First ever HPV tests in Belize initiated in the hope of developing vaccination program against cervical cancer
Posted: 10/08/2007 - 12:00 AM
Author: Adele Ramos
A 47-year-old mother of seven who lives in Ladyville is one of the 500 people who visited the Belize Cancer Society over the course of the last three days, in an intense campaign to get women to take the necessary tests for early detection of the potentially deadly cervical cancer – early detection being the key tool for fighting the disease. Her last pap smear test was in May 2006, and this is the first time she is getting tested for the sexually transmitted virus linked to cervical cancer – the Human Papilloma Virus, or HPV. She explained that a close relative of hers died from cervical cancer because by the time she found out she had the disease, it had already made her terminally ill. This woman is taking preventative measures because she does not want the same thing to happen to her.
Last year, 28 women were hospitalized because of illness from cervical cancer, and a total of 10 died in the same year from the disease. Sadly, these deaths were preventable if the cancer was detected early or if these women had access to the right vaccine earlier in life. Local medical authorities are now looking at ways to prevent cervical cancer deaths, and ultimately that means integrating a new vaccination program for sexually active women. The problem is, Belize currently lacks the technology to undertake such a program.
Consequently, medical authorities in Belize have teamed up with personnel from Drew University in the USA. This week they launched a cervical cancer campaign in which women are given pap smears, colposcopy exams, and HPV tests.
Dr. Peter Allen, the vice president of Belize Cancer Society (BCS) and the director of Policy, Analysis and Planning Unit in the Ministry of Health, said that cervical cancer is the main cause of cancer deaths among women in Belize.
Dr. Allen told our newspaper that this is the first time local authorities are testing for HPV. The aim is to determine the strain or strains of the virus existing in Belize so that a vaccination program can be initiated to curb the incidences among women.
During the process of a pap smear, an instrument is inserted in a woman’s vagina to open it just enough for the doctor or nurse to swab the cervix to get a sample of the cells, which are viewed under a microscope to determine if they are normal or show potentially cancerous growth. This same sample can be tested for the HPV.
A colposcopy is done on women with abnormal pap smears. During this procedure, the cervix is examined using a special microscope to determine exactly where the abnormal growths exist. Tissue samples can also be taken for further analysis.
The pap smear and colposcopy tests will help medics determine what, if any, treatment a woman requires, and so these are extremely important on an individual level.
The data from the HPV tests has more of a national importance, as it would enable authorities to plan a proper vaccination program.
While patients will get the results of their pap test in as little as 24 hours after the visit, the results of the HPV screening, which has to be done abroad in the US, won’t be available for months.
The results of the research garnered during this week’s campaign will be presented in October at the Annual Medical and Dental congress in the hope that medical colleagues from around the country can generate the best possible response, said Dr. Allen.
The local testing centers in this week’s campaign are the Belize Cancer Society and the Belize Family Life Association.
Dr. Helen Cathro, cyto-pathologist from the University of Virginia, who is assisting with the cell screening at BFLA, said that about 7% of the samples she has looked at since Monday appear abnormal, which she said compares closely with a 6% rate reported in Guatemala. While she has been perusing hundreds of slides with stained cell samples, another pair of technicians has been busy logging data from the patients and preparing vials of samples to send abroad for HPV testing through Drew University.
During the campaign, testing is free, and women have come from as far as San Pedro in the extreme east and Punta Gorda in the deep south.
Even before these women are sent to get their tests, they are invited to participate in an informational session to learn about cervical cancer, how it develops in women and what can be done to prevent deaths.
Dr. Alba Mendez Sosa, gynecologist and oncologist (cancer specialist), is a private doctor who also works along with the Belize Cancer Society. She told us that the pap test has a sensitivity of 85% - meaning that 85% of the cases are caught in the first time they test. She also told us that not every woman who is detected with the HPV will develop cervical cancer – but there is that 1% who slowly progress to develop the potentially deadly condition.
According to Dr. Mendez Sosa, a woman’s uterus should be preserved as much as possible, and hysterectomy (removal of the womb) should be the last resort in treatment. If a woman is diagnosed with abnormalities arising from the virus, there is the possibility of removing only the affected parts of the cervix.
A big part of the problem, though, is that some women are dying from cervical cancer and don’t even know it. Joan Burke, BFLA executive director, says that currently, only about 10% of the women who should be getting tested are being tested in the entire health care system – that’s 8,000 out of 80,000 women.
Statistics we have obtained from the Ministry of Health in Belmopan indicate that most of the cervical deaths recorded have been from the Belize District area. In 1998, when 18 deaths were recorded, 50% of them were from this district. In 2006, that trend continues with 6 of 10 deaths coming from the Belize District.
Young people, too, are affected, as young girls in the 15 to 19 age group have had to be hospitalized for cervical cancer illness. There is a tendency for the frequency of these cases to increase with age. The accompanying graph shows a steady increase in the number of cases as we progress from the sexually active age group of 15 to 19 to the older age groups, with a peak at the 45 to 49 age group.
Dr. Allen notes that nationally, Belize lacks a sophisticated response system to deal with cervical cancer. One of the challenges being faced is the expense in securing the necessary treatment for women.
The cervical cancer campaigners from BFLA and BCS all agree, however, that it is far cheaper to do routine pap smears and other diagnostic tests to catch the cancer before it is in its advanced stage. The cost of delaying this could be a woman’s life.
There is no mystery as to why more women have not been coming forward for testing. Dr. Allen, Dr. Mendez Sosa and Ms. Burke share their perspectives based on their professional experience.
The first problem is that both patients and health care providers tend to be passive. A lot of women don’t bother to test, and some doctors and nurses don’t bother to offer patients the test.
Dr. Mendez Sosa notes that two key factors that keep women away are fear and shame – fear of the procedure itself and the shame of having someone inspect their private parts.
Dr. Allen also notes that the community casts a stigma on cancer, as it does with HIV and sexually transmitted diseases, making it more difficult for women to come forward for testing.
He and Burke note that the very anxiety of waiting for results can also keep women away. While the results of pap tests routinely take about two weeks at BFLA, there have been reports that women testing elsewhere in the health care system have had to wait up to three months to know their status.
Now, the team hopes that once this campaign wraps up on Thursday, that more women will become sensitized, and that the experience of the 500 or so women who are taking the tests this week will serve as testimony that the procedure is not as painful as rumored, but above that, that it can help to ensure that women live longer, healthier lives.
Dr. Allen notes that men too need to become more educated. He said that it is important for men to know what affects their partners and to be more responsible about their relationships.
While HPV does not affect men the way it affects women, men can pass the virus to their sexual partners. The virus can cause genital warts in men and women, but most men who carry the virus don’t show any symptoms.
Aside from abstinence, the major ways of combating the virus are continued screening and vaccination. For the moment, though, patients in Belize only have ready access to screening services, which, Dr. Allen says, has been responsible for a 60 to 70% reduction of cervical cancer deaths in the United States.
Officials of BFLA and BCS urge women to continue their check-ups even after this week’s campaign.
While the focus now is on cervical cancer, Dr. Allen notes that the same preventative approach should apply to all the major cancers in Belize – gastrointestinal cancer, breast cancer in women and prostate cancer in men.
Burke notes that each BFLA center undergoes two campaigns a year that women should take advantage of. For a nominal fee of $25, women can get a breast exam, pap test, pelvic exam, and a weight and height check. San Ignacio will have its campaign later this month, and centers around the rest of the country will undergo their campaigns in December.
Persons who would like more information on the Belize Cancer Society’s program can call 223-0922.
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