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Dr. Eduardo Paulino Discusses His Global Cancer Fellowship

Dr. Eduardo Paulino from Rio de Janeiro, Brazil, served as a 2016 GCI Global Fellow from June to December. Throughout his Fellowship, Eduardo participated in all of the projects we do here at GCI, from leading research publications on cancer control in Brazil to helping design projects that will help patients in his home country and beyond. Eduardo has been a fantastic and energetic addition to our GCI team, and in the last few days of his Fellowship, I was able to speak with him about the projects he has been working on with GCI, his time in Boston, and his goals upon returning to Brazil.


 

1. Could you tell us a little bit about your background, your work as an oncologist, and what you do in Rio? 

I’m a medical oncologist, dedicated specifically to treating gynecologic tumors. I work in the department of Gynecology Oncology at the National Cancer Institute (Hospital do Cancer II) in Rio de Janeiro, Brazil, which is a public cancer institute. Most of my patients are under-resourced and have some serious obstacles when they try to access high-quality cancer care. In my hospital, we are able to provide public care for all women with the best evidence-based practices, which is a very rewarding environment to work in.

 

2. Do you like Boston? How has your experience been in our city?

Boston is an amazing city, and it has been a great host. I have had no problems at all (if you don’t count apartment hunting…) Wherever you are, you always have access to markets, drugstores, gyms, grocery stores, etc.  The city is also very welcoming to foreign students and tourists, with so many schools, hospitals, and things to do. All of the Bostonians that I have met are very friendly and helpful.

 

3. What has been your favorite experience in your fellowship so far?

My favorite experience in my fellowship has been the opportunity to share my ideas and have them taken into account. The interaction with my mentors was very fruitful, and I believe that both sides benefited from collaborating together. It is great to work with so many different people and to meaningful contribute to projects that will change the landscape of cancer care for patients in my country.

 

4. What kinds of projects are you working on here with Dr. Goss and GCI? What projects or ideas are you most excited about sharing with your colleagues and starting at your hospital when you get back to Rio de Janeiro?

My projects with Dr. Goss and GCI are based on the barriers that patients in low- and middle-income countries (LMICs) face when trying to access quality cancer care. We believe that the first step is to find these obstacles and create plans to overcome them, in order to better serve cancer patients in under-resourced countries. GCI’s patient navigation programs and prospective databases are the most exciting projects that I would like to implement in my hospital. GCI already has a global database for young women with breast cancer, but since I specialize in gynecologic oncology, I helped to design a cervical cancer database, so we can begin to learn more about the treatment choices and outcomes for women in Brazil and elsewhere who are suffering from this disease. It will be very exciting to implement this database with my own patients and contribute to a global body of data that will help us help women around the world.

 

5. What do you think will be your biggest take-away or lesson-learned from your time here at GCI?

Multidisciplinary work! Here, I really got to experience how important it is to engage in multidisciplinary teamwork–taking into account everyone’s opinions, respecting everyone’s experience, and maximizing our impact with the best approach. This pattern of working with multidisciplinary teams is one of GCI’s key goals, and it is used in patient care, as well as any kind of research project the group performs. By engaging the right people and various experts in the field, we are able to make the best decisions possible for our patients.

 

6. What advice would you give to young oncologists, doctors, or students who are thinking about getting into public health or cancer research?

That is possible to make a difference! Public health, especially in LMICs, is challenging. When you hit your first obstacle, don’t give up because there will be many more ahead. With continuous effort, you do have the ability and power to change patient care (whether that is by treating individual patients, improving screening practices, connecting a patient to other services, providing palliative care, or even finding a cure). Believe in yourself!

 

Cervical Cancer Control in Latin America

GCI collaborators recently published an extensive review article “Cervical Cancer Control in Latin America: A Call to Action,” led by Dr. Brittany Bychkovsky. The paper outlined the current state of HPV vaccination and cervical cancer screening in Latin America, and noted the challenges of a successful campaign against cervical cancer throughout the region.

 

Here are some key facts from the paper:

  • Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide
  • HPV is associated with the majority of cervical cancers
  • 88% of cervical cancer deaths occur in low- and middle-income countries (LMICs)
  • Cervical cancer is the second most common cause of cancer-related deaths among women in Latin America
  • Deaths from cervical cancer are 100% preventable by vaccination and screening
  • <55% of eligible women in Latin America received a recent Pap test
  • Although 80% of young girls in Latin America live in countries with an HPV immunization program, the majority of girls lack access to receive and complete the vaccine series

 

The paper concluded with a call to action to improve cervical cancer control throughout Latin America. Dr. Bychkovsky and her team put forth some possible strategies for controlling cervical cancer in Latin America moving forward:

  1. Primary prevention (HPV vaccination): The Pan American Health Organization (PAHO) recommends that HPV vaccination be introduced only if the immunization program is public, targets the whole country, and gradually increases its rates to achieve high coverage. The most important factors to consider include:
    • Coverage: The incidence of cervical cancer will be reduced if vaccination coverage is high (>70%).
    • Cost: The HPV vaccine should be procured at reduced rates so the program may be cost-effective for the LMICs of Latin America.
    • Target population: All vaccination plans in Latin America recommend vaccinating preadolescent girls between 9 and 12 years of age.
    • Dose: PAHO and WHO recommend introducing the vaccine on a 3-dose or 2-dose schedule (studies have shown that the 2-dose will likely become the new standard in Latin America.)
    • Administration: Vaccination programs will be most successful if integrated into schools.
    • Monitoring: Programs must be monitored to ensure efficacy, efficiency, and cost-effectiveness.

 

  1. Secondary prevention (screening): In addition to HPV vaccination, screening will remain essential because it can take decades for HPV vaccination to have substantial effects on cervical cancer incidence. The team put forth some strategies for optimal screening practices:
    • Novel approaches: Mobile HPV screening programs, like one implemented in Panama, are effective in reducing cervical cancer incidence and are able to reach the most underserved  communities.
    • HPV-DNA testing: This has proven to be effective as a stand-alone test for screening, and allows self-sampling, which increases participation rates among women in Latin America.
    • Visual inspection with acetic acid (VIA): This has been proven to be an effective screening tool in low-resource areas and can reduce cervical cancer mortality by over 30%.

 

  1. Further management:
    • Patient education: Educational initiatives are essential for increasing awareness, especially among disenfranchised and rural populations. This can be done through media campaigns, or through the use of patient navigation programs (PNPs).
    • Patient navigators: PNPs not only help increase awareness and education on cervical cancer prevention, but they also help assist positively screened women with accessing timely follow-up care and health resources.