BO­BIE-LEE DIXON

bo­bie-lee.dixon@guardian.co.tt

Ahead of to­mor­row’s start of week-long ac­tiv­i­ties in ob­ser­vance of Cer­vi­cal Can­cer Pre­ven­tion Week, which con­cludes on Jan­u­ary 27, this coun­try’s on­ly fe­male gy­nae­co­log­ic on­col­o­gist, Dr Vanes­sa Har­ry, is call­ing on stake­hold­ers in the health sec­tor to get se­ri­ous about women’s re­pro­duc­tive health.

She said thou­sands of women’s lives could be saved if T&T im­ple­ments a com­pre­hen­sive na­tion­al Pap smear screen­ing pro­gramme in the fight against cer­vi­cal can­cer, which is grow­ing at an alarm­ing rate with more than 200 di­ag­noses an­nu­al­ly.

Har­ry said al­though cer­vi­cal can­cer is a po­ten­tial­ly pre­ventable dis­ease, it was still too preva­lent in T&T and that was as a re­sult of a non-ex­ist­ing com­pre­hen­sive ap­proach that in­cludes pre­ven­tion, ear­ly di­ag­no­sis, ef­fec­tive screen­ing and treat­ment pro­grammes.

“Cer­vi­cal can­cer is ac­tu­al­ly very slow grow­ing, it pro­gress­es through from sub­nor­mal to pre-can­cer­ous changes and can last for years and years be­fore it can de­vel­op in­to can­cer. So all that in be­tween phase of pre-can­cer is what leads to ear­ly de­tec­tion. That is why we so strong­ly con­tin­ue to ad­vo­cate for Pap smears to be done. Dur­ing this screen­ing, pre-can­cer changes can be de­tect­ed be­fore can­cer de­vel­ops,” she ex­plained.

Har­ry re­in­forced that cer­vi­cal can­cer, the fourth most fre­quent can­cer in women, is caused by the Hu­man Pa­pil­lo­ma Virus (HPV), which is al­so de­tect­ed through pap smear screen­ings.

Ac­cord­ing to the WHO in 2018, an es­ti­mat­ed 570,000 new cas­es of cer­vi­cal can­cer were di­ag­nosed, rep­re­sent­ing 6.6 per cent of all fe­male can­cers.

It al­so stat­ed 90 per cent of deaths from cer­vi­cal can­cer oc­curred in low and mid­dle-in­come coun­tries.

Re­gard­ing screen­ings, Har­ry said its been re­port­ed by some epi­demi­o­log­i­cal stud­ies in T&T, that less than five per cent of women of screen­ing age ac­tu­al­ly ac­cess screen­ing. This was not good. she said as it would mean that all the pap smears done at pub­lic health in­sti­tu­tions would ac­count for less than ten per cent of the num­ber of Pap smears that ac­tu­al­ly need­ed to be done.

But it was “tricky” she added, when it came to gath­er­ing def­i­nite sta­tis­ti­cal in­for­ma­tion on screen­ings, as there is no na­tion­al screen­ing pro­gramme where tests are sent to a cen­tral lab, which would aid in qual­i­ty con­trol of sta­tis­ti­cal re­port­ing.

“There are so many labs both in the pri­vate and pub­lic health sec­tor and some peo­ple even send tests abroad. So you don’t re­al­ly know how the qual­i­ty of re­port­ing is. This re­sults in poor da­ta col­lec­tion and un­con­firmed and un­sub­stan­tial sta­tis­tics. There has to be ap­pro­pri­ate train­ing to re­port these things ac­cu­rate­ly and for the pur­pose of fol­low­ing up on them,” Har­ry said.

Asked why was it still so much of a chal­lenge to get women to do pap smears, Har­ry list­ed, four rea­sons; fear, fi­nance, for­get­ful­ness and lack of ed­u­ca­tion. She fix­at­ed on the lat­ter, say­ing though there is a lev­el of per­son­al re­spon­si­bil­i­ty to be fac­tored in, there needs to be a con­tin­ued “in your face” ap­proach, that would serve to con­stant­ly re­mind and ed­u­cate women on the im­por­tance of Pap smear screen­ings as well as all things re­lat­ed to re­pro­duc­tive health.

She point­ed to coun­tries like the Unit­ed States, Unit­ed King­dom and Aus­tralia, which em­bark an­nu­al­ly on Pap smear screen­ing pro­grammes for women, say­ing T&T needs to “take note.”

“In coun­tries like the UK with a well-es­tab­lished screen­ing pro­gramme, its cer­vi­cal can­cer rate is prob­a­bly at num­ber 13 or 15 in all the can­cers which af­fect women. For us in T&T, in gy­nae­co­log­i­cal can­cers, cer­vi­cal can­cer stands at num­ber one, sur­pass­ing all oth­er gy­nae­co­log­i­cal can­cers, in­clud­ing ovar­i­an and uter­ine can­cer.”

She re­ferred to the “ter­rif­ic” cam­paign­ing that was done when po­liomyelitis (po­lio) was the “big” dis­ease-af­fect­ing chil­dren and said due to all its cam­paign­ing and ad­ver­tis­ing for par­ents to get their chil­dren vac­ci­nat­ed, this even­tu­al­ly led to the erad­i­ca­tion of the dis­ease. She said it was is this same ag­gres­sion T&T needs to ap­proach the po­ten­tial erad­i­ca­tion of cer­vi­cal can­cer.

“Don’t just do an­oth­er dri­ve! Cre­ate a well-sus­tained na­tion­al screen­ing pro­gramme with all the re­minders and in­for­ma­tion avail­able. And if some­one still de­vel­ops cer­vi­cal can­cer, you can go back and look at all the pre­vi­ous pap smears done to see why or how it might have hap­pened.”