Cervical Cancer Outreach Screening Program in Chennai, India
University of Michigan Investigator(s) and unit: Jason Bell, MD, MPH, MS, University of Michigan Medical School; Obstetrics & Gynecology
Rationale: Worldwide, cervical cancer is the third most common cancer among women. The highest burden is observed in developing countries with these countries representing 85% of the estimated 529,000 new cases and 275,000 cervical cancer deaths. In India alone, more women die from cervical cancer than in any other country. Each year cervical cancer kills around 72,000 Indian women, representing nearly 26% of deaths worldwide from cervical cancer.
Over the past 7 years, Dr. Rajan Dewar (Pathology, University of Michigan), has been able to create a cervical cancer screening model, which focuses on cost effectiveness and raising human capacity in the local area (training of non-medical personnel in cervical cancer screening). Since 2012, he has partnered with Sri Ramachandra Medical College (SRMC) and Udhavum Ullangal (UU) to raise awareness about cervical cancer screening, and to increase local capacity for cervical cancer screening. Dr. Dewar’s collaborator and co-host is Dr. S. Rajendiran (Pathology, SRMC); through this partnership Drs. Dewar and Rajendiran have studied barriers in implementing Pap smear based cervical cancer screening in both Chennai and Tamil Nadu, India. Dr. Rajendiran will serve as the onsite mentor in Chennai and oversee your day-to-day experience. New to the project this year is Dr. Jason Bell (OBGYN, University of Michigan). Dr. Bell will serve as the primary mentor for this summer project. He will travel to the research site with participating students to help everyone acclimate to Chennai and will continue to keep in contact via Skype conference calls. Additionally, Dr. Rich Lieberman (Pathology/OBGYN, University of Michigan) will lend site expertise to students. All UM faculty will be onsite at one point during the project.
Study design: Students will be exposed to the outreach cervical cancer screening programs that are currently being conducted by our partner with UU. These screening programs are working to conduct mass screenings for cervical cancer and identify those at high risk. During each of these outreach programs the students will assist with data collection, data management, and data storage. Additionally, they will assist with logistics of the screening programs and will have the opportunity to build on the basic work and data which is ongoing at UU/SMRC and UM. Since much of the outreach will be conducted in Hindi, or other local dialects, UU will provide translators to assist with the project. Students may be involved in one of three projects:
1. Massive Online Open Course (MOOC) for Paps: University of Michigan with Global REACH’s support and through DEI is developing a program to train cytoscreeners through online modules. Students will go through the modules to acquire cytoscreening skills. In addition, students will participate in effectiveness of the MOOC for Paps program – asking the question, can medical skills be acquired without a direct contact? The purpose of the MOOC is to expand knowledge without the prerequisite clinical skills and involved students would help to demonstrate if the MOOC will be successful in expanding care.
2. Glandular lesions and positive VIA: From our recent data, we have observed that many of our patients are positive for VIA, but test negative in Pap smears (High false positives). A subset of these patients appear to have glandular lesions, which are benign – we want to address the link between glandular lesions of the cervix and VIA positivity. Students on this project will assist with chart reviews and data abstraction.
3. Implementation of rapid HPV point of care test: In this collaboration, we will be comparing HPV to the current test and implement a paper chip based screening strategy. A previous pilot project with SRMC to implement our Microfluidic chip showed promise. The goal is to now expand the use of these chips during the outreach screenings conducted by UU. Students working on this project would be directly involved in evaluating samples with these chips, data collection, and analysis.