Smoking cuts the risk of developing breast cancer by 50 percent in a tiny fraction of women who carry a genetic pre-disposition for the disease, says a new study published in the Journal of the National Cancer Institute (JNCI).

The Bill and Melinda Gates Foundation announced that it will donate US $ 50 million funding for a major international initiative to boost prevention and early detection of cervix cancer in low-resource, high prevalence countries.

The International Agency for Research on Cancer (IARC), the cancer research branch of the World Health Organization, is a member of the "Alliance for Cervical Cancer Prevention" (ACCP). Together with its partners [AVSC International, the JHPIEGO Corporation, The Pan-American Health Organization (PAHO) and the Program for Appropriate Technology in Health (PATH)], they will investigate different early detection approaches for their effectiveness in preventing cervical cancer and the feasibility of implemention in low-resource countries.

Cervix cancer a major killer

Globally, cervix cancer affects 450,000 women and kills around 230,000 each year, the vast majority of whom live in developing countries. These countries are hampered by limited capabilities to implement conventional cervical cancer screening programmes by Pap smears every 2-5 years.

Monitoring and evaluating screening methods

The screening methods considered for evaluation by IARC and their partners are:

• Visual examination of the cervix after applying 4-5% vinegar solution (Visual inspection with acetic acid, or VIA): well demarcated, dense white patches on the cervix following the application of vinegar indicate the presence of precancerous changes that may become invasive cervical cancer later;
  
  
• Pap test: high quality cytology tests to identify women with precancerous conditions in the cervix (this is the test mainly used in developed countries); and
  
  
• Testing for the presence of certain types of Human Papillomavirus (HPV) that may cause cervical cancer in the long run in some infected women. There is increasing evidence that cervical cancer cannot develop in the absence of persistent HPV infection.
  

"We're particularly happy that people like Bill and Melinda Gates are willing to invest in this scientific program as they have done in the past in other areas, but also in a program whose objective is the improvement of women’s health in impoverished countries around the world", says Dr. Rengaswamy Sankaranarayanan, staff scientist at the IARC in Lyon, and co-author of the proposal.

These studies will involve a total of 120,000 women in Barshi (Central India) and Ambillikai (Southern India), which are economically backward rural areas in India. "We plan to provide VIA for 60,000 women, Pap tests for 30,000 women and HPV tests for 30,000 women. Today, the occurrence of cervix cancer in these two areas is high, and the comparative efficacy of the above approaches in preventing cervical cancers will be evident in these populations within a few years of the implementation of screening programmes", Sankaranarayanan said.

The collaborating institutions in India are the Nargis Dutt Memorial Cancer Hospital in Barshi, the Tata Memorial Centre, Mumbai, the Christian Fellowship Community Health Centre in Ambillikai, the Chittaranjan National Cancer Institute, Calcutta and the Regional Cancer Centre, Trivandrum. In Africa, the collaborating institution is the School of Medicine of the University of Ibadan (Nigeria).

« When completed in five years, this study should provide a clear indication of the most promising and cost-effective means of preventing at least 100,000 deaths from invasive cervical cancer in the world annually » added Dr Paul Kleihues, Director of the IARC.

An international effort to collect cancer data globally

"We also plan to work with a world-wide network of cancer information systems to help in the collection of data on occurrence of and survival from cervical cancer by developing and distributing a user friendly software called ‘CANREG-4’. This will help to create a global cervical cancer database on a continuing basis, to evaluate screening and prevention of cervical cancer by tracking the occurrence, stage distribution, and survival", Dr Max Parkin, Chief, Descriptive Epidemiology Unit at IARC, added. "New collaborations will be established in regions where currently there is no available information. A software to help in the management and evaluation of cervical cancer screening programmes will also be developed thanks to this important funding.

Training an active component of the Alliance initiative

In collaboration with other Alliance partners, IARC will organise ‘international schools of diagnosis and treatment of cervical precancers’ to train ‘master trainers’ in different countries in colposcopy, cytology/pathology, and treatment of precursor lesions. Very limited expertise on diagnosis and management of cervical precancers exists in many high-risk countries. A multi-regional core faculty will be identified to conduct the training. Three schools will be organized, one each in Asia, Africa and Latin America. Training of these ‘master trainers’ from different countries will be made possible through fellowships, and active technical support will be provided to establish national training facilities in different countries.

An emphasis on research

The International Agency for Research on Cancer is committed to conducting research into the causes of cancer and cancer prevention, and co-ordinates a number of international efforts in this domain.

The Bill and Melinda Gates Foundation

The Bill and Melinda Gates Foundation places a major focus on helping to improve people’s lives through health and learning. Led by William H. Gates, Sr. and Patty Stonesifer, the Bill and Melinda Gates Foundation is located in Seattle (Wash., USA). Significant Foundation projects include: the Bill and Melinda Gates Children’s Vaccine Program, a $100 million commitment to speed the delivery of lifesaving vaccines to children in developing countries; the Maternal Mortality Reduction Program, a $50 million commitment to prevent pregnancy-related deaths of women in developing countries; and the Gates Millennium Scholars program, a $50 million annual commitment for 20 years to provide financial assistance to high-achieving minority students who are in severe financial need and would otherwise be excluded from higher education.

For further information please contact Dr Nicolas Gaudin, Chief, IARC Communications ( )