Cervical cancer is the most common cancer among women in developing countries. A detectable and often preventable disease, cervical cytology (Pap smears) is currently the most common and effective form of cervical cancer detection. However, in developing countries – which comprise 80% of cervical cancer deaths – they lack the medical supplies and manpower needed to test and treat cervical cancer. The main cause of cervical cancer is the human papillomavirus (HPV), which is transmitted through sexual intercourse and activity. There are many strains of the virus, but a number of them are potentially deadly, as they cause cervical cancer. Men can be HPV carriers without knowing and pass it on to multiple partners. In underdeveloped countries, where contraception is limited and health resources are inadequate, the problem is growing.
Studies conducted in conjunction with the World Health Organization (WHO) conclude “the vast majority of cervical cancer cases worldwide are caused by persistent infections with some high-risk types of the human papillomavirus family. From the perspective of defining preventative strategies, the HPV-attributable fraction should be considered 100%”. Additionally, the report suggests that, in most cases, the sensitivity of testing for HPV over the traditional cytology is approximately 10% higher in determining the presence cervical cancer. The WHO’s (2002) report found additional advantages of HPV testing versus traditional cytology, which include:
The objectivity of the test resulting in very low inter- and intra-observer variability.
- The possibility of almost complete automation of the process. This should ensure high throughput at a standard level of quality.
- Built-in quality control procedures.
- Opportunities for self-sampling for HPV DNA in some populations with limitations in health care facilities and manpower, albeit with some loss of sensitivity.
- The high sensitivity of the HPV DNA test to identify HSIL [high grade dysplasia] in women aged 30 and above.
- Gains in effectiveness could be achieved by increasing the length of the interval between screens and reducing the total number of lifetime screens required.” (p. xi-xii)
However, according to the WHO report, there are a number of challenges in HPV testing, including: cost, dependence on reagents, requirement for a molecular diagnostic laboratory, and its low specificity in younger women and populations with significant rates of HIV. Furthermore, since HPV DNA testing, like cytology, is traditionally not a test that provides results at the time of the visit or soon afterwards, many of the traditional barriers to cytological screening remain.
Tackling these challenges, QIAGEN, a provider of sample and assay technologies, created a test system designed to screen for HPV. The system, which is made up of three major components: The controller, the thermoshaker and the luminometer, can test 96 samples at a time. Additionally, the system decreases test time of the typical cervical exam from days to hours – eliminating the barrier of delayed results. QIAGEN also required that a person with limited training/experience in medical testing and who was unable to read or understand the English language, be able to use the system. This required an easy-to-use interface with simple icons to provide instructions, test status and results. In order to reduce user error(s), system set-up was designed to be straight-forward and automatically detect the three component cables’ correct connection. By doing so, minimally trained persons could run the test, thereby eliminating the need for additional manpower and formal labs and healthcare facilities.
To initiate this design, QIAGEN developed a new as say procedure for rapid detection of HPV in women in low resource settings, followed by a series of clinical trials. Making the system available for field use required a team of engineers to create a control mechanism. The mechanism would act as a virtual chemist and make the test easy-to-use for the technicians in developing countries. To implement the solution required a small, low-power and lightweight user interface control unit to present the test instructions. The unit had to walk the technicians through tasks to complete the test. The unit’s step-by-step directions – which included auto-detection of RS-232 and USB ports – controlled a shaker table and a luminometer, and would alert users of any errors during the procedure. The device was required to: Run WindowsCE, boot directly to the application, be basic and not flashy to deter theft, and be rugged and able to survive spills, including chemicals.
Additionally, the device necessitated control of the shaker table(s) and luminometer(s); this included sending commands and receiving responses from the device and providing specific step-by-step directions as a linear process to the user including error conditions, alert messages and other information. QIAGEN’s specifications also required that the device be able to store test results and make them available for review on, and downloadable from, the device. Lastly, the device was required to pass tests for compliance with CE safety and EMC standards.
Requiring a four month turn-around, QIAGEN sought the engineering expertise of InHand Electronics, a leading provider of embedded solutions of wireless and handheld devices. After understanding QIAGEN’s complete requirements and collaborating on best solutions, InHand created a custom device and application software which met all requirements with quick turn-around. The solution utilized InHand’s standard COTS Fingertip4 single board computer, which includes: 128MB of SDRAM, 64MB of on-board Flash, LCD controller, touch screen controller, USB Host and Client, 3 Serial Ports, and SD and CF slots, with the devices utilizing 2 serial ports and USB 1.1 Host and InHand’s COTS daughter card, Fingerboard, which includes: LCD connector, touch screen connector, Serial port headers, and USB Host and Client connectors. Additionally, InHand designed in a NEC 4.1” WVGA display with integrated 4-wire resistive touch screen and created a custom enclosure, by using injection molded ABS plastics via a rapid, low-cost process. Utilizing Microsoft’s .NET compact framework enabled InHand to quickly create an easy-to-use GUI-driven application that met all of QIAGEN’s requirements and completed the detailed instruction process.
The software began with a mock-up of user interface screen shots, which where then shown to QIAGEN; customer feedback was incorporated to improve the design and overall application logic. The original program required the chemists to turn on and manually manipulate the thermoshaker in set-up, temperature change, etc. InHand’s final software solution streamlined the effort, creating minimal steps for technicians, as to reduce error and increase ease-of-use. Utilizing the hardware, the new software program can save all the information and requires almost no manual manipulation; the device and software were required to take care of the system test complexities, including all conditional test sequence items, such as temperature control, with the use of ambient temperature sensing within the hardware design.
Lastly, QIAGEN needed the device to permit the ability to update the process flow and timing in the field without recompiling the application. InHand created a configurable solution that allows QIAGEN scientists to use a simple text editor to modify critical aspects of the process control. The simplicity of the software was achieved through a linear design which bridged the gap between QIAGEN’s and InHand’s areas of expertise. The result: A software program that provides technicians with step-by-step instructions, while hiding the technical aspects of the test instruments, then reading the results, utilizing software written with specific calculations of positive or negative and saving results to an SD Card.
With this information, the presence of HPV in women with limited medical care can be detected within hours – not days. The women who test positive for HPV can then be treated for cervical cancer before it becomes life threatening. With InHand’s single board computer and custom enclosure and application and Microsoft Windows Embedded Compact expertise, QIAGEN was able to deploy their assay test quicker and, in turn, help thousands of women. Thanks to this collaboration, the new, language independent system assay test and subsequent treatment can save thousands of lives in developing countries, while drastically reducing the number of women who lose their lives to such a preventable disease.
World Health Organization. (2002). Cervical Cancer Screenings in Developing Countries: Report of WHO Consultation. Retrieved from http://whqlibdoc.who.int/publications/2002/9241545720.pdf.