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Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests).
Women who have had a hysterectomy without removal of the cervix (called a supracervical hysterectomy) should continue cervical cancer screening according to the guidelines above.
Women who are at high risk of Cervical Cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long-term steroid use) or because they were exposed to Diethylstilbestrol (DES) while in the womb, may need to be screened more often. They should follow the recommendations of their health care team.
Not only is it possible to catch the disease early, but also the disease can be prevented with the vaccine developed against HPV. Because we know that HPV causes cancer, at the turn of the century, a vaccine was developed against the HPV types that predispose to the development of cancer. HPV vaccine is available free at the public system from preteen male and females. This reduces not only cervical cancer but also oropharyngeal, anal and penile cancers. It also prevents anogenital warts. The ideal time to administer the vaccine is before the start of sexual activity, this is because the vaccine will be most effective once administered before contracting the virus. However, it can still be administered after sexual activity starts or even in women who are diagnosed with an HPV infection. It is recommended that women be given the vaccine between nine and 26 years of age. Women who have been vaccinated against HPV should still follow these guidelines recommended for regular Pap smear screening.
All services as noted above are available free to the public. However, are severely underutilized by women in Trinidad and Tobago this is evident by the statistics presented in the first line of this article. If cervical cancer is very preventable and the services to prevent it are readily available in the public sector, then why are the incidence and prevalence still so high in T&T? There are population factors and healthcare factors that are at play to create this scenario.
Because the risk of cervical cancer is associated with HPV and sexual activity, there is much stigma attached to a diagnosis of cervical cancer, which may deter woman from seeking a Pap smear.
Also, in T&T, there was a slow uptake where the vaccine was concerned, as many orthodox perspectives equated having the vaccine as a nod to young people to indiscriminately indulge in sexual activity. Such issues are not unique to cervical cancer, but also pose a challenge to curbing other illness. To lay sole blame on the population’s reluctance to access its facilities is counterproductive. Just as the corporate sector has
perfected the art of using effective publicity to promote their products, in the same way the health sector can learn this art for effective health promotion and health education. Encouraging those with or who have survived cervical cancer to share their stories with the public and highlighting how simple it is to avoid such experiences by just having a Pap smear, can be very effective with a proper public relations plan which includes using primetime media advocating healthy behavior practices.
Cervical cancer incidence is the international surrogate objective marker for how well a health sector is doing. Current statistics of cervical cancer incidence in T&T reflects poorly on our health sector. The country looks forward to these initiatives by the MOH in 2020 to positively change this trend.
After all is said and done, nothing beats the slogan ‘Don’t let cervical cancer stop you, please get vaccinated and have your Pap smear screening test!’
For more information please contact your healthcare provider privately or at your local health center or the T&T Cancer society at http://cancertt.com/ or call 800-TTCS (8827) or 226-1221.
Dr. Visham Bhimull,
Diploma in Family Medicine(UWI)