On this episode, we are joined by Dr. Marion Saville, Executive Director of the Australian Centre for the Prevention of Cervical Cancer and Executive Producer for the Conquering Cancer impact film. Dr. Saville discusses the progress made to increase access to cervical cancer testing in underserved and lower-income communities around the world.
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Thanks for listening to the GOSH podcast. GOSH stands for the Gynecologic Oncology Sharing Hub, an open space for real and evidence based discussions on gynecologic cancers. We'll share the stories of gyne cancer patients and survivors and hear from researchers and clinicians who are working behind the scenes to improve the lives of people with gynecologic cancers. Our podcast is produced and recorded on a traditional unceded territories of the Musqueam, Squamish, and Tsleil-Waututh Nations. It is produced by the Gynecologic Cancer Initiative, a province wide initiative in British Columbia with a mission to accelerate transformative research and translational practice on the prevention, detection, treatment and survivorship of gynecologic cancers. Hi, I'm Nicole Keay, and I'm Stephanie Lam and you're listening to the GOSH, podcast.
The GOSH podcast presents a three-part series to celebrate the Conquering Cancer campaign. Conquering cancer is a global social impact communications initiative designed to celebrate the efforts made to eliminate cervical cancer around the world. While cancers are a leading cause of death worldwide, a global movement is building to put cervical cancer in the history books. The aim of the conquering cancer campaign is to propel change by supporting the World Health Organization's Cervical cancer elimination targets through a 3 pronged approach of vaccination screening and treatment. In this three part series, we interview three important women behind this campaign. Dr. Marion Saville, executive director of the Australian Centre for the Prevention of Cervical Cancer. Sue Collins, filmmaker behind conquering cancer and Kirsty Brown, a cervical cancer survivor and patient advocate. Through the conquering cancer campaign these three women are seeking to raise awareness about the prevention and elimination of cervical cancer and how by implementing vaccination screening and treatment it is entirely possible and will save the lives of an estimated 62 million people around the world.
So welcome back to the GOSH podcast. Today we have a very exciting guest who have joined us. We have Doctor Marion Savil who is a New Zealand medical graduate who trained in anatomical pathology at Northwestern University in Chicago. She went on to complete a fellowship in cyto pathology at East Carolina University and a research fellowship at Georgetown University focusing on HPV. She has held the position of Executive director of the Australian Centre for the Prevention of Cervical Cancer since the year 2000. Marion is interested in how culturally safe screening can meet the needs of disadvantaged groups who have poorer cancer outcomes in Australia and New Zealand. She has also focused on research and implementation projects demonstrating that it is possible to deliver high quality acceptable cervical screening in a range of resource poor settings.
So thank you so much for joining us on the podcast today. Uhm and to start us off, would you be able to tell us a little bit about your work as the Executive director of the Australian Centre for the Prevention of Cervical Cancer?
Sure, and thanks for having me.
So I am I am a cyto pathologist by background, which means I specialized in the laboratory interpretation of conventional pap smears and and that's what our organization did for many, many years. We did about 300,000 Pap smears a year. We had 50 laboratory scientists. We had a team of pathologists and and we read Pap smears which we we did in Australia every two years. And so about 5 or 10 years into the role it became apparent to me that the HPV vaccine was going to have huge impact on the way we did things. We already knew that this is a cancer that almost always is caused by the human papilloma virus. And and so we started to think about how we could improve the function of the screening program.
So here in Australia we've changed our program from a PAP program to a program where the primary screening test is an HPV test, still collected the way the PAP was collected for the moment. But only necessary every five years, and so that five yearly HPV testing is more effective at preventing cancer than two yearly paps, and certainly than three year packs. So, so we've been involved in ACP, CC and laboratory aspects and also in the population health aspects of screening. So we give advice to government and we've had a history of running registries and that's that's how we follow up people who've been screened invite them to re screen and how we also follow up those whose screening test is positive, but we can't see evidence that they've had a follow-up colposcopy and biopsy, and that's aimed at recognizing that screening is a pathway it's not an event and unless we follow up those who have a positive screening test with appropriate assessment and treatment, then we're not going to have the outcome of preventing the cancers. So we've had a a lot of involvement in running those registers, and we do associated research as well.
