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Promising results for Curacao + Caribbean in prevention of cervical cancer. (Dr. Desiree Hooi | Interview part II)

March 5, 2015
Dr Desi Hooi in the Lab - HPV research

 

Fundashon Prevenshon

Dr. Desiree Hooi has been leading a significant research project on the prevalence and prevention of the spread of HPV Human Papillomavirus with Fundashon Prevenshon in Willemstad, Curaçao.

We are back with  Part 2  of  a previous interview with Dr. Hooi  you can read PART 1  here.

 


 

CF: What is HPV?
Dr. Hooi: 

•  HPV stands for Human Papillomavirus and is a double   stranded DNA virus.

•  HPV is the number one most common STD.

•  80 to 84% of the population was once in contact with this virus.

Fortunately the body takes care to eliminate the virus and it may take 1 to 2 years for the immune system to get rid of the virus. HPV knows approximately 160 genotypes from which can be subdivided in cutaneous and mucosa. This virus is known for in some occasions depending which genotype causing the so-called genital and some cutaneous (skin) warts.  HPV is divided in low risk (lr HPV) and high risk (hr HPV).  The last subdivision is important because the hr HPV is known to cause cancer and is an oncovirus.  HPV 16 & 18 are the most prevalent in causing Cervical Cancer.

The HPV genotypes known for causing cancer do not give any symptoms.

CF: So is HPV a Public Health issue?
Dr. Hooi: Indeed; HPV is considered a Public Health issue due to findings of cancer caused by a very
contagious sexual transmitted virus in the cervix (feminine organ) and also in other tissues in women and men e.g. vulva, vagina, anus, oral cavity and throat in women.  There are reports of HPV in men with cancer of the penis, anus, oral and throat cavity.

 

 


HPV prevention dr. Desi Hooi in Lab

 

CF: Is this a preventable cancer?
Dr. Hooi: Yes. Besides the fact that young children can be vaccinated this cancer develops slowly.  One must become infected with HPV to develop cervical cancer.

This virus causes changes in the human DNA structure and provokes a pre-cancer lesion which most of the time will take 10-15 years to turn into cancer. During this period, the pre-cancer lesion can be detected and treated on time if you have a screening (Pap smear) done regularly.

CF:Why do you think this is important in the Caribbean?
Dr. Hooi: 

The cervical cancer mortality rate is high in the Caribbean region and it is the 2nd place most prevalent cancer among women between ages 15 to 44.

It is noticed that in developed countries screening programs have reduced the incidence of cancer and mortality rate. More data is needed to analyze the situation in the Caribbean.  Guidelines must be adapted on the basis of the results within the culture and ethnicity of the medical community in the specific Caribbean area.

The results of the studies can be applied to other islands where the necessary adjustments are aimed in specific medical standards and cultures.

CF: What is your estimated result of this HPV study?
I estimate a high % positivity in the upcoming 1000 tests given. The results of the study held among 253 women on Curaçao in 2013 had a high prevalence (20.2%) in the specific age group 45-75 years.
The prevalence by country is:

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Europe is 6%,
The United States 13%,
Latin America 18%
Africa 23%.

We expect a higher prevalence from the upcoming 1000 samples since the age group <40 years will be representative in this survey.  Among this age group of individuals less than 40 years, HPV prevalence is the highest according to literature. Regarding our study on paraffin embedded tissue; we can mention that the HPV 16+18 was not that prevalent compared with the rest of the world.

This may have important significance for the introduction of vaccine considering the fact that other HPV genotypes are playing a role in causing cancer in our population.  What type of role still needs to be discussed.

A study performed among sex workers in our community revealed no significant differences between this group and the results from the pilot in volunteered participants. We have to wait for results of the population in this specific age group <40 years that represented the sex workers in order to compare and do analysis on these findings. We can preliminarily say that it will not make an important difference since the virus is very contagious and promiscuity or multiple sex partners does not only happen amongst sex workers.

