Chemtai Mungo, MD, MPH: Bringing Cervical Cancer Treatment to More Women
An innovative self-treatment strategy for cervical precancer could save lives in low- and middle-income countries as well as underserved areas in the United States.
Chemtai Mungo, MD, MPH, has had the privilege of practicing medicine around the world, from the University of North Carolina Chapel Hill, where she is an assistant professor of obstetrics and gynecology, to hospitals and clinics in Kenya, where she grew up.
As a physician-scientist whose research focuses on cervical cancer, Dr. Mungo has seen firsthand how health disparities impact the lives of women in low- and middle-income countries (LMICs).
“During my training, I almost never took care of a woman with cervical cancer; I never saw women dying from cervical cancer in the United States,” she said. “But when I did spend time abroad, there were a lot of women with advanced cases dying.”
In April 2023, Dr. Mungo was recognized as a NextGen Star at the AACR Annual Meeting. In her NextGen Star lecture, she explained some of the reasons cervical cancer is more prevalent and deadly in sub-Saharan Africa than in the United States. Rates of human immunodeficiency virus (HIV) infection are significantly higher in sub-Saharan Africa. HIV weakens the immune system, making patients more susceptible to human papillomavirus (HPV) and less likely to clear that infection.
Further, fewer treatment centers for cervical precancer and cancer exist in sub-Saharan Africa than the U.S. In 2022, the Kenya Obstetrical and Gynaecological Society stated that the country has approximately 500 obstetricians and gynecologists (OB-GYNs) for a population of over 48 million. This averages out to 1.04 OB-GYNs per 100,000 people, compared to nearly 6.5 per 100,000 people in the U.S.
“If a woman is screened and has precancer, she’s given an appointment in six months, because that’s the next available appointment to get treated by a specialist,” Dr. Mungo explained. “She doesn’t have the money to go back to the capital city, then in three or four years, she shows up with invasive disease.”
Even for women able to access treatment, recurrence rates remain high. Current treatment methods include surgical removal of the cancer or precancer, or a process called ablation, in which doctors apply extreme cold or heat to treat the lesion. Dr. Mungo said that, for women with HIV, these methods do not address the root cause of a persistent HPV infection that could cause these lesions to return. She hypothesized that if patients had easier access to medications that treat their disease at a cellular level, they may experience lower rates of recurrence with fewer trips to healthcare providers.
A study published in 1999 showed that intravaginal self-application of the chemotherapy 5-fluorouracil (5FU) was safe and effective after removal or ablation of high-grade cervical lesions in women with HIV. Eighteen months after surgery or ablation, 8% of patients treated with 5FU had a recurrence of a high-grade lesion, compared with 31% of patients in the control group.
A similar study in 2014 explored this approach as a first-line treatment for women without HIV who could not undergo or did not want surgery. After six months, 92% of women treated with 5FU experienced disease regression, compared with 54% of patients who were not treated. Furthermore, 83% of women who received the treatment reported that they were satisfied with the experience.
While these studies were performed at large research centers in the U.S., Dr. Mungo recognized a unique opportunity to apply the method to communities that may struggle to access other forms of treatment.
“One thing that I’m trying to address is whether we can use topical treatments to either help clear HPV in women with persistent infection following treatment, or as a bridge for patients who have to wait a long time until they get to an expert who can do an excision or a hysterectomy,” Dr. Mungo said.
She and her colleagues are studying the feasibility of using self-administered 5FU in LMICs. One of her projects involves qualitative interviews with Kenyan women with HIV about their experience with the treatment, including questions of safety, privacy, and the ability to negotiate sexual abstinence with their partners. The researchers will also interview male partners of women undergoing cervical cancer screening to assess their opinions about the treatment and better understand potential obstacles.
Dr. Mungo also has a clinical trial in the works, funded in part by the Victoria’s Secret Global Fund for Women’s Cancers Career Development Award, in partnership with Pelotonia and the AACR. She and her colleagues are recruiting Kenyan women with HIV to undergo a course of 5FU self-treatment after excision or ablation of a cervical precancer. Dr. Mungo aims to study the uptake of the treatment when offered, adherence to the treatment schedule, and safety.
“Cancer is a disease that affects all people, not just those in the United States. For my work to be honored in this big American conference means that AACR appreciates that,” Dr. Mungo said. “Equity must not be focused on American cancer patients only, but globally, because innovation internationally will improve the lives of American patients and vice versa.”