And the latest thing that we're doing is working with the Australian government because the Australian government decided that as of July 1st, anyone eligible for screening can choose to have the sample collected like the old Pap smear or can collect their own sample using a swab to collect a sample from the vagina. And we know from the evidence that that's just as effective as a sample collected by the clinician. So we're in a very exciting time where we can hand control of the screening process to the person who needs to be screened and and we get a lot of reports that in our pilots that people like that because they have autonomy and control over their body and it overcomes a lot of embarrassment, fear, shame that some people feel about obviously having that intimate medical exam with a speculum.
So can I ask a little bit about that? Like so how would that work, would you go into the doctor and get the swab and you'd take it home? Or is it something that if you registered for it, is sent to your home or or what would that process look like?
It's an excellent question, and we're seeing a lot of different approaches around the world. Here in Australia we think that one of the strengths of our screening program is it's very strongly embedded in primary care and so. So we. In our pilots, what's happened in Australia is that we have. We've provided primary care with those swabs and typically the person asked to collect the swab while still in the clinic so where they're usually provided privacy. Whether that's behind exam curtain or in the bathrooms, and they collect the sample. And in one of our pilots targeting people who said no to to a uh, usual collection of a sample. We got a sample on 85% of patients.
Well, through the pandemic we in our laboratory have offered a through the mail in in conjunction with a telehealth consultation with a primary care physician. So we've tried to keep that embedded in primary care. We haven't seen huge uptake of that, and we get a kit back about 2/3 of the time. And then internationally in one of our earlier research projects, we sent the kits out through the mail. Using our registry infrastructure that I talked about earlier and we have still lower participation. I think that from my point of view, it's best if it's done in the setting of a of of a clinic. We're more likely to get the sample, but we take the view that node or is the wrong door to get a sample from an unscreened or under screened person who needs it and so I think I think probably my view would be the ideal thing is is that that health care practitioners setting. But we're gonna need other ways to reach people that aren't regularly in primary care, marginalized people, community outreach, whether it's through the mail or whatever, so. I think we need to be flexible about how we do that. I think we need to work with communities and and the Primary Health care people who know their communities about what works for them.
Wow, this is amazing and I think that some some some of our colleagues here in BC also do a lot of that work around self collection, particularly Dr. Gina Ogilvie, who has run similar pilots primarily primarily looking at the uptake of self collection in our rural and remote communities. So in BC and in Canada we have a lot of different communities who just aren't, just don't have the same health care infrastructure as those in the major cities. Is that something that is also an experience that you folks in Australia experience like? Are there a lot of disparities between rural and remote communities? Or are people quite accessible to larger metropolitan environments where there maybe are more health care providers.
Sure, I'm I'm a good friend and colleague of Gina's, and aware of the work in in Canada. Uhm, yeah. Well, first of all, our biggest disparity is without First Nations people, so Aboriginal Torres Strait Islander women are more than twice as likely to get cervix, cancer and almost four times as likely to die of it. Uhm, I think there are complex reasons for that, and certainly some of it overlaps with the gap in services in remote settings, but it's not the entire story for Aboriginal Torres Strait Islander people there are all sorts of reasons why our previous screening programs have not met the needs of those community. And you know, it's really important that we work with communities that we have community led initiatives about how to how to improve the services to improve access to screening, to make the screening culturally acceptable, and we specifically piloted self collection in Aboriginal health service in a regional community with very very strong uptake and again very good feedback in the qualitative research, so it certainly meets the needs of many Aboriginal people not screening here in Victoria, which is our state. We have to look, I think globally at remote communities come around the opportunities afforded not only by self collection but new technology that allows the test to be run on on site. So point of care testing and getting a result within an hour or so and what that facilitates is if you take that technology into a community, that's very resilient. It works in the field and and you also have someone who can take the next steps in terms of assessment and treatment and then that can be done on the same day, because these are communities potentially where there's visiting services. And so if you do the testing you bring all the swabs back to a metropolitan lab. By the time you're next there, it might be quite difficult to find that person who's got a positive result, so we are involved in a project in. Uhm, in the Kimberley in remote parts of Western Australia, but we're also working with colleagues in Papua New Guinea and the Western Highlands and and what? What those communities have in common is their distance from health services and their poorer access to services. So again, it's about thinking flexibly, uh? About what will work for the the person that you're trying to screen and and making sure that you've got a way of joining up the screening from the to the assessment and treatment, because otherwise it's just activity. It's not cancer outcomes, which is what we're all here to deliver. Elimination of cancer.