The oral cavity study it is still ongoing with results pending this year.  We think that the results will not differ from the rest of the world.  Regarding the women with hysterectomies with intact cervix I think there might be a large number with no cervical cancer screening afterwards because they are:

1. Not aware of the relevance of having the cervix intact and the need to perform a Pap-smear.
2. This group will be considered the non-responders to well established cervical cancer screening programs in some countries.

This fact maybe underestimated.

Community Service, Health & Wellness, Lifestyle, The Pulse

Interview with Dr Desiree Hooi MD, Research Physician ( HPV)| Fundashon Prevenshon | Part 1

November 27, 2014

 

Ever since I was little I had two loves, music and medicine. I possessed a precocious curiosity about the “science” of life in general. I always knew that one day I was going to become a Medical Doctor and I was well aware that there would be a long road ahead.


I studied medicine with a goal to understand the behaviors and mechanisms behind human bodily functions and to find (the solution or the cure) for specific diseases.

I believe that the urge for finding these answers has brought me to where I am today; studying and working as a medical professional and researcher. However, I have since learned that studying medicine was not enough to answer all the questions about this thing we call life!

 


 

 

Can you tell us about how you started working for Fundashon Prevenshon?

Since my return from Costa Rica I  have worked as a general practitioner and as physician assistant at the Neurology ward in the General Hospital.

In November 2012 a former colleague, the actual director of Fundashon Prevenshon Ms. L. Elstak who always I have considered a role model, brought me in contact with professor Pinedo. I was offered a job as a research physician on the HPV and Cervical cancer program. At that moment I thought that I could keep my interest in science. I consider this an opportunity to do medical research on Curaçao with the well-respected global authority in medicine; emeritus Professor Bob Pinedo.

Of course I saw the opportunity to work on uniform guidelines, developed and adapted to our specific community. From my experiences I had so far, I want to contribute, by means of evidence-based research projects to set these guidelines and safeguards.

 

 

What is Fundashon Prevenshon?

Fundashon Prevenshon is a private foundation that was founded by Emeritus Professor H.M.(Bob) Pinedo and Mr. L. (Paps) Capriles with the objective of supporting and administering a center for the prevention of disease in Curaçao. As of 28th of October 2009, the foundation has been listed at the Ministry of Health of Curaçao and is situated at the Klipstraat 11 in Otrobanda.

What is HPV?

Human Papillomavirus (HPV) is the most common sexual transmitted disease and it’s a well-established cause of cervical cancer. Although cervical cancer is the most common cancer caused by the HPV virus, studies have shown that the virus can also cause cancer in areas such as anus, vagina, vulva, penis, and oropharynx. It represents an additional 0·7% of all cancer sites in men and women, meaning that HPV is estimated to be responsible for 5·2% of all cancers worldwide.

 

What research projects are you currently working on?

I am  the person responsible for writing the protocol, organizing the population screening associated with scientific research about HPV and cervical cancer. I will perform the scientific research by collecting 1000 Pap smears and HPV samples.  All the participants of the scientific research will receive a self-test. It will be a total of approximately 2000 HPV samples that I will be analyzing in the lab.  Last year we already did a pilot trial consisting of 253 women in order to have preliminary results and analyze the work and study the logistics.

Currently, I am working on data analysis of a study we just have finished in The Netherlands consisting out of HPV genotype on paraffin embedded cancer and pre-cancer material in Curaçao women from 2003 to 2013. This study was done to specify which HPV genotype is causing cancer in our population  which is relevant issue to address in order to introduce the HPV vaccination.

“…many women are not aware of having their cervix intact after having the uterus removed.”

There is also another ongoing analysis happening in tandem with this research to help pin-point the number of women who have had hysterectomies (uterus extirpation) with intact cervix.  An interestnig fact we came to find during the first trial was that many women are not aware of having their cervix intact after having the uterus removed. This must be considered a risk for developing cervical cancer, espescially if these women still have their cervix and do not routinely have a Pap smear done. We will analyze this population in order to tackle the situation of awareness and to incorporate this group in the population-screening program.

We will work with the organization to start  randomized research in 1000 women in the coming months. This study will be realized under the supervision of Professors at VU mc Vrije University of Amsterdam and DDL Diagnostic Center at Rijswijk in the Netherlands. A local Gynecologist and Professor Pinedo are involved to support the research and for advice.


Besides this being an important opportunity for the population of Curaçao, I will also obtain my doctorate in science and medicine with the completion of this PhD study.

So, is HPV currently a public health issue in the Caribbean?

Caribbean data reveals that cervical cancer is ranking second place in most common cancer among women in the Caribbean. HPV is the established cause of this type of cancer. There is currently not enough data reported regarding the HPV virus and its effects in the Caribbean; not all islands have implemented a cervical cancer-screening program within their communities. Furthermore, even with the introduction of the HPV vaccine most Caribbean islands currently do not have a government regulated vaccination program.

 

 

“…Caribbean data reveals that cervical cancer is ranking second place in most common cancer among women in the Caribbean. “



800px-Scheme_hysterectomy-en_svg
However, there have been findings of cancers caused by this very contagious sexual transmitted virus in the cervix (feminine organ) and also in other tissues in both man and women e.g. vulva, vagina, anus, oral cavity and throat in women. There are reports of HPV being found in men with cancer of the penis, anus, oral and throat cavity.


That is why we are working diligently to educate and stimulate the population to participate in screening programs and be aware that this is not only a female but also a male public health issue.

 

How is this study geared towards the Curaçao community and how are test subjects picked out?

Subjects are selected according to the needs and the current situation in the population. Prior to the scientific study, a literature analysis will be done. The reason is to analyze existing publications on this subject and to determine the importance of the results for this population. This HPV study on Curaçao will start from scratch. There is little data available in the Caribbean. Some of the results are well-known from Jamaica and Cuba but considering the fact that the mortality rate for cervical cancer is high in the Caribbean, more studies are requested in order to address this form of cancer in the right manner.

 

CF: Wow! That is a lot to digest on a daily basis! Can you tell us a little more about yourself and how you spend any free time you have left? 

 

I am a dreamer and a believer. I am  also very ambitious and always think about the bigger picture. If you really want something it depends on you and only you to achieve that goal.

 

The most important thing is to never give up. Everything is possible when you dream & when you believe. I have a saying since my childhood: “This world is big enough for all my dreams, and small enough for me to achieve them” (quote by me). Prior to my medical study, I graduated as a Registered Nurse. At age 16 I started to work as intern aspirant nurse at the St. Elisabeth Hospital in Curaçao.

I find it incredibly inspiring to be part of this scientific study. I work hard to stay on the right track to achieve this goal and fully contribute to my community.  This survey requires a lot of time for reading other studies and analyzing the results. Working in the lab is a challenge of endurance and concentration. The calculations and the discussion on the results with my supervisors contribute each day to get a better understanding of the behavior of the HPV virus genotypes on the island.  Furthermore, providing information to patients and other interested parties is inherent in my profession and gives me great satisfaction.


My balance in this scientific research is music and I play the ‘Cuatro’ instrument. I love music and I compose my own songs. I have several compositions and a c.d. to be published with 9 self composed songs. I am a member of a 25 person choir. Making music together and studying the details of the different voices and the various musical instruments is one of my hobbies. I’m part of the folkloric music group “Tipiko Pasabon”. I play Cuatro in harp & Cuatro duets with Marco Dorothea. I also play with my beloved uncle Rudy Plaate on special occasions.  Benito (Broertje) Dolorita, Alberto (Betto) Betrian, Eduardo Pereira, Norman Moron, Lindo Casper, Hershel Rosario, are some more local musicians I used to perform with.

I can now travel less while I complete this study, but I cannot wait for the day I can act and perform in theaters and musicals again.
Also, when I do have some free evening hours I like to try and stop the clock by enjoying a self made dish with family and friends.
My cooking skills come from my curiosity for other cultures and I find experimenting with existing recipes helps bring the travel back to me.