World Health Organization Taps Sylvester in Global Fight Against Cervical Cancer

Julio Frenk, MD, MPH, PhD

Recognizing Sylvester Comprehensive Cancer Center’s enduring commitment to addressing the inequities that perpetuate cervical cancer in South Florida and beyond, the World Health Organization (WHO) on Wednesday designated the University of Miami institution as the first WHO Collaborating Centre for Cervical Cancer Elimination.

Sylvester’s key role was announced during a virtual media conference, led by WHO Director-General Tedros Adhanom Ghebreyesus, Ph.D., and Assistant Director-General Princess Nothemba Simelela, M.D., that commemorated the first anniversary of the global movement the WHO launched last Nov. 17 to eliminate cervical cancer. Though preventable and curable, the disease still kills more than 300,000 women around the world who usually lack access to the vaccines, screening tests, and treatments that would prevent, detect, or cure the disease in its early stages.

“The world is united to end cervical cancer, and the University of Miami is immensely proud to officially take a leading role in this ambitious and essential endeavor,” said President Julio Frenk, MD, MPH, PhD. “From the crossroads of Latin America and the Caribbean to the persistence of disparities around the world, we are honored to expand our collaborations to address a cancer that humankind already has the tools to eliminate.”

Although cervical cancer disproportionately affects women in low- and middle-income countries, Stephen D. Nimer, M.D., director of Sylvester, noted that rates remain unacceptably high in marginalized communities across the United States. This includes pockets of Miami, where the multipronged approaches Sylvester has developed with local partners are slowly removing the barriers to prevention, detection, and treatment.

“For years, we have worked diligently with our community partners and the WHO to create novel outreach programs that raise awareness and provide screening opportunities in marginalized communities that bear the largest burden of this preventable disease,” Dr. Nimer said. “We are honored to be part of the WHO initiative to find more solutions that will eliminate cervical cancer in our hemisphere and around the world.”

A Global Strategy

As a collaborating center, Sylvester will work closely with the Pan American Health Organization, the WHO’s regional office for the Americas, to identify practices that will best enable girls born today to live in a world free of the cancers caused by one of the high-risk strains of the ubiquitous human papillomaviruses (HPVs). The 194 member nations of the World Health Assembly embraced that vision in August 2020 by adopting a global strategy to accelerate the elimination of cervical cancer — which develops silently over years — by meeting three key targets by 2030.

Known as the 90-70-90 goals, the targets call for 90% of all girls to be fully vaccinated with the HPV vaccine by age 15; 70% of all women to be screened with a high-performance HPV detection test by age 35, and again at age 45; and 90% of all women with precancer or cervical disease to be treated, and 90% with advanced cancer to be under managed and palliative care.

“The collaborating center will provide important opportunities to share the lessons that organizations and academic institutions have learned while working independently to address the inequities in cervical cancer,” said Erin Kobetz, Ph.D., M.P.H., Sylvester’s associate director for population sciences and cancer disparity and the University’s vice provost for research and scholarship. “It will be a platform for true bidirectional engagement to come up with sustainable and scalable solutions that address gaps in vaccinating, screening, and treating cervical cancer. So, by 2030, we really have accelerated the promise of achieving elimination.”

Raising Local Awareness

To help raise local awareness about the preventable global and local health problem, Hard Rock Stadium, loanDepot park, and the Miami-Dade County Courthouse will join the University and Jackson Health System on Wednesday evening in illuminating fountains, facades, signs, and passageways in teal, the color of cervical cancer awareness. Then on Thursday evening, the Miami Hurricanes women’s basketball team will don teal before taking on Florida Atlantic University at the Watsco Center. Their stylized “Fight” T-shirts will urge the broader community to be part of the solution for eliminating cervical cancer — a goal that HPV vaccines and DNA screenings have put in reach in wealthy countries.

Since the HPV vaccine was introduced in the U.S. in 2006, infections with the roughly 14 stains of the HPV virus that cause most HPV cancers, as well as benign genital warts, have plunged by more than 80 % among teen girls and young women. Given that the vaccine has proven most effective when administered before exposure to the HPVs that cause those cancers, the U.S. Centers for Disease Control and Prevention recommends that all children get the HPV vaccine by age 11 or 12.

But, as Dr. Kobetz knows all too well, the lack of access to and mistrust of the formal health system contributes to increased cervical cancer burden in communities grappling with other structural, social, and cultural barriers that drive disease risk. Shortly after joining the University faculty in 2004, Dr. Kobetz discovered that the incidence of cervical cancer among women in Miami-Dade’s Little Haiti neighborhood was more than four times the national rate. Among the reasons: Haitian women did not participate in routine Pap tests, which detect abnormal cells on the cervix that could eventually lead to cancer.

Today, the number of women undergoing more advanced HPV screenings in Sylvester’s catchment area has increased dramatically, thanks in large measure to Creole-speaking community health workers who distribute home tests that enable women to collect their own cells, and to Sylvester’s Game Changer bus and Office of Outreach and Engagement. As they do most weekdays, the office’s health educators drove the bus on Wednesday to a community at high risk for cervical cancer to offer free HPV screenings and navigation to free HPV vaccinations for those who are age eligible.

Research Priorities and Community Needs

“The most important lesson that we have learned at Sylvester, and working with the WHO, is to match our research priorities with the needs of communities and to engage local stakeholders in collaborative science and action that creates solutions to address gaps in cancer care, from screening to survivorship,” Dr. Kobetz said.

Many other researchers and clinicians across the University have made addressing cervical cancer one of their top academic priorities. Among them is Marilyn Huang, M.D., an associate professor of clinical medicine and co-director of Translational Gynecologic Oncology Research. She is developing new immunotherapies that show the promise of prolonging the survival of women living with recurrent or late-stage cervical cancer in South Florida and beyond.

In addition, Matthew P. Schlumbrecht, M.D., M.P.H., Sylvester’s chief of gynecologic oncology, is pursuing critical epidemiologic research demonstrating the global challenges in addressing persistent incidence of cervical cancer.

And, Sylvia Daunert, Pharm.D., M.S., Ph.D., the chair of biochemistry and molecular biology, and Sapna Deo, Ph.D., a professor in the same department, collaborated with Dr. Kobetz and research associate professor Jean-Marc Zingg, Ph.D., to develop a rapid HPV test that will enable women anywhere in the world to administer their own detection tests. As Kobetz noted, that could be a huge game-changer in the fight against cervical cancer because women who live in places devoid of laboratories — or even regular electricity — would have access to secondary prevention and, in turn, life-saving treatment.

At least there is an increasing likelihood of that becoming a global reality, now that the world is committed to accelerating the elimination of cervical cancer.