I feel like we could poke and ask so many more questions just on that whole topic.
But we were here to chat with you about is this other hat that you wear, which is the executive producer of a documentary called Conquering Cancer. So we'd love for you to tell us a little bit more about that and why that's so important to you.
Yeah, sure. So the Conquering Cancer initiative came to my attention when. When the director was, Mike was looking around for how we were going to get this up and and what I recognize straight away in in the context of the WHO call for elimination and then we didn't have the strategy then, but we have the announced strategy now was that advocacy requires storytelling and and if we're going to get every woman in the world to have two tests between the age of you know, at 35 and 45 we're going to need billions of tests. We're going to need adequate follow up and for that we're going to need political will. And you can't get that always just from the cost effectiveness from the compelling scientific evidence it needs to be complemented with advocacy and storytelling. And so I saw this as an enormous opportunity, and our involvement really has been with uhm, putting putting the documentary team in touch with with them with people that that might support it and we have got strong link links to people in the technology sector across a range of manufacturers. So people who whose products support the elimination of cancer and are going to be needed most, particularly those who manufacture these HPV tests. We don't have and we're very careful not to have an alliance with any particular manufacturer so. What we were able to do was just give give the the team a bit of guidance and and and I think that was probably my main role as an executive producer. Apart from my willingness to share, you know, to the extent that I did in in the documentary.
And to talk about in particular the Rose project, which is now a program and a not for profit foundation, so it's been some further developments in Malaysia, which is great. It's all part of the at the Australian Centre. We're not for profit agency and and and you know our our charitable purpose as as they talk about is is the the control, unlike the main one, is a control of cervical cancer. And and the prevention through screening and and vaccination where we can help with that.
That's amazing, could you talk a little bit more about cervical cancer elimination and what that looks like from Australia's perspective and maybe if you could touch on a little bit about that project that you mentioned in Malaysia, I think that would be really interesting to hear about as well in the context of cervical cancer elimination.
