12/12/17  Portland, Ore.

Amy Wiser, M.D. (far right) stands with Gambian colleagues during a trip to "train the trainers" in better ways to screen for cervical cancer.

 

This November, Family Medicine's Amy Wiser, M.D., packed her bags and headed to The Gambia to talk to local general practitioners, OB/GYN physicians and midwives about cervical cancer screening. The trip began with an invite from the American Society for Colposcopy and Cervical Pathology (ASCCP), where Dr. Wiser serves as a faculty member and contributes to the Education Committee.

Cervical cancer is the most common cancer in Gambian women, making up one-third of all women's cancers. With a 20 percent 5-year survival rate, cervical cancer also has the highest mortality (death) rate in The Gambia. In spite of cervical cancer's toll on the Gambian population, there has been very limited introduction of the HPV vaccine, and the country has no organized cervical cancer screening program. 

Dr. Wiser's visit was sponsored by the SOS Children's Village NGO, the Edward Francis Small Teaching Hospital in Banjul, The Gambia, and the Ministry of Health of The Gambia, and included a "Train the Trainers" conference and practicum. She accompanied ASCCP colleagues, Alan Waxman, M.D. and Jim Faherty, M.D, on this ASCCP Humanitarian Committee mission.

The Gambian physicians participating in this ASCCP training are  motivated to add colposcopy to their screening model of VIA (visual screening with acetic acid) as a confirmatory test, directing their next step in patient care. A five year strategic plan , in development by Dr. Wiser's Gambian colleagues, intended for approval  by the Ministry of Health includes acquiring a point of care HPV test and ultimately converting from VIA to HPV screening. Currently, pursuing cytology as a screening method is not feasible as there is no practicing pathologist in the country. The few pap smears that are performed, and all biopsies, have to be sent out of the country to Dakar, Senegal for interpretation.

Dr. Wiser plans  to continue in discussion with her Gambian colleagues over their goals of establishing the role of colposcopy and converting to HPV screening for the country She is hopeful that the use of colposcopy will improve upon  the quality of screening available and that the initiative, starting with these training sessions, will promote the national adoption of a cervical cancer prevention program in The Gambia.