Cervical Cancer: A killer in the developing world

by Sue Patterson and Laurel White

Last May, Emma, a 35-year-old mother of nine, passed away from cervical cancer, now considered a sexually-transmitted disease. Her premature death was a terrible and preventable tragedy. After hearing a radio announcement about a WINGS-sponsored screening in Chimaltenango, she came for her first such screening two years ago, but the test revealed Emma had advanced cancer.

Feeling helpless at first because she couldn’t afford any treatment, Emma found great support from WINGS’ staff members, who arranged for her to be seen by a doctor and to receive available treatment, including radiotherapy, from INCAN, the Guatemalan Cancer Institute. Unfortunately, Emma’s cancer was very advanced by the time it was discovered, and the treatment was unsuccessful.

During her lifetime Emma, like 60 percent of Guatemalan women, had never used any contraceptive method because she believed, as do so many people here, that contraceptives cause cancer. After attending the cervical cancer clinic, she learned that this widespread belief was actually a dangerous myth. Until her death, Emma continued to spread the word to other women in her community that all women are at risk for cervical cancer and that cancer is not caused by family planning methods. She encouraged all the women she knew to be screened, telling them that the test could save their lives.

Cervical cancer has a major impact on women’s lives worldwide, particularly in developing countries where it is the leading cause of cancer deaths among women. According to the latest global estimates, 493,000 new cases of cervical cancer occur each year, and 274,000 women die of the disease annually. Because the disease progresses over many years, an estimated 1.4 million women worldwide are living with cervical cancer, and two to five times more—up to 7 million worldwide— may have precancerous conditions that need to be identified and treated.

If it is not detected and treated early, cervical cancer is nearly always fatal. The disease, which affects the poorest and most vulnerable women, sends a ripple effect through families and communities that rely heavily on women’s roles as providers and caregivers. Four out of five new cases, and a similar proportion of deaths, occur in developing countries where screening programs are not well established or effective.

In Guatemala, cervical cancer is the leading cause of cancer-related deaths among women of reproductive age, with 3.77 million Guatemalan women currently at risk for this potentially fatal cancer. Over 60 percent of female cancer cases attended by the National Cancer Institute in Guatemala are cervical cancer, which accounts for more than breast, skin, ovarian and stomach cancers combined.

Cervical cancer is a slow-growing cancer, easily prevented through regular screen ing and treatment of pre-cancerous lesions, which can reduce incidence and mortality by as much as 90 percent. Unfortunately, Guatemala, like most developing countries, has no effective national screening program, and hundreds of Guatemalan women continue to die unnecessarily each year from this preventable disease. Women in poor, rural areas are at especially high risk for cervical cancer due to factors such as unfaithful partners, early initiation of sexual activity, high fertility, poor nutrition and lack of access to health services. More than 75 percent of the women living in Guatemala’s rural areas and poor urban communities have never been screened for cervical cancer.

At least two organizations are working to address the widespread lack of cervical cancer screening services in Guatemala. The Women’s International Network for Guatemalan Solutions (WINGS), an NGO based in La Antigua Guatemala with a mission to create opportunities for Guatemalan families to improve their lives through family planning education and reproductive health care, operates a mobile cervical cancer detection and treatment program. Because many women are not aware of the risks of cervical cancer or methods for prevention, WINGS also conducts educational outreach to expand knowledge and increase demand for screenings. Women who attend WINGS’ talks or clinics are encouraged to share information about cervical cancer with their friends, relatives and neighbors. In 2008, WINGS screened more than 4,300 women at its mobile clinics.

Faith in Practice is an NGO that aims to improve the physical, spiritual and economic conditions of the poor in Guatemala through short-term surgical, medical and dental mission trips and health-related educational programs. Last year, Faith in Practice screened almost 3,000 women and provided training for Guatemalan doctors and nurses who went on to screen over 12,000 women at public health clinics.

Both WINGS and Faith in Practice utilize the low-cost VIA/Cryo method (visual inspection of the cervix with acetic acid and same-day treatment using cryotherapy), also called the “see and treat” method or la prueba rápida. This technique is especially appropriate for low-resource settings because results can be given the same day, and up to half of abnormalities detected can be treated immediately using cryotherapy, a simple procedure which involves freezing the surface of the cervix. VIA/Cryo greatly diminishes the need for return visits, which are often prohibitively difficult or expensive for women in isolated or low-income areas. In addition, when the result of a screening is negative, the test only needs to be repeated every three years, whereas Pap smears should be repeated annually because of the high prevalence of false negatives with the Pap smear test. VIA/Cryo can be performed by any trained healthcare provider, not necessarily a physician, and costs less than $6 per patient (including the cryotherapy needed by some 5 percent of the women). The cost per person of the WINGS program, including the follow-up treatment that WINGS pays for (colposcopies, biopsies, assistance at INCAN) comes to $14 a person.

The Guatemalan government has also shown that it may soon make fighting cervical cancer a higher priority. Although government health clinics have traditionally used Pap smears to screen for cervical cancer, some public health providers have recently undergone trainings in the VIA/Cryo method in order to expand the screening services available at government health clinics. Earlier this year, the Ministry of Health announced an extremely ambitious goal to screen 85 percent of reproductive-aged women by the year 2012 and has asked WINGS to advise it on a national screening strategy. This request provides hope that someday in the near future all Guatemalan women will have access to detection and treatment services and that the hundreds of deaths that occur annually from cervical cancer in Guatemala will be prevented.

About the Authors
Sue Patterson, the founder of WINGS, graduated from Duke University before serving in the Foreign Service for 25 years. She now lives permanently in Guatemala and donates her time to WINGS.
Laurel White, a graduate of the New York University School of Law, is the Development Director of WINGS and has been living in Guatemala since August 2008.

To learn more about WINGS’ work in Guatemala, please visit www.wingsguate.org or email info@wingsguate.org