Hinterland campaign looks to nip cervical cancer in the bud
700 tests taken so far in Regions 1 and 9 By Samantha Alleyne
Stabroek News
August 9, 2003

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At fifteen, Yvette Irving lost her mother to cancer of the cervix and it was then that she vowed to do something for many other Amerindian women who suffer from cervical cancer and only find out when it is too late.

Irving, who is of Amerindian descent, is now 41 but has not forgotten her vow to help not only Amerindian women but others living in outlying areas. She is now the Head Researcher for a project titled, `Cervical Cancer in the Guyana Amerindian Population’.

The research is targeting women between the ages of 25 and 50 and is part of a research project she is undertaking for Charles Stewart University in Australia where she is reading for her Masters Degree in Medical Science Pathology through distance education.

Stabroek News recently caught up with Yvette at her Ministry of Health office where she is a lab director and spoke about the project.

She said the research was being piloted in Regions One and Nine.

The Amerindian population in Guyana is approximately 63,000, and in those two regions there are about 37,000 Amerindians.

The project holder is the Ministry of Amerindian Affairs and it is funded by the Canadian International Development Agency (CIDA). The collaborating agencies for the project are the Amerindian Affairs Ministry, the Regions One and Nine Regional Democratic Councils and the Guyana Cancer Society. There is also a small amount of funding from the Ministry of Health.

Irving explained that the general objective of the project was to strengthen education and training programmes to prevent cervical cancer through “community based and culturally sensitised intervention.”

Other than that, the specific objective is to determine the prevalence of cervical cancer in the Guyanese Amerindian population.

Originally the project was scheduled to last from July to December 2002, however, the researchers were forced to revise their timetable because they encountered some problems. Yvette said it was sometimes hard to get persons to travel into those regions to take the pap smears.

She said she would usually explain the questionnaire then get a doctor or a nurse to do the pap smear test.

Stage one of the project was completed in November 2002. This comprised sensitising the communities as to why the women should have pap smears.

“...we had to sensitise them to the pap smear, why they should have it, the project on the whole and let them feel comfortable that this is not just something you are just rushing in to do and then disappear.

In fact, one of the setbacks in doing research with indigenous people, they want to see what is in it for them, what benefits they will have, and most times when people do researches they just go then leave and nothing comes out of it.”

Also the team encountered problems in some areas where key persons told the women not to have pap smears because it would prevent them from having children.

She acknowledged that this could be because those persons themselves were not properly educated.

Phase two of the project, which is the actual taking of the pap smears, started in February and to date the teams have completed about 75% of their visits. It is hoped that the project will be completed by December.

However, because of the poor turnout in some of the locations, Amerindian Affairs Minister, Carolyn Rodrigues, has asked them to re-visit those areas as she feels more samples could be taken. Irving was unable to say what the prevalence rate of cervical cancer was as they had only received the tests of the first one hundred slides. Out of those, five have shown some indications that those women might have the disease.

The team is now trying to get those women to visit Georgetown to have follow-up biopsies. Those who have normal pap smears will be registered to have another test in two years. Some seven hundred smears have been taken so far.

What is cancer?

According to an informational brochure issued by the Missouri Women’s council, cancer is a group of more than 100 different diseases and it occurs when cells become abnormal and divide without control or order.

Cancer of the cervix may also be called cervical cancer. Like most cancers, it is named for the part of the body in which it begins. Cancers of the cervix are also named for the type of cell where they originate.

The cervix is the lower, narrow part of the uterus (womb).

There are two types of tumours, benign and malignant. Benign tumours are not cancerous. They can usually be removed and, in most cases, they do not come back. In contrast, malignant tumours are cancerous.

Early detection of cancer of the cervix

If all women had pelvic exams and pap tests regularly, most pre-cancerous conditions could be detected and treated before cancer develops.

In a pelvic exam, the doctor checks the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor checks these organs for any abnormality in their shape or size. A speculum is used to widen the vagina so that the doctor can see the upper part of the vagina and the cervix.

The pap smear is a simple, painless test to detect abnormal cells in and around the cervix and it is advisable that a woman have this test when she is not menstruating with the best time being between 10 to 20 days after the first day of her menstrual period.

For about two days before a pap test, a woman should avoid douching or using spermicidal foams, creams, or jellies or vaginal medicines, which may wash away or hide abnormal cells.

During a pap test a wooden scraper and/or a small brush is used to collect a sample of cells from the cervix and upper vagina. The cells are placed on a glass slide and sent to a medical laboratory to be checked for abnormal changes.

Women should have regular checkups, including a pelvic exam and a pap test, if they are or have been sexually active or if they are 18 or older. Those who are at increased risk of developing cancer of the cervix should be especially careful to follow their doctor’s advice about checkups. Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) should ask their doctor’s advice about having pelvic exams and pap tests.

Symptoms of cancer of the cervix

Pre-cancerous changes of the cervix usually do not cause pain. In fact, they generally do not cause any symptoms and are not detected unless a woman has a pelvic exam and a pap test. Symptoms usually do not appear until abnormal cervical cells invade nearby tissue. When this happens, the most common symptom is abnormal bleeding. Bleeding may start and stop between menstrual periods, or it may occur after sexual intercourse, douching, or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual. Bleeding after menopause may also be a symptom of cervical cancer. Increased vaginal discharge is another symptom of cervical cancer.

It is important to note that these symptoms may be caused by cancer or by other health problems and as a result only a doctor can tell for sure. It is advised that a woman see her doctor should she be having these symptoms.

Treatment of cancer of the cervix

Treatment for a pre-cancerous lesion of the cervix depends on a number of factors.

These include whether the lesion is low or high grade, whether the woman wants to have children in the future, the woman’s age and general health, and the preference of the woman and her doctor.

A woman with a low-grade lesion may not need further treatment, especially if the abnormal area was completely removed during a biopsy, but she should have a pap test and pelvic exam regularly.

When a pre-cancerous lesion requires treatment, the doctor may use cryosurgery (freezing), cauterization (burning, also called diathermy), or laser surgery to destroy the abnormal area without harming nearby healthy tissue. Treatment for a pre-cancerous lesion may cause cramping or other pain, bleeding, or a watery discharge.

In some cases, a woman may have a hysterectomy, particularly if abnormal cells are found inside the opening of the cervix. This is more likely to be done when the woman does not want to have children.

Pap smear on pregnant women

There are concerns that a woman’s pregnancy may be affected if she takes a pap smear during pregnancy.

However, Dr Margaret Davy, writing in `PAP NEWS’ in November 1999, which is a joint Commonwealth/State Health Initiative, called these beliefs “mistaken” adding that some feel that pap smears usually “de-medicalise” the process of pregnancy.

She stated that unfortunately, several women’s pregnancies had recently been turned into nightmares when they were diagnosed with invasive cervical cancer in pregnancy.

The truth is, she said, smear tests do not cause miscarriage.

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