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Regular testing helps prevent
the deadly disease
It’s not easy for Maria Rodriguez to talk about cervical cancer.
Down in the Dominican Republic where she was born, folks just didn’t talk about things like sex. And they certainly didn’t talk about any diseases that could be caused by sex.
It just wasn’t done.
Even now, she still doesn’t want her real name to be used.
But in Boston, Rodriguez, 68, has learned the value of open and honest discussions about personal responsibilities and basic health tests.
Basic tests like mammograms and Pap tests.
Rodriguez has had them for years. The thought of breast cancer, or worse, is enough to frighten most women to their doctors at least once a year.
But during her latest physical last January at Martha Eliot Health Center in Jamaica Plain, her Pap test came back with an abnormality. Further testing revealed she had cervical cancer.
All was not lost. Because the test was able to detect the suspicious cells in their earliest stages, doctors were able to treat the disease sooner rather than later, when the affected cells could have developed into more advanced stages.
Rodriguez is yet another example of one of modern medicine’s major miracles.
Developed in the 1930s by Dr. George Papanicolaou, Pap tests, or Pap smears, enable doctors to detect and diagnose suspicious cells before they become cancerous. At the time, the medical community was slow to embrace Dr. Papanicolaou’s findings.
But the tests survived the initial scrutiny, and their use over the years has had significant impact in reducing the number of cases of cervical cancer. In the developed world, such cases have dropped from one of the top cancer killers to under 2 percent of all estimated cancer deaths in women in 2007.
Between 1975 and 2004 alone, the age-adjusted incidence and mortality rates for cervical cancer dropped by 200 percent for white women and over 300 percent for black women.
The importance of early detection is not to be dismissed. In the United States, the five-year survival rate of cervical cancer is more than 92 percent if found early, and decreases to less than 15 percent if it spreads to other organs.
The availability of Pap tests is one thing. Eradicating the disease is another.
According to the American Cancer Society, an estimated 11,150 new cases of invasive cervical cancer will be diagnosed in this country in 2007, and nearly 3,700 women will die of the disease.
More troublesome are the racial disparities. The incidence and death rates are higher in blacks and Hispanics than in whites. The incidence of cervical cancer is highest in Hispanics, but blacks die of cervical cancer at a rate 35 percent higher than Hispanics and more than twice the rate of whites.
No one can say for certain why the disparities exist. But Dr. Sarah Feldman, a gynecological oncologist at Brigham and Women’s Hospital, cited the usual suspects — lack of access to quality health care, lack of health education, and, in the cases of some women from Latin America, a historical reluctance to embrace early vaginal screenings such as Pap tests.
Part of the problem is a lack of awareness. A 2005 study sponsored by the Gynecologic Cancer Foundation found that though most women are very worried about developing cancers of the reproductive system, only half are aware of their risk factors or symptoms.
Of the 800 women interviewed for the study, roughly half could not name those factors or symptoms. Furthermore, of those who could cite risk factors, only 11 percent mentioned viruses and sexually transmitted diseases (STDs), or having multiple sex partners — all major risk factors for cervical cancer.
This particular cancer strikes women in midlife — typically between the ages of 35 and 55 — and rarely occurs in women under 20. Only about 20 percent of the cases are in women over the age of 65.
Cervical cancer is very slow growing and is usually preceded by precancerous changes in the cells of the cervix that can be found during Pap tests and easily treated before cancer develops. For that reason, it is a largely preventable disease.
Pap tests can also find cancer in its early and most curable stage. As a result, the death rate from cervical cancer continues to decline by roughly 4 percent a year.
Several risk factors increase the probability of cervical cancer. Human papillomaviruses, or HPVs