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Joining Together to Fight Cervical Cancer

GAPConnect -

Collaborating to Battle Cervical Cancer: Instituto de Cancerología Las Américas and MD Anderson

Forty years ago, cervical cancer was the leading cause of cancer death among women in the United States. As a result of education and prevention, the risk of those same women has decreased by 74% (Centers for Disease Control (CDC)).

The same is not the case in the developing world, where 80-85% of all cervical cancer cases arise and the disease maintains its rank as the number one cancer killer of women. The highest incidence globally occurs in Latin America, Africa, India and parts of Asia (American Cancer Society).

This simple fact is the impetus behind a growing collaboration between researchers at The University of Texas MD Anderson Cancer Center and the Instituto de Cancerología - Clinica las Américas (IDC) in Medellin, Colombia.  In Colombia 30 to 40 women per 100,000 will develop cervical cancer, compared to less than 6.5 per 100,000 in the United States, and for many of those, diagnosis will be at a late stage in the disease (American Cancer Society).

“It is the culture in Colombia that many women are not used to looking out for themselves…they don’t want the attention. For many reasons, they don’t seek preventive care and when they come to us they have had cancer for a long time,” Dr. Rene Pareja of IDC explains.

According to Pareja screening Pap tests are performed on only 30% of women, with most of those in urban settings. This is in contrast to the more than 70% of all women in the United States who receive screening (CDC). But it is the very disparity between incidence and stage of diagnosis, which brought Pareja and researchers at MD Anderson together.

The Roots of Collaboration

In 2008 Pareja visited MD Anderson as an observer in the Department of Gynecologic Oncology. At that time, he became acquainted with two physicians in the Department, Associate Professor Pedro Ramirez, and Assistant Professor Kathleen Schmeler, both of whom Pareja invited to Colombia to visit. The MD Anderson physicians were impressed with the modernity and mission of the IDC.  

“When you visit most places in the developing world, you don’t anticipate the resources and technology we found at IDC,” says Ramirez.

IDC also maintains a common vision with MD Anderson in that they employ multidisciplinary care with the goal of eradicating cancer and developing the most effective way to combat the various types of the disease while caring holistically for the patient.  IDC is Colombia’s largest cancer care hospital and treats more than 70,000 patients a year from throughout Latin America.

Drs. Rene Pareja, Pedro Ramirez and Kathleen Schmeler, from left to right

Working Together

Confident they had a dedicated research partner in Pareja and the IDC, Schmeler and Ramirez worked to incorporate IDC into two separate protocols; one for A Phase III Randomized Trial of Laparoscopic or Robotic Radical Hysterectomy vs. Abdominal Radical Hysterectomy in Patients with Early Stage Cervical Cancer, headed by Ramirez; and one for Conservative Surgery for Women with Low-Risk, Early Stage, Cervical Cancer, led by Schmeler. IDC has taken on the collaboration task by enrolling more patients in the protocols than any other participating institution.

Ramirez explains why he believes the relationship with IDC has developed relatively quickly, and will continue to evolve, “It’s a combination of reasons. First, Pareja and his team have provided the largest contribution to both trials. Second, the reputation and character of Pareja and his team, and third the impressive organization and work of IDC… it all adds up to a mutually beneficial collaboration.”

Respective Benefits

For Ramirez and Schmeler the benefit of partnering with Pareja and IDC is clear, they have the opportunity to enroll additional patients with cervical cancer, which is rare in the United States. Not only are there more cervical cancer patients, there are more patients with advanced stages of disease.

When asked why Schmeler thinks the project is important, her response is instantaneous, “Cervical cancer is uncommon here in the U.S. because of what we have done to prevent it. And that’s the thing, it is preventable. If there is screening and good treatment at an early stage, it can be cured. It seems to me if we are from an institution like MD Anderson we have an obligation to take what we know, and learn what we don’t, in order to prevent cervical cancer globally.”

From IDC’s perspective, collaborating with MD Anderson provides an opportunity to definitively establish its reputation as a prominent cancer care institution, not only in Colombia, but as a global contributor to the search for cancer cures and the highest standard of care.

Future Objectives

The conservative surgery protocol under Schmeler already has three additional Sister Institutions signed on to contribute patients: Clínica Alemana in Santiago, Chile; The National Institute of Neoplastic Diseases (INEN) in Lima, Peru; and The Instituto Nacional de Cancerología (INCAN) in Mexico City, Mexico. Future plans include working with soon to be Sister Institution Hospital de Câncer de Barretos in Barretos, Brazil to implement a cervix cancer screening program between Schmeler and Dr.  José Humberto. In the long term, Schmeler hopes to incorporate similar efforts with institutions in India, Asia and Africa, as MD Anderson’s Global Academic Program’s (GAP) Sister Institution network expands.

Although the ultimate goal is to seek avenues of education and prevention -- for the time being the objective is clear.

“This research is to help people who have cancer now, and to help patients who need it the most,” Schmeler says.

IDC hopes the research projects and continued interaction will lead to status as a Sister Institution with MD Anderson, a goal Ramirez thinks will enable greater contribution between the two institutions.

“Becoming a Sister Institution will mean we can elevate our research to a multidisciplinary level,” he explains. “Without SI status most research is limited to one researcher on each side, but if IDC is a SI we can expand our interactions to include multiple investigators in multiple disciplines.”

The groundwork for possible expansion of research and collaboration began during a recent visit to MD Anderson by Pareja and Chief of Scientific Protection at IDC Alejandro Yepes. The pair visited with current MD Anderson partners, as well as counterparts in Breast Oncology and Pediatrics.

In the meantime, Ramirez and Schmeler are preparing an internal proposal to allow MD Anderson Fellows in Gynecologic Oncology to rotate through IDC. Fellows would perform surgery, under Pareja’s guidance, on cases they would not otherwise encounter in the United States. At the end of May, Pareja will attend the Annual GAP Conference in Houston, where he, Ramirez and Schmeler will present results from the two protocols. In addition, in October of this year IDC will host a conference focused on cervical, breast and head and neck cancer.  Both Ramirez and Schmeler plan to attend, as they did a conference held last year at IDC.

The Administrations of both institutions may soon be involved in defining the relationship between MD Anderson and IDC in terms of Sister Institution status, but the focus of the researchers remains consistent. Both sides agree with Pareja’s assessment of the need for this collaboration.

“We have the chance to work with MD Anderson and provide the best treatments and most advanced practices to patients in a poor country….We have the chance to change a bad story.”

© 2015 The University of Texas MD Anderson Cancer Center