HPV screening: Saving lives in resource-poor nations

Sue J. Goldie, Roger Irving Lee Professor of Public Health

[Fall 2013 Centennial issue]

Each year, approximately half a million women develop cervical cancer, a malignancy linked to high-risk strains of the sexually transmitted human papillomavirus (HPV). In wealthy nations, cervical cancer deaths have plummeted over the six decades that the Pap smear has been used for routine screening. But in countries lacking the resources to support organized screening, the cancer kills nearly 200,000 women each year.

Pioneering work over the past 10 years by Sue J. Goldie, Roger Irving Lee Professor of Public Health and director of the School’s Center for Health Decision Science (CHDS), predicted that two promising interventions—a rapid DNA test for cancer-causing types of HPV or visual inspection after applying acetic acid to the cervix, followed by same-day treatment—could cut cancer risk by a third. Empirical data from India confirmed a 31 percent reduction in cervical cancer deaths in 150,000 women with visual screening.

Since then, the HSPH team has shown, based on analyses in 25 developing countries, that the most promising approach consists of screening women three times per lifetime, between the ages of 30 and 45. This work has led to a paradigm shift—from developing new technologies to forging new strategies for delivery.

More than 50 studies by Goldie and colleagues have contributed to position statements on this issue by the World Health Organization, influenced investment choices by foundations and public-private alliances, and framed government policies.

Most recently, Goldie and colleagues assessed the impact, affordability, and cost effectiveness of preadolescent HPV vaccination, showing that a decade’s delay in access would mean the loss of more than a million lives. They argued that if the vaccine’s price were lowered, HPV vaccination would be as cost effective as childhood immunization, one of our greatest public health buys. This catalyzed the decision of the Global Alliance for Vaccines and Immunization to prioritize HPV vaccination and influenced industry to drastically lower prices—from $100 per dose to as low as $4.50. A related program in middle- and high-income countries is being led by CHDS’ Jane Kim, associate professor in the Department of Health Policy and Management.

“Doing nothing is a choice,” said Goldie, who also serves as director of the University-wide Harvard Global Health Institute. “And that choice has tragic consequences: for individuals, for families, and for society.”

Amy Roeder