Prevention is better than cure

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May 9 (Granma) In Cuba, women’s gynecological healthcare is fully guaranteed, Dr. Ana Margarita Solares Asteasuanizarra, a member of the Cuban Society of Obstetrics and Gynecology, and Assistant Professor at Havana’s University of Medical Sciences, told Granma International.

She explained that there is a national structure is this regard, based on primary care in health institutions at the local level, which guarantee prevention, education and awareness actions aimed at women and their families. The Federation of Cuban Women and other mass organizations are linked to this work to provide preventive knowledge about personal care and signs one should see a doctor.

“Cervical cancer is a preventable disease,” the second grade specialist in Gynecology and Obstetrics continued. It can be detected through regular cervical cytology tests (better known as Pap smears), that women should undergo every three years from the age of 25 through to 64.

Test kit produced by Cuba’s Immunoassay Center and distributed across the country’s network of community clinics. Photo: Yaimí Ravelo

According to global data, it is estimated that 466,000 new cases of cervical cancer are diagnosed each year, and 231,000 women die from it annually, of which more than 80% of deaths occur in developing countries. In Latin America and the Caribbean, there are an estimated 68,000 new cases reported every year.

Dr. Solares, who is also Havana provincial head of cervix disorder consultations and chairperson of the colposcopy and lower genital tract diseases committee, highlighted the efforts of the Cuban state to ensure the necessary equipment and technologies are available in each family doctor’s office and local health institution, to carry out cervical screening tests on one hundred percent of Cuban women in the aforementioned age range.

“Unfortunately, 30% of women do not come for a Pap test. Simply, women at risk of suffering from this cancer are asymptomatic, and at an age in which they are developing socially, intellectually and professionally. So they don’t go to the doctor of their own accord,” explained Dr. Solares, who also holds a Master of Science in Contemporary Biotechnology Trends.

Awareness on the importance of visiting the doctor as a preventative measure is still something that needs to be addressed, the specialist noted. Although records are held regarding the location of at risk women, and they are advised of when they should have a Pap test done, there are a large number of cases of changes of address, even from one province to another, which are not reported to authorities.

Pap smears are performed in all family doctor and nurses’ offices across the country. Photo: Nuria Barbosa

“In this age range, women have an active sex life, not always with the same partner, and sometimes without using protection against sexually transmitted diseases. There is the possibility of being infected with viruses with oncogenic risks such as human papillomavirus (HPV), which can cause changes in the cells of the cervix, vagina, vulva and anal area. In addition, we know that menarche and physiological development in girls occurs at an early age, and they also become sexual active early. If we add drug habits, the consumption of alcoholic beverages, nutritional disorders and a lack of physical exercise, all this favors the development of neoplasms in the female genital organs, as the immune system is weakened,” Dr. Solares added.

Immediately after receiving test results confirming any abnormalities, patients are referred to secondary or tertiary level health institutions, where cervix disorder consultations are held, although these cases are also followed by their family doctor. According to the diagnosis, patients attend regular consultations or are referred to research institutes for further treatments. If an adolescent is suspected of having a cervix disorder, a Pap test is undertaken and their case is closely followed.

TIMELY MEDICAL CARE

Cuba has 46 cervical disorder consultation services throughout the island’s 168 municipalities, providing full coverage. All are staffed with highly qualified and trained professionals to provide care for any condition. High-tech equipment has been installed to ensure accurate diagnoses for quick decision making regarding treatment.

When the results of a Pap test come back positive, the patient is informed and given an appointment with a gynecologist in the shortest possible time (within 30 days). A clinical record is put together, patients provide their informed consent regarding any tests and treatments that they may require, and they are evaluated with a complete gynecological clinical examination, including a colposcopy, to confirm the diagnosis. Patients are also informed as to the doctor who will be following their case, and of the possibility of consulting with other specialists.

A program is then prepared to provide specialized care for the patient and their families, which is institutionally evaluated with trained professionals, Dr. Solares noted, highlighting that Cuba spends considerable resources on treatment, and all services are offered free of charge to the population.

She explained that some developed nations such as Australia and Italy, among others, have changed their cervical screening process, with samples now tested for HPV first, instead of the traditional cytology test. However, it would currently be very expensive for Cuba to introduce this test for one hundred percent of its female population.

“Today efforts are being made to corroborate the specificity and sensitivity of the results of cytology testing through the HPV test. We are aiming for this type of more specialized test to be conducted at least once from the age of 30, as a check associated with the cytology test, because we have been evaluating feasibility and diagnostic predictive values, but we still don’t have all the resources,” she added.

“I think we have a good program according to what is practiced in the world. It just needs to be fully complied with. Today this disease appears in Cuba in women between the ages of 30 and 40, while a decade ago it appeared after 45. Cervical cancer mortality exceeds 450 Cuban women per year, which positions us with a mortality rate per 100,000 of between 8 and 8.5, and rising,” the gynecologist explained, noting that she finds this data concerning given the state guaranteed healthcare available to everyone.

TESTING AND CONSULTATIONS

Graduate Nurse Ana Teresa Díaz Piñeiro performs the Pap test for women who belong to clinic 3-4 of the Marcio Manduley polyclinic, in the municipality of Centro Habana. She records the women in her area who must attend a consultation during the year, and she reminds them personally, through a family member or through neighborhood organizations.
The simple procedure only takes a few minutes and samples are sent to the nearest maternity hospital for processing. The result arrives in about 15 days and if positive, it is accompanied by a scheduled appointment with a specialist.

Both interviewees emphasized the need for increased awareness among women about the importance of regular screening and their responsibility to comply with the established guidelines to ensure their own health.

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Cervical cancer arises from malignant neoplasms that develop in the lower fibromuscular portion of the uterus (cervix).

Cervical cancer risk factors are related to lifestyle and the presence of other diseases, and include:
1.    Having several sexual partners
2.    Living with a male partner who has several present or past sexual partners
3.    Becoming sexually active at a young age
4.    Having many pregnancies
5.    Persistent infection with human papillomavirus (HPV) or other STDs
6.    A weak immune system
7.    Long-term use of oral contraceptives
8.    Toxic habits (smoking, drugs and alcohol)
Levels of cell abnormality 
CIN (cervical intraepithelial neoplasia, or dysplasia)
CIN I: Dysplasia (abnormal cells) is only observed in the lower third of the epithelium. In most cases, these cell changes return to normal over two years, but 10% progress to a higher grade CIN.

CIN II: There is dysplasia in the lower two thirds of the epithelium.

CIN III: The epithelium is dysplastic in its entirety. This is also called “carcinoma in situ.” In most cases, cells do not return to normal if untreated, and in 10% of cases, this progresses after two years to become an invasive cervicalcarcinoma.

Symptoms

Women with pre-cancers or early-stage cervical cancers usually have no symptoms. The symptoms often do not start until a precancerous condition becomes an invasive cancer and grows into the adjacent tissue.

Symptoms of cervical cancer can include abnormal vaginal bleeding, such as bleeding after having intercourse, bleeding after menopause, bleeding and spotting between periods, and menstruation that lasts longer or is heavier. Bleeding after a pelvic exam is a common symptom of cervical cancer, but not of precancerous conditions.

Other symptoms are an unusual vaginal discharge (the discharge may contain some blood and may occur between your periods or after menopause), and pain during sexual intercourse.

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