Cervical Cancer Research at UT:
Instant, More Accurate Detection through Fiber Optic Technology
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Cervical cancer is the second most common cancer in women worldwide, with approximately 15,000 new cases diagnosed each year in the United States alone. However, if detected early enough, there is a 91% five-year survival rate, making early screening and detection essential. Unfortunately, diagnosis is currently hindered by a screening process that is time-consuming and expensive. University of Texas biomedical engineering professor Rebecca Richards-Kortum has developed remarkable new technology that may change this. Dr. Richards-Kortum, the Robert M. and Prudie Leibrock Endowed Professor in Engineering at UT Austin, is a nationally recognized expert in optical imaging. She has developed a small fiber optic probe that can detect the presence of cancerous or pre-cancerous cells in the cervix. The probe employs fluorescence spectroscopy, which measures the wavelengths of light bounced off different surfaces. The device shines light on the cervix and reports what it sees to a computer in the physician's office. Because cancer cells interact with light differently than they do with healthy cells, the computer translates the light's interaction into either a healthy report or a possible problem. The patient gets immediate, accurate results. The probe has the potential to dramatically improve the current standard of care in cervical cancer detection. Today, diagnosing cervical cancer typically requires three office visits and three lab screenings. In a routine physical, a woman is given a Pap smear in which cells are removed from the cervix and applied onto a microscope slide for evaluation. Often, the evaluation is done at an independent lab, with results taking a week or longer. If the initial results are abnormal, the patient is scheduled back into the office for a second Pap smear. After two abnormal smears, the patient is scheduled for a colposcopic examination. A colposcope uses a magnifying lens to view the cervix under white and green light after a mild acid solution is applied. If trouble spots are detected, a biopsy is performed. The results of this biopsy, also sent to an independent lab, determine whether the patient has cancer or its precursors. This cumbersome process can take weeks to complete and requires that health care practitioners follow up with patients and schedule them for repeated office visits. The cervical cancer probe developed by UT's Rebecca Richards-Kortum has the potential to replace colposcopy and eventually even replace the Pap smear as a primary screening tool. Richards-Kortum points to three primary advantages of this technology. First, the results are instantaneous, reducing the need for subsequent office visits. On her first visit to the doctor's office, a patient can either test negative for any signs of cervical cancer or be referred to another physician to start treatments. This also reduces the number of patients who are lost through missed contacts, or those who don't come in for follow-ups because of financial constraints. 
The probe, which is far less invasive than colposcopy, also eliminates the need for unnecessary biopsies. Pap smears have a false positive rate of more than 40%. Thus, many women at no immediate risk of cervical cancer undergo uncomfortable surgical biopsies simply because of problems with the screening device. Further, not all lesions are likely to progress to cancer, yet at the current time all identifiable lesions need to be biopsied. Reducing biopsies also has terrific financial benefit. Richards-Kortum estimates that the probe could save $625 million a year in the United States alone in unnecessary tests or treatments. A third advantage to the cervical cancer probe is that it reduces the need for advanced technological training. Because the results are fed directly into a computer in the doctor's office, fewer people are involved in the diagnosis process. This also diminishes the possibility of human error. A clinical trial of the cervical cancer probe is currently under way at The University of Texas M.D. Anderson Cancer Center in Houston, funded by an $11 million grant from the National Institutes of Health. The probe is being used on 1,800 women in five locations as an alternative to colposcopy. Richards-Kortum says that they have completed testing on 600 women as of the fall 2001. The trial will run for two more years and then the data will be studied. In the meantime, the technology has been licensed to LifeSpex, Inc., which may seek FDA approval and commercialization of the devices. When looking toward commercialization of the technology, Richards-Kortum says that one of the primary challenges she and her researchers face is making sure that the tools developed are cost-effective. The group has worked with health care economist Scott B. Cantor at M.D. Anderson to look at trade-offs between cost and performance. In general, greater accuracy leads to higher cost. However, Richards-Kortum acknowledges that the device needs to be affordable to ensure wide usage, especially considering the need for this technology in developing countries, where cervical cancer often goes undetected because of the cost of the tests and the lack of trained personnel and resources to screen and diagnose. The technology used in the cervical cancer probe has potential applications beyond the diagnosis of cervical cancer. Richards-Kortum's research group is actively pursuing the development of devices to detect a number of cancers, including cancer of the mouth. People who chew tobacco and smoke are at high risk of getting pre-cancerous lesions in their mouths. Spectroscopy can be used to investigate those lesions without the need for biopsy. Spectroscopy may also have a role in diagnosing ovarian cancer in its early stages. Ovarian cancer is trickier to diagnose than cervical cancer because the ovaries are less accessible for examination than the cervix. Thus, ovarian cancer is most often diagnosed in an advanced, incurable stage. Researchers are pursuing the possibility of creating tiny probes that allow physicians to view the ovaries. Paired with genetic screening tools that identify women at high risk of ovarian cancer, these probes could detect the disease in its early, treatable stages. 
Rebecca Richards-Kortum joined the faculty of The University of Texas at Austin in 1990, after receiving her bachelor's degree in physics and mathematics at the University of Nebraska at Lincoln and her master's and doctorate degrees in medical physics at the Massachusetts Institute of Technology. She says that the ability to partner with M.D. Anderson, ranked the top facility for cancer care in the nation, makes UT a terrific place to undertake her research, and she acknowledges that she couldn't do this groundbreaking work without collaboration with the excellent physicians at M.D. Anderson, including Drs. Michele Follen, Ann Gillenwater, and Molly Brewer. Working at UT Austin allows Richards-Kortum and fellow researchers and students in the new Department of Biomedical Engineering to take advantage of the University's strong programs in the basic sciences. New technologies developed in these related areas can go directly into the clinic, and information can be exchanged between the departments. Richards-Kortum says this is not only important for the research, but it is also motivating for students. UT has had an interdisciplinary graduate program in biomedical engineering since 1969, but the new department extends the offerings and opportunities for students. Undergraduate degrees in biomedical engineering are available for the first time, with three specialization tracks. The department also builds upon an established relationship with M.D. Anderson, allowing even undergraduate students to conduct summer internships in Houston and work directly with faculty at M.D. Anderson and The University of Texas Health Sciences Center. Richards-Kortum applauds the establishment of the department, noting that there is a demand within industry for people with more extensive training in biomedical engineering, and her new department will train more students who are qualified for that work. 
Rebecca Richards-Kortum has received numerous awards and honors for her research, including the prestigious Y.C. Fung Yung Investigator Award from the American Society of Mechanical Engineers. Her research has resulted in 9 awarded patents, with 12 additional applications in process. However, she points to her most recent teaching achievement as something of which she is particularly proud. This year she was elected to UT's Academy of Distinguished Teachers, an honor bestowed on only 5% of the tenured faculty. According to the Academy, "Members are chosen on the basis of their outstanding teaching, their personal commitment to students and the learning process, and their ability to inspire and motivate in the classroom." Add one more accolade to that description. If Rebecca Richards-Kortum's fiber optic spectroscope finds widespread use in the detection of cervical cancer, she will also be saving women's lives. By Vivé Griffith
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