Con­tin­ued from pre­vi­ous page

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,

Fam­i­ly Physi­cian

MBBS (UWI)

Diplo­ma in Fam­i­ly Med­i­cine(UWI)