Too embarrassed to have a pap smear test?
Cervical cancer is completely curable. So why are so many Guyanese women still dying from it?
Stabroek News
June 16, 2004
Symptoms of cervical cancer show up at least ten years before the onset of its final deadly stages. And one prominent local gynaecologist sees this as a blessing since in Guyana the facilities to act quickly to address it are not available.
But if this is the case, it is a blessing that is sadly under- utilized as too many women are still dying of this curable disease. The Guyana Cancer Society (GCS) says cervical cancer kills 30 of every 100 registered patients.
According to the Cancer Registry report for the period January 2000 - June 2003 this form of cancer "rates high for a cancer that with an early diagnosis can be cured."
The report says "early changes in the cervix can be detected years before cancer develops through pap smears" and it recommends that "pap smears should be carried out regularly in women who engage in sexual activity, particularly those having multiple sexual partners."
But the gynaecologist observes that getting women to take pap smears is a major hurdle to early detection. He explains that it is an invasive procedure in which women have to put themselves in a vulnerable position, something that they are averse to doing. As such, he says, many women find it embarrassing to go their doctor's office for such an examination.
He compares it to the "embarrassment" which prevents more men from being screened for prostate cancer.
Another doctor with whom Current Affairs spoke described the regime in Guyana as a sickness-based programme adding that only some of the 'well-to-do' women have a medical check-up at least once a year. This doctor opines though that were all women to cultivate the habit of regular testing, it would put a severe burden on the health system because of the lack of sufficient technologists to read the smears.
But the gynaecologist disagrees. He says the local laboratories are under-utilized and that the best places for examining the cells obtained from the smears are the laboratories at the Georgetown Public Hospital and the Guyana Responsible Parenthood Association (GRPA).
He says the Cancer Society sends smears overseas for testing and he has a difficulty with this. A spokesperson for the GCS said the smears are sent to Barbados because the results from the laboratories there are generally more accurate than results obtained from the local laboratories.
Asked if there are any procedures in use that would spare women the embarrassment he spoke about, the gynaecologist explains that there is a procedure being developed in South Africa which involves the use of an antigen, but it is several years away from being widely used.
With regard to management of cervical cancer, he says there are two aspects. One is a cure which rids the body completely of the disease, but this cannot happen if the disease is diagnosed late. However, he says, in many cases depending on the timing of the diagnosis, the disease could be managed so that it is not a major issue in the woman's life. He says radiotherapy is the method of treatment used and the results have been very good.
But it is not all doom and gloom and he stresses that the challenge is to get women to have the pap smears done.
A nurse at the GRPA says her organisation encourages women who go to the clinic there to have a pap smear test done once they are within the age range. She explains too that there is usually a good response after television programmes about the disease and the test that should be done to enable early detection.
The nurse says clients are mainly from urban areas but there are some who are referred by doctors in the rural and hinterland areas. She says she has observed that there is a growing awareness among women about reproductive and sexual health, especially those approaching menopause.
Mitzy Campbell of the Guyana Cancer Society says her association is engaged in a number of initiatives to educate women about the benefits of being screened. She says the Cancer Society networks with women's groups in the regions as well as responds to requests from groups to have someone speak to them about the disease and the benefits of early screening as against not being screened and having to undergo treatment for the disease if they are eventually diagnosed with it. Campbell also says that her organisation is usually accommodated in the programmes for Amerindians funded by the Canadian International Development Agency (CIDA).
Campbell agrees that there is some embarrassment at the screening process that could prevent women from making it a routine part of their medical check-up. However, she says doctors have to put their patients at ease and women have to learn to trust the medical personnel who are often most professional in their conduct.
Another cause for embarrassment, she says, is the stress some doctors place on the disease being contracted through transmission of the Human Papillomavirus, rather on the effects of multiple childbirth, another cause of the disease.
She says that as a consequence of research conducted by Yvette Irving, the Cancer Society plans later this year to conduct screening tests in the hinterland regions at least twice a year. Irving's research has discovered a high incidence of the precursor conditions to cervical cancer among 1,221 Amerindian women examined in 46 communities in Regions One (Barima/Waini) and Nine (Upper Essequibo/Upper Takuu). The GCS plans to target Regions One, Seven (Cuyuni/ Mazaruni, Eight (Potaro/Siparuni) and Nine.
Irving told Current Affairs that as a follow-up to her study, arrangements have been made for the women identified as being in need of it, to be treated at the Georgetown Hospital or sent abroad.
She explained that initially there was some reluctance by the women to be screened; it was only after the assistance of their husbands had been enlisted that they cooperated. She said that as a result of her exercise the women are fully sensitised and cooperative.
Campbell also says that during Cancer Awareness Month the Cancer Society conducted two outreach programmes which targeted secondary school girls and some older women at Lethem and Maburuma in one-day sessions at which sexual health issues were addressed. She says it was felt that some of the girls were engaged in sexual activity, even though they are still at school and as a consequence they should be aware of sexual heath issues.