrHPV). However, even when the HPV is positive, the patient must still be visualized to be sure that the above-mentioned criterion are met to determine appropriateness for treatment. Since point-of-care testing for hrHPV testing is still not widespread there is loss to follow-up to locate the patient and provider, especially with the advent of self-collection. Overall, it demonstrates a 3-year reduction of CIN3+ of 77%.
What follows is a curriculum to equip a medical provider to contribute to this WHO goal by providing an overall understanding of WHO strategy and targets. In addition, it will allow a student to approach mastery of cervical screening and treatment of precancerous lesions over the course of a one-month rotation. The source of the curricular materials comes from WHO-sanctioned content consisting of three web-based modules. The workshop will provide hands-on experience using ablative tools to include the thermal ablation gun.
Dr. Aycock is setting up a program in Honduras for others to learn how to screen and treat cervical pre-cancers. Having a thermal ablation device to leave with the community would complete their training program.