Recently, PATH’s Dr. José Jerónimo received the highest award that the American Society for Colposcopy and Cervical Pathology (ASCCP) can bestow—the Distinguished Scientific Award for significant positive impact on underserved populations. ASCCP works on cervical health worldwide and recognized Jose for his contributions in low-resource settings. Recently, PATH’s Scott Wittet caught up with him for a quick interview.
Scott Wittet: Hello, José! Before we begin I’d like to congratulate you on your award.
José Jerónimo: Thanks, Scott. It’s an honor to receive this award from one of the most influential societies in the world for cervical cancer. For example, ASCCP, in collaboration with the American Cancer Society and the American Society for Clinical Pathology, published prevention and treatment guidelines and created disease management algorithms that are used worldwide.
SW: You’ve devoted most of your professional life to fighting cervical cancer. How did you become so focused on that issue?
JJ: After graduating from medical school, I was working in a very poor part of southern Lima and saw many advanced cases of cancer—cases that were difficult to treat—and I got very interested in prevention. Through the grapevine I heard about a new cervical screening technique called visual inspection with acetic acid, or VIA. Dr. Paul Blumenthal was promoting it; he came to Peru and trained me along with a few other colleagues.
Initially we were a bit suspicious that such a simple and inexpensive method could possibly compete with Pap. In fact, most of my friends stopped using the new method. But I was working in a poor area with limited access to the laboratories and staff needed for Pap, and I had no choice but to continue with VIA. Before long I realized what a difference it could make, and I became a proponent.
There was a strong emotional component to my decision, too. I remember one patient in particular—I’ll call her Carmen. Carmen was suffering terribly when I first met her in Lima. At age 37 she had three children—a teenaged boy and his two younger sisters. Carmen had completed radiotherapy for cervical cancer but unfortunately the disease did not respond and there was no more treatment to offer her. I had to tell Carmen that her case was terminal. It is the most difficult part of that job. Carmen was not afraid of dying, she was more concerned about her children since she had been abandoned by her husband after learning about her diagnosis. Carmen was a strong and a brave woman. She kept asking how much time she had left to make arrangements.
One by one she found homes for the girls. They would live with relatives, though unfortunately in two different homes, but she had less luck with her son. By the time she passed, she had not found him a home. I don’t know what became of the boy.
It was Carmen I thought of, and the nearly 300,000 other women who die from cervical cancer each year, when I decided to concentrate on this terrible disease. I knew that 85 percent of those deaths occur in low-resource settings. I knew the toll it took on women and their families, I knew it was preventable, and I knew I could make a difference in many people’s lives. So, I thought, what better way is there to spend my time?
SW: Now VIA is globally accepted as an important tool for cancer prevention, and is promoted in World Health Organization guidelines. You were a frontrunner!
JJ: And now we are interested in new tests that do an even better job of screening. I currently manage the Scale-Up project, aimed at getting molecular screening technologies to the places they are needed most, and at national scale. We have three very interesting projects in Latin America, all of which were initiated with supplies from PATH. As part of the project plan, procurement responsibilities now are being transferred to the governments. It’s a sustainable program that can continue without PATH support. That’s what we call success!
SW: Sounds great! In addition to that work, what else has you excited these days?
JJ: A few things. The first one is the idea of using the molecular tests in a “self-sampling” mode; in other words, enabling women to take their own samples, either in their homes or in a clinic. The samples are then processed by clinic staff, and women who test positive receive treatment. This is exciting because it removes a major barrier to scaling screening services—the need for a pelvic examination to get a cervical sample. We believe this may be the way to screen all women, no matter where they live.
Another area is technologies for treating precancer—the abnormalities on the cervix that can progress to invasive cancer. The tools we have now work, but they could be much better. PATH is collaborating with several private companies to adapt their technologies to be more appropriate for low-resource settings; we expect to have those technologies in the market by July or August this year.
Overall, the best news is that additional companies are coming forward with new tools—both for screening and for treatment. For example, a Chinese firm has recently announced that they are selling a molecular test that seems to work well and could be sold at a lower price point. This type of competition is very good for public health; PATH will do all it can to make sure new tools become available as soon as possible.
José shares the story of Carmen in a talk on cervical cancer during the Women Deliver global conference in Copenhagen.