Michael Abrahams | Cancer Awareness Month and cervical cancer
April is Cancer Awareness Month, and this year the focus is on cervical cancer. Being a gynaecologist, this is right up my alley, literally and figuratively. I always get excited speaking about this type of cancer, because it is the only one that can easily be prevented.
Cervical cancer is the second-leading cause of cancer deaths in Jamaican women. Breast cancer is number one and attracts the most attention, which is understandable, not just because of its prevalence and the possibility of death, but also because of the disfiguring effects of surgically removing a breast (mastectomy), which is often performed in order to adequately treat the condition.
However, the fact that cervical cancer is second on the list is a tragedy because the disease is not just avoidable, but is extremely easy to prevent. The majority of cases of cervical cancer are caused by a virus called the human papilloma virus (HPV), which is usually acquired during sexual activity. There are more than 100 types of this virus, but only a few cause cervical cancer.
What many women do not know is that cervical cancer takes a relatively long time to develop. It takes an average of 11 years for a normal cell in the cervix to become a malignant (cancerous) one. In 11 years, you can watch three World Cup competitions, three Olympics and have a child enter high school, graduate and subsequently obtain a first degree at a university.
However, despite its sluggish development, the prevalence of this cancer in our country remains high. In regions such as Scandanavia (Denmark, Norway, Sweden, Finland and Iceland), cervical cancer does not even make the top 10. The main reason for this disparity is that these countries have organised screening programmes, and we do not.
The cornerstone of these screening programmes is the Pap smear, a test that has helped to save millions of lives and continues to do so. The test is extremely simple to perform. It involves obtaining a sample of cells from the cervix, which is then examined microscopically to detect abnormal changes that may indicate that the patient is at risk for developing cancer. So, it is not really a test for cancer, but a test to detect women at risk. Occasionally, it may detect cancer cells in women who are already afflicted, but its main use is to pick up pre-cancerous changes.
Not only is the Pap smear easy to perform, but managing a patient with an abnormal smear, and preventing the development of cancer, is also a very simple process. In some cases, patients are managed by performing follow-up smears. In most cases, mildly abnormal changes resolve spontaneously.
If the changes are persistent or severe, there are minor procedures that are performed to eradicate the abnormalities from the cervix. The procedures usually involve the use of an instrument known as a colposcope, which is used to illuminate the cervix and allow the physician to examine the cervix under magnification. During this procedure, which does not even require sedation, abnormal areas are identified, and often removed. The procedure is short, associated with minimal morbidity, and is fertility sparing. In other words, women are able to bear children after treatment.
The procedure is more than 95 per cent effective, which means that the overwhelming majority of patients will not have the abnormal changes recur and will not develop cervical cancer. It really is as simple as that. The Pap smear is so effective that in more than 20 years of practice as a gynaecologist, I have never seen anyone develop this disease while under may care. The test should be performed every one to three years.
Pap smears are performed at health centres, by general practitioners and gynaecologists, and at the Jamaica Cancer Society. Our cancer society is special. Most other cancer societies, such as the American Cancer Society, only concern themselves with public education and advocacy. There is no hands-on interaction with patients. The Jamaica Cancer Society, however, has been providing services such as mammograms, prostate examinations and Pap smears, not only at their branches in Kingston, St Ann and St Elizabeth, but through their mobile units and during their outreach programmes. Regarding the prevention of cervical cancer, the organisation is dedicated to providing Pap smears for vulnerable and underserved women living in inner city and rural communities.
If you are a woman over the age of 21 and have never had a Pap smear, of if your last smear was performed more than three years ago, the time for you to have the test done is now. If you would like to contact the Jamaica Cancer Society, become a member, or assist them with their mission, your communication would be greatly appreciated.
Main office address: 16 Lady Musgrave Road, Kingston 5, Jamaica, WI
Fax: 1 876 978 1918
email: firstname.lastname@example.org or email@example.com
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