By Shermakaye Bass, Fara Foundation reporter and editor
Guesswork is no longer necessary. Cervical cancer is almost entirely preventable, and its presence needn’t be a mystery. What that really means is, Women, get an annual Pap smear, get tested. Prevent cervical cancer before it starts and before it spreads. End of story.
Major cancer institutes and medical nonprofits agree that one of the world’s deadliest killers doesn’t have to be so. From the World Health Organization (WHO), the Union for International Cancer Control, the global group Cervical Cancer Action and American-based Grounds for Health, to our own Fara Clinic in Matagalpa, Nicaragua, the consensus is that cervical cancer is almost always associated with sexual activity. And in impoverished rural countries like Nicaragua, where many women have no awareness of it or of the early detection methods, that can segue into an epidemic.
On the surface, its prevention may seem simple. But in fact, cervical cancer (CC, hereafter) is an extremely complex issue both socially and medically, linked with the Human Papillomavirus (HPV). HPV’s are a set of sexually transmitted infections that can go undetected for years if not for that one simple screening: annual Pap smears for women. The test takes minutes. And at Fara Clinic, which has mounted an aggressive campaign during the past year, the test costs $1.50 or less.
Why now? Why us?
What stirred Fara to action? Why are we targeting hundreds of rural women — young and old — with our outreach programs and awareness push? Because the regional statistics are jolting: Nicaragua has the highest cervical cancer rate in Central America and the 12th-to-15th highest rate in the world. The country’s CC-related mortality rate for women over 30 is 27th globally; that’s according to a 2008 study of 184 countries conducted by WHO’s International Agency for Cancer Research. Closer to home, recent stats from Globocan show that CC is the most frequent cancer diagnosis among women in Nicaragua, constituting 46 percent of all cancer cases treated at the country’s National Radiation Center (CNR).
Fara Foundation’s staff expert is epidemiologist and coordinator of Cancer Prevention Services Susana Howe, who has Master’s of Public Health in Epidemiology, plus two decades of field experience in the U.S. and Nicaragua. She notes that, regretfully, “Nicaragua has all the risk factors that lead to development of the disease, but they/we have thus far not been able to build and maintain an effective population-based screening program.”
But Fara Clinic is determined to help reverse those trends — starting with Matagalpa, where rates are up to 20 percent higher than other regions of Nicaragua.
Worldwide, HPVs lead to more than 70 percent of all cases, and experts suspect the percentage is much higher in countries plagued by extreme poverty — countries like Nicaragua, where cervical cancer is the leading cause of death in women over 30. A mostly unseen killer, it’s waging a war of attrition on wives, daughters, mothers, aunts, grandmothers, BFF’s. On young married women and single mothers, women who are monogamous and women who have multiple partners. Because HPVs and early-stage cervical cancer can go for years undetected, the problem grows exponentially, insidiously.
That’s why Howe and Fara gynecologist Dra. Chavarria stress that annual Pap smears are crucial. If enough women start getting screened and treated — and start preventing CC in the first place — they can stop the cycle. They can spread the word, not the disease.
Howe, a San Diego native who’s lived in Nicaragua eight years, explains that Fara Foundation’s on-site staff and outreach efforts are making a difference. “In the six months since gynecologist Dra. Chavarria joined our staff full-time (June through November, 2011) the clinic has screened (or) performed diagnostic work-up or treatment on 650 patients. Twenty-four of these have received treatment for dysplastic (pre-cancerous cervical cells) lesions, and all but one of these was diagnosed and treated in the pre-invasive stage, with only one requiring referral to the hospital for an invasive lesions.”
That’s progress, even if measured over a few months’ time. It indicates what we can do to fight the global battle, locally and regionally. As of now, on
average our gynecologist and staff screen more than a 100 women monthly. For those presenting with dysplasia, we offer fast on-site treatment with cryotherapy or LEEP procedure. The test is $1.50, and the follow-up treatment costs the same or less.
Perhaps prevention, even eradication, seems like a no-brainer. But infrastructures in struggling countries like Nicaragua simply aren’t able to create the necessary network of outreach; they don’t have the tools or resources to raise awareness, much less provide affordable and accessible screening.
“Globally, cervical cancer is the second most common cause of cancer death in women,” states a 2007-2008 report by the American Cancer Society, adding it’s the most common among women in developing countries. “Virtually all cervical cancers are causally related to infections by HPV,” the report adds. “Approximately 70 percent of cervical cancers are caused by HPV types 16 or 18. …”
Once contracted, however, the slightly better news is that medical professionals know how to eradicate both HPV and non-invasive CC, at least long-term. That involves awareness, screening, preventative measures like the use of condoms (not entirely preventative, but helpful), limiting the number of sexual partners, and having partner(s) screened for HPVs also. This clear path to a CC-free world gives the experts reason to be hopeful.
Even the American Cancer Society sees a light at the end of the tunnel, some tunnel somewhere. … Worldwide, “cervical cancer screening, including widespread implementation of the Pap test, has led to a 75 percent drop in incidence and a 74 percent drop in deaths from cervical cancer in the past 50 years,” the ACS has reported. “… The burden of HPV-related diseases, recent scientific discoveries of viral etiology of several anogenital cancer types, and the development of prophylactic vaccines together present an unprecedented opportunity for global cervical cancer prevention.”
Yes, that could take decades, but awareness and action are on the rise. And in our own little part of the globe, in the semi-tropical coffee-growing communities of Nicaragua, we’re fighting on the front lines.
Fara’s Sue Howe puts it this way. “There are two main forces that determine rates of cervical cancer in a population or a country. First is the presence of risk factors that the female population is exposed to and second is the effectiveness of a prevention program. … Nicaragua has all the risk factors — especially for women in the countryside: early age for initiation of sexual activity (age 13 to 15); high parity (high number of pregnancies per woman); multiple partners (due to both social norms and to disruption of family from warts, etc.) which leads to more exposure to HPV’s; use of wood indoors for cooking (smoke inhalation and smoke are possible co-factors); inadequate retinoid intake in the diet (vegetables and fruits); and lack of access to early detection and effective treatment.
“Without an early detection and screening program, cervical cancer rates in the USA would probably still be high,” Howe concludes.
It just so happens that January is International Cervical Cancer Awareness month. Whether you live in Nicaragua, the United States, or elsewhere, if you’re reading this and you or someone you love is at particular risk for the disease, convey two words to them: “Pap smear”. Now.