Dec 20, 2017
Dr. Chigbu, center, with community health educators.
ASCO and the Conquer Cancer Foundation established the International Innovation Grant (IIG) to provide research funding for novel and innovative projects that can have a significant impact on cancer control in low- and middle-income countries. The IIG supports proposals that have the potential to reduce the cancer burden in local communities, while also being potentially transferable to other resource-constrained settings. Chibuike Chigbu, MBBS, FWACS, of the University of Nigeria, served as principal investigator for one of the first projects supported by an IIG, “Impact of community health educators on uptake of cervical and breast cancer screening and HPV vaccination in rural southeast Nigeria.”
What led to your interest in gynecologic oncology?
CC: I took a special interest in the subspecialty of gynecologic oncology when I realized that I could help women prevent some female reproductive tract cancers while offering optimal management to those already diagnosed with gynecologic cancers. I completed my basic and specialist medical training in Nigeria, and my gynecologic oncology training in Germany. I also had a short gynecologic oncology experience in Australia.
My major research interest is cervical cancer prevention. This interest was driven by my realization that the best hope for adequate cancer care in Africa lies in prevention. Soon after I returned to Nigeria from my training in Germany, I realized that the conventional pathway for cervical cancer prevention in high-income countries (through routine Pap smear, colposcopy, and loop excision procedures) will have very limited success in Nigeria due to lack of requisite health infrastructure, scarcity of adequately trained personnel, and poor socioeconomic status of the majority of Nigerian women. I observed the compelling need for an alternative effective, cheap, and acceptable means of cervical cancer prevention. This informed my interest in cervical cancer prevention research while continuing to provide the conventional preventive services.
While researching Pap smear uptake and colposcopy, I observed the scandalously low level of awareness of cervical and breast cancer prevention by the population, even the most elite population. I also observed that community cervical and breast cancer prevention holds the key to an acceptable level of uptake and utilization of these services. The idea of an integrated approach in community breast and cervical cancer prevention education and provision of preventive services was born therefrom.
What led you to apply for the IIG?
CC: I provided free cervical and breast cancer prevention education and services to several thousands of women in southeast Nigeria through a self-funded nongovernmental organization, the Women Life Care Foundation. The charity work exposed me to two hypotheses, that 1) a community engagement approach, and 2) home-delivered cancer prevention education might provide the missing link in the quest for improved population awareness of cervical and breast cancer prevention. The scientific testing of this hypothesis was the objective of the IIG, which I received in 2014.
How was your IIG project structured?
CC: With the grant, we were able to carry out a “before and after” real-time population study in rural southeastern Nigeria. During the pre-intervention stage of the study, baseline population indices were collected, and selected primary health care workers were trained as community health educators on cancer prevention and as community cervical and breast cancer prevention service providers. These health workers acquired skills for cervical and breast cancer prevention education, visual inspection of the cervix with acetic acid (VIA), visual inspection of the cervix with Lugol’s iodine (VILI), HPV vaccination, cervical cryotherapy, and clinical breast examination (CBE). Four health care facilities were equipped with skills, equipment, and materials for VIA, VILI, CBE, and cryotherapy.
This was followed by an intervention stage during which the trained health workers were deployed to the field to conduct house-to-house, face-to-face education of women on cervical and breast cancer prevention. It was expected that the intervention (home-delivered face-to-face education on cervical and breast cancer prevention) would significantly increase the uptake of cervical and breast cancer prevention services at the health facilities.
At the post-intervention period, CBE, VIA, VILI, and cryotherapy were provided at the health facilities. Data obtained at the post-intervention period were statistically compared with the pre-intervention data.
What were the results?
CC: In total, 1,327 women were enrolled. Before the intervention, 42 (3.2%) women had undergone cervical cancer screening; afterwards, 897 (67.6%) women had received screening (p < 0.001). CBE was performed for 59 (4.4%) women before and 897 (67.6%) after the intervention (p < 0.001). Only two (0.9%) of 214 children eligible for HPV vaccination had received the vaccine before the intervention, versus 71 (33.2%) after (p < 0.001).
The results of the study showed that the intervention of home-delivered cervical and breast cancer prevention education significantly increased awareness and voluntary uptake of cervical and breast cancer prevention services.
The outcome of the study was published in the June 2017 edition of the International Journal of Gynecology and Obstetrics.1
How is your research advancing progress against cancer, both in Nigeria and globally?
CC: The project made appreciable contributions to cancer prevention in local communities. With the support of the Women Life Care Foundation, two of the four centres that participated in the research study have continued to provide free cervical and breast cancer prevention services to date. A new centre has been created to offer the same free services to urban women in Enugu, Nigeria. Arrangements are advancing to replicate this model at a statewide level by the Enugu state government, through its directorate for non-communicable diseases. I have been providing technical assistance to the directorate on the issue.
The results of the study will help guide policy development on cervical and breast cancer prevention in Nigeria and similar low-income settings. The study has proven that an integrated cervical and breast cancer prevention program based on health education of the population and prevention services provision at the primary health care level is feasible and effective in enhancing service utilization. Enhanced cancer prevention services utilization will contribute significantly towards reducing the burden of cancer in low-resource settings like Nigeria.
Why is the IIG a valuable research funding mechanism?
CC: The strength of the Conquer Cancer Foundation IIG lies in the novelty and innovative nature of the grant projects. The grant encourages innovative, effective, and culturally sensitive solutions to cancer. I find this very important, as many internationally proven solutions to cancer prevention encounter severe challenges of implementation when deployed to resource-constrained regions. A good example is the conventional cervical cancer prevention through regular periodic Pap smear screening and colposcopic procedures, which no single sub-Saharan African country has been able to implement on an acceptable national scale to date. The huge and rising burden of cervical cancer in sub-Saharan Africa has been rightly attributed to this failure.
By encouraging local innovative ideas, ASCO and the Conquer Cancer Foundation are taking a front seat in the drive towards the reduction of the cancer burden in Africa and other low-income regions of the world.
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