Yeah, so as as you probably know the WHO I think in 2018 called for elimination of cervical cancer as a public health problem, and elimination is not the same as eradication. We will still have small numbers of cases and the agreed target is on an age standardised rate of four per 100,000 women. 9So we expect through the modeling work of Professor Karen Canfell and her team that Australia will get there no later than 2035. We're currently around six per 100,000 and we're on track to be the first country in the world to achieve that, so that's really exciting and I think that reflects the commitment of the history of Australian governments, and over time, different. You know different governments to our screening program, historically, and and then, when the vaccine came along, we're the first country in the world to have nationally funded HPV vaccination. Having that high coverage of vaccination, although we could do better with some of the disparity and the very successful screening program which has been HPV based now since 2017 really puts us strongly on the pathway to reduce that incidence by then. We we've been a very Australian focused organization for many decades, but we could see, particularly with the WHO initiative and and and talking to colleagues in other countries, that you know, we've been in a very privileged position with that that government support to the programs in Australia, and we feel that we have an obligation to work with colleagues who are. in less well resourced settings, particularly in our region, so we at ACP CC to the majority of our work in in the Asia Pacific region, or even the Indo Pacific region with some projects in India. But the Malaysian project was the first one and that came about when I met Yin Ling, I think this is in the documentary at a science scientific meeting in Singapore and we just started talking about what was needed and I think Uhm, Yin Ling, had you know she grew up in Kuala Lumpur but she did her training to be a gynecologist in the UK, so I think she was a little bit confronted when she came home and saw so much late stage disease in a country that's supposed to have had a pap smear program since the 1950s. But it hasn't been meeting or reaching enough people and there are some systems complexities too so and we worked together with teams on the ground and I I did say to her that I I I couldn't really make strong recommendations without visiting the setting where screening would take place. So we went into those clinic we met the nurses we talked about what would happen and what we brought together was our. What we knew about self sampling so self sampling was part of the package and the other part of the package was that registry background I talked about. We we put it into the cloud and made it available on mobile devices for use in these settings. We haven't done that in Australia, so this was new technology in a lower resource setting and so the nurses were able to register patients collect the sample, the result then goes onto can screen and then actually the way things work is that a patient who's going through this process gets their result on their mobile phone by text message. I remember, this was before everyone started doing it with COVID, so this was quite a radical thing to be doing and what that showed us was that of those who had a positive test 2/3 called the Rose Team the same day to organize their appointment and then supported by our technology infrastructure, the Rose team then followed up those who didn't call and and we facilitate that with work lists and things through the the registry infrastructure that we've given them. And through the dedication of that team using that tool, they have got the follow up rates to over 90% and that is one of the targets one the WHO strategy is screen 70% of age eligible women and ensure that 90% of screen positive people get followed up and get appropriately treated. So that's one of the few screening programs that I'm aware of in in these sorts of low and middle income settings where the follow up rates are so high it's because we embedded the digital technology together with the self collection. And I think what had been happening is that they were facing problems with firewalls with lab results coming in. So they were working with workbooks, so then if they had a positive PAP they then had to look back to get the contact numbers. There was significant delay in reporting, so we cut through a lot of those barriers, but I think the main thing for me was I learned so so much from the team on the ground in Malaysia so we we bring some technology, but they tell us what will work and and so we we know what to do, we need to screen people with HPV. We need to join them to treatment. They're the experts on how to do it in their setting, and I think that's why that partnerships been so successful.
Wow, I love that. I think it speaks to kind of what you were mentioning a bit earlier about how you know there's no one size fits all approach to this work. And I love how it was such like a community based. And community focused initiative to identify what was going wrong and to then implement the the technology is just amazing to hear and it sounds like they've been really they've been able to meet some of those targets in in the coming years.
Yeah, and I think. I think what what makes it work so well. The team on the ground are fantastic but Yin Ling and I have a very strong friendship now and the team see our collaboration and it supports a culture of collaboration problem solving.
Yeah, yeah, that's amazing. So just to wrap things up. You know this podcast we do reach out to a lot of patients and survivors, but we also reach out to our researcher and clinical colleagues as well.
If you had one message to share with the public about cervical cancer. What would that message be?
Oh look, I think. Wherever you live, uhm? If if you're a woman or a person with a cervix. Uhm, you should be seeking screaming. Uhm, you should be taking advantage of what's available, and if it's not available, you should be asking for it. And you should be asking for and seeking vaccination for your children.
Yeah, that's a really important message that I think cuts through a lot of Kirsty's message as well, and a lot of our other folks who work in the cervical cancer space. So those are some really important key steps for people to take as they move along in their personal health journeys.
Uhm, so thank you so much Marion for joining us today. It was such a pleasure to get to hear about Australia work in this space and to hear also about the advocacy and the global health work that you're doing and we're really looking forward to seeing the documentary and we hope that. The message that you share today will really resonate with our listeners, so thank you so much for joining and for being part of this podcast.
Thanks very much.
Thanks for joining us on the Gosh podcast. To learn more about the Gynecologic Cancer initiative and our podcast, make sure to check out our website at gynecancerinitiative.ca.