Woman looking off to the side with head on hands.
Mississippi has one of the highest rates of deaths from cervical cancer in the nation, and the numbers are worse for black women in the state. The School of Nursing and the NIH’s National Cancer Institute are entering in a unique partnership that aims to change that.
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SON, NIH team up to reduce cervical cancer in Mississippi

Published on Thursday, April 11, 2019

By: Kate Royals

The University of Mississippi School of Nursing and the National Institutes of Health’s National Cancer Institute are partnering to reduce the number of cervical cancer deaths in Mississippi, and hopefully everywhere.

The seed for the project was planted when Dr. Carolann Risley, a women’s health nurse practitioner who will graduate from the School of Graduate Studies in the Health Sciences with a Ph.D. in Nursing in May, noticed something peculiar while working for the Mississippi State Department of Health in 2014.

Her observation would later guide her dissertation research, which then led to the unique SON/NCI partnership. Beginning in June, Risley will hold a dual appointment on the faculty of the School of Nursing and as a postdoctoral fellow at the National Cancer Institute. 

“By performing cervical colposcopies and biopsies I could clearly see there were differences in Mississippi when compared to other populations where I worked,” she said. “HPV was acting differently by race or ethnicity … and cancerous infection was somehow persisting and progressing at a faster rate and infecting women at an earlier age” in the state.

Dr. John Schiller, center, deputy chief of the Laboratory of Cellular Oncology at the NCI's Center for Cancer Research, led the initial development and characterization of the HPV vaccines with co-Principal Investigator Dr. Douglas Lowy. Left, Dr. Carolann Risley, and right, Caroline Powles, at the National Institute of Health in Bethesda Maryland.

Through her 20-year career, she worked all over the East Coast. She is a graduate of the University of Pennsylvania and worked at the University of Florida and with the military in rural South Carolina before moving to Mississippi. 

Risley called Dr. Kim Geisinger, former professor of pathology at the University of Mississippi Medical Center.

“He had an excellent pathologic impression that was correlating with what I was seeing clinically,” she recalled.

Women in Mississippi have more than triple the risk of dying from cervical cancer compared to women living in Vermont, according to the Centers for Disease Control and Prevention. But the data also shows further disparities by race – black women in Mississippi die from cervical cancer at greater than twice the rate of white women.

HPV, or human papillomavirus, is a highly contagious infection that encompasses a group of more than 150 types. It also causes most cases of cervical cancer in women, as well as other cancers in women and men, according to the Mississippi State Department of Health. Types 16 and 18 are responsible for the most HPV-related cancers.

“There was no type-specific HPV data in Mississippi to describe the prevalence of cervical precancer or why black women are dying at greater than two times the rate of white women,” said Risley.

Risley reached out to Dr. Mary Stewart, interim dean of the School of Nursing and director of the Ph.D. in nursing program at UMMC, and began her Ph.D. in 2015 under Stewart’s direction and with funding from the School of Graduate Studies, the School of Nursing and the Mississippi Nurses Foundation. After getting Institutional Review Board approval, she started looking at data from Pap smear and HPV test results from women across the state to see whether her original hunch was supported by data.

UMMC uses a screening technology called cobas4800® that divides patients’ test results into three categories of HPV types: type 16, the most dominant high-risk type in cervical cancer; type 18, which leads to a certain type of cervical cancer; and finally, another category that encompasses 12 less common cancerous types of HPV.

The dissertation committee for Risley. Left to right, Dr. Kim Hoover, professor emeritus and former dean of the School of Nursing, Dr. Mary Stewart, interim dean of the School of Nursing and director of the Ph.D. program, Risley, Kim Geisinger, former professor of pathology, Susan Lofton, professor of nursing, and Lei Zhang, professor of nursing and director of data and research at the Mississippi State Department of Health.

Risley found something interesting when comparing black and white women who had an abnormal Pap smear result defined as “Atypical Squamous Cells of Undetermined Significance,” or ASCUS, which can be a sign of HPV infection.

“Black women were more likely to have the other less-common HPV types,” or have results that fall into the third category containing the 12 less common cancerous types of HPV, she said. “White women were significantly more likely to have HPV 16 than black women. That’s a significant finding because type 16 and 18 are the types that frequently guide our clinical HPV triage to colposcopy and biopsy, the tests that diagnose cervical cancer.”

The findings are significant because there is not much of this data available for African-American women, said Geisinger, who went on to be a member of Risley’s dissertation committee.

“Little HPV data is available in this population, and an investigation using a genomics approach contributes data to make screening recommendations that may reduce those deaths in this population,” he said.

Enter the National Cancer Institute’s Division of Cancer Epidemiology and Genetics, which will help further investigate Risley’s findings and potentially answer several questions, such as: should race be considered along with genotype in determining screening  for Mississippi – and possibly all – women?

Risley became part of the NIH Graduate Partnership Program after attending the NCI Summer Fellowship in Cancer Prevention in 2018.  There she met another NIH fellow, Dr. Megan Clarke, and they formed a diverse investigative team under the guidance of Dr. Nicolas Wentzensen, deputy branch chief and senior investigator in the NCI’s Clinical Genetics Branch of the Division of Cancer Epidemiology and Genetics.

The team’s research is titled STRIDES, short for STudying RIsk and Improving DisparitiES in Mississippi. The collaborative study, which also includes the Mississippi Department of Health, will evaluate risk of cervical precancer and cancer. It will also study potential new screening tests for the future.

Risley’s work fits perfectly into the NCI’s new research effort funded through the Cancer Moonshot Program, a seven-year, $1.8 billion project to accelerate cancer research and make more therapies available to more patients, while improving the ability to prevent cancer and detect it at an early stage.

“Mississippi has one of the highest cervical cancer mortality rates in the United States with many disparities related to race/ethnicity, socio-economic status and access to care,” said Wentzensen. “There is a unique opportunity to join forces between NCI and multiple partners in Mississippi to address these challenges and work towards reducing cervical cancer mortality.”

The collaborative effort will include clinicians, laboratory scientists, epidemiologists and implementation scientists, and Risley will have a dual appointment at UMMC and the NIH. At the NIH, she will receive training in clinical epidemiology, study design, risk assessment and data analysis, according to Wentzensen.

“As a result of her passion, persistence and expertise, Mississippi is now one of the major sites, along with California and Brazil, for the NCI’s efforts surrounding cervical cancer prevention, detection and treatment,” said Stewart. “The collaboration is only beginning, but it is incredibly promising for the School of Nursing – but more importantly for the women in Mississippi.”

See, Test and Treat

The UMMC Cancer Institute will offer free cervical and breast cancer screenings on Saturday, June 1 to uninsured and underinsured women ages 21 to 64. The screenings, from 8 a.m.-1:30 p.m. at the Cancer Institute, 350 West Woodrow Wilson Drive in the Jackson Medical Mall, are part of the College of American Pathologists Foundation See, Test and Treat program.

Call 601-815-3572 to determine eligibility and set up an appointment.