Cancer Detection, Diagnosis, and Treatment Technologies for Global Health: Supporting the development of low-cost technologies for LMICs
, by Paul Pearlman
It is estimated that nearly two-thirds of the 7.6 million annual cancer deaths in the world occur in low- and middle-income countries (LMICs). Furthermore, the incidence rate of cancer is on the rise in populations of many LMICs, with substantial inequalities in cancer survival rates across the world. Access to cancer prevention, screening, detection, diagnosis, and treatment are significant challenges in many LMICs, especially in rural areas with limited infrastructure.
Prevention, early detection, and treatment are vital to the successful treatment of many cancers in LMICs. However, much of this depends on effective technologies, many of which are not suitable for use in low resource settings due to expense, dependency on extensive medical infrastructure, or both. This situation warrants translational efforts to develop appropriate technologies that could help improve treatment of cancers in resource-poor settings.
NCI’s Center for Global Health (CGH) supports the development and validation of low-cost, portable technologies with the potential to increase early detection, diagnosis, and non-invasive or minimally invasive treatment of cancer. In that spirit, CGH is excited to be funding six exceptional awards under RF-CA-13-015: Cancer Detection, Diagnosis, and Treatment Technologies for Global Health (UH2/UH3). These awards will support the following technologies:
- A low-cost enabling technology for image-guided photodynamic therapy of oral leukoplakia - Jonathan Celli and Tayyaba Hasan, Massachusetts General Hospital;
- High resolution microendoscopy for cervical cancer diagnosis - Kathleen Schmeler, MD Anderson Cancer Center and Rebecca Richards-Kortum, Rice University;
- Adaptation and testing of the CryoPen cryotherapy device for treating cervical neoplasia for use in low-income settings - Miriam Cremer, Magee-Women’s Research Institute and Foundation;
- Adapting the Cepheid GeneXpert test to detect HPV - Louise Kuhn, Columbia University;
- A low-cost test for hepatitis C virus to identify patients at risk for developing hepatocellular carcinoma -Robert Murphy, Northwestern University; and
- Assessing the performance, safety and efficacy of a new cryotherapy device using liquid CO2 - Jean Anderson, Johns Hopkins.
Additionally, CGH is proud to have partnered with the National Institute of Biomedical Imaging and Bioengineering (NIBIB). NIBIB has expanded funding to sponsor a seventh award to the Dr. Susan Love Research Foundation, proposing to develop low-cost, portable computer-aided detection and diagnostic (CADD) tools for non-invasive screening of breast cancer patients in remote locations in LMICs.
Description of Projects
Low-cost enabling technology for image-guided photodynamic therapy of oral leukoplakia: Oral cancer accounts for 30% of India’s reported cancers. This project will bring a well-established photodynamic therapy (PDT) and activate it by low cost commonly available battery technology to treat premalignant lesions in the mouths of Indians who chew tobacco or tobacco-related products. PDT is a low cost therapy that can eradicate such early lesions and if adopted as planned will drastically reduce the incidence of malignant neoplasms of the mouth.
High resolution microendoscopy for cervical cancer diagnosis: This work will optimize and validate a micro endoscope that can acquire real-time images of the cervix at very high resolution for real-time diagnosis of cervical cancer in low resource settings. This endoscope will be portable and battery operated with a fiber optic imaging system. The whole system will be optimized, validated and incorporated into a mobile diagnostic and treatment unit and field tested in Brazil in a mobile clinic. This device will provide cervical cancer screening and diagnosis to areas with no access to real-time screening and where the normally used methods (pap smear) are not available and impractical, leaving women with very few options for diagnosis of a cancer that is preventable and treatable if diagnosed early.
Adaptation and testing of the CryoPen cryotherapy device for treating cervical neoplasia for use in low-income settings: Investigators will adapt the CryoPen, which is used to treat cervical cancer by freezing suspicious lesions, into an inexpensive and easily transportable device (powered by car batteries) for use in low and middle income countries by healthcare workers with minimal training. The CryoPen draws heat from the cervical tissue causing freezing and crystallization of the intracellular water, producing death of the tumor cells. The investigators have established collaborations to validate and deploy the CryoPen in Peru and Columbia.
Adapting the Cepheid GeneXpert test to detect HPV: Partnering with Cepheid, a major diagnostics manufacturer, and investigators from the University of Cape Town, the Kuhn team seeks to determine if a diagnostic that detects diverse HPV genes can be adapted to distinguish invasive carcinoma from inconsequential cervical neoplasms. If successful, this project will not only adapt a simple technology to a third world country but also determine how the diverse population of South Africa differs from that of Europe and the United States and contribute to better utilization of medical resources to treat cervical carcinoma.
Low-cost test for hepatitis C virus to identify patients at risk for developing hepatocellular carcinoma: The device developed in this project will aid in identifying patients at risk of developing HCC, and in monitoring treatment outcomes of the viral infection. A tiered pricing for hepatitis drugs for use in LMICs negotiated by NGOs, making the drugs available at a fraction of the cost in the USA, along with the availability of the low cost technologies developed in the proposal to detect active viral infection will prevent progression of hepatitis to HCC, and significantly reduce HCC incidence.
Assessing the performance, safety, and efficacy of a new cryotherapy device using liquid CO2: Teams from Johns Hopkins University, the international clinical research organization, Jhpiego, and the Cancer Institute Foundation in the Philippines will determine whether a novel low cost cryosurgery device driven by liquid CO2 can treat cervical dysplasia, the premalignant lesion that leads to invasive carcinoma. Dr. Anderson’s approach is novel because liquid CO2 is widely available in LMICs for such carbonated beverages as Coca-Cola and Pepsi. The device achieves temperatures as low as those achieved with liquid nitrogen devices, which are very expensive. If successful, this project will insure a lower cost approach to ablation of neoplasia, a major health hazard in the Philippines.
Low-cost, portable computer-aided detection and diagnostic (CADD) tools for non-invasive screening of breast cancer: The CADD system will be used to locate and distinguish between clearly benign and potentially malignant palpable breast lumps in premenopausal women in Mexico. Novel algorithms will be developed to enhance ultrasound images and to enable CADD. These algorithms will be combined with low-cost portable ultrasound transducers and hardware platforms (including mobile phones and tablets). The goal of the overall technology is to enable minimally-trained health care workers to hold the ultrasound probe over the palpable lesion and tell the woman whether she should obtain a biopsy.
While the treatment of cancer in LMICs is challenging, early detection and minimally invasive treatments are more likely to yield successful outcomes. Through this opportunity, CGH is able to support the development of low-cost, portable technologies, which have the potential to increase early detection, diagnosis, and non- or minimally-invasive treatment of cancer, for LMICs.
NCI has announced a Notice of Intent to Publish a re-issuance of this funding opportunity. For more information, see NOT-CA-14-055.