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.

Public Health Relevance

The goal of this proposal is to develop a portable, low power consumption spectroscopic device that can be used to obtain accurate and reproducible quantitative measurements of absorption and scattering coefficients with applications to screening of cervical cancers for global health. The proposed research is significantly relevant to public health due to the potential to contribute to the improvement of cervical cancer, and thus the reduction of mortality rate worldwide.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA195500-02
Application #
9090047
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Tandon, Pushpa
Project Start
2015-07-01
Project End
2018-06-30
Budget Start
2016-07-01
Budget End
2017-06-30
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Duke University
Department
Biomedical Engineering
Type
Biomed Engr/Col Engr/Engr Sta
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
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Lam, Christopher T; Mueller, Jenna; Asma, Betsy et al. (2018) An integrated strategy for improving contrast, durability, and portability of a Pocket Colposcope for cervical cancer screening and diagnosis. PLoS One 13:e0192530
Asiedu, Mercy Nyamewaa; Agudogo, JĂșlia; Krieger, Marlee S et al. (2017) Design and preliminary analysis of a vaginal inserter for speculum-free cervical cancer screening. PLoS One 12:e0177782
Mueller, Jenna L; Asma, Elizabeth; Lam, Christopher T et al. (2017) International Image Concordance Study to Compare a Point-of-Care Tampon Colposcope With a Standard-of-Care Colposcope. J Low Genit Tract Dis 21:112-119
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Lam, Christopher T; Krieger, Marlee S; Gallagher, Jennifer E et al. (2015) Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings. PLoS One 10:e0135869