African American women face disproportionate rates of many health conditions, including lupus, cervical cancer and Human Papilloma virus, or HPV. Dr. Patricia Dhar, program director, Rheumatology Fellowship Program, Ascension St. John Hospital, is working at the intersection of all three conditions, as she embarks on a yearlong study that will hopefully increase the frequency of testing, improve access and catch cervical cancer earlier, which could ultimately save lives. The study is made possible in part due to a $10,000 grant from the Blue Cross Blue Shield of Michigan Foundation.
Testing the potential for self-screening methods
Lupus is an autoimmune disease that affects predominantly African American women of childbearing age. Because lupus weakens the immune system, women with lupus are less able to fight off HPV, the virus that can cause cervical cancer. Women with normal immune systems are often able to get rid of HPV without even knowing they had it, but if the immune system isn’t optimal, the virus can linger and cause changes that lead to cancer or remain dormant in the body and reappear later in life. “If you don’t have a good immune system, HPV can hang around,” Dhar explained. Thirty African American women with lupus will be recruited to take part in the study. Since their risks are higher, the women in the study should ideally be monitored at close regular intervals for cervical neoplasia, i.e., abnormal cells growing on the cervix that could be precancerous. These abnormal cells can be found through a routine Pap smear, but guidelines currently only call for women to have a Pap smear every three years. Testing for HPV can help identify strains of the virus that are more likely to develop into cervical cancer, but testing is only recommended every five years. “That’s woefully inadequate for this high-risk population,” Dhar said. Women in the study will be trained to self-collect their own cervical cell sample vaginally using a cervical self-sampling brush. Samples will be collected privately at a clinic study site. Dhar and her team will then process the sample by sending it to the cytology laboratory at Ascension St. John Hospital to evaluate for any abnormal cells, and then have the specimen analyzed for high-risk HPV types at the University of Michigan HPV research laboratory. The samples will also be sent to the Wayne State University Mott Center for Human Growth and Development to analyze for the presence of inflammatory substances that can be caused by HPV. Self-sampling provides a less invasive and more patient-friendly way to collect cervical and vaginal samples with less discomfort than the traditional gynecologic exam, Dhar said. If the method works to collect HPV cells, she is hopeful it could lead to additional funding for a larger-scale study with more women.
Empowering women to get the care they need
The self-sampling method would never take the place of a full gynecological exam, but if it works, it would allow for more frequent testing with a less invasive method. This is important as women of color often disproportionately face barriers to health care, including not being able to take time off work for appointments. While her work for this initial study focuses on women living in Detroit, Dhar said the self-sampling method could also be beneficial for women living in rural areas, who also often face barriers to access care. “This provides access to underserved populations that we have here in the city and that we have in rural areas,” she said. For women with lupus, Dhar urges them to proactively talk to their doctor about getting the HPV vaccine, which can be administered until age 45. Having lupus raises the risk for developing cervical cancer and dying from it and the vaccine is an effective prevention measure. “Women need to advocate for themselves,” she explained. Funding for the study furthers the BCBSM Foundation’s focus on projects aimed at increasing access to health care for underserved populations and for projects that are tackling issues related to health disparities. “We’re hopeful that this exciting and innovative work being undertaken by Dr. Dhar and her team will help women identify HPV earlier, giving them a better chance to get the treatment they need and potentially help them avoid developing cervical cancer,” said Audrey Harvey, executive director and CEO, BCBSM Foundation. Related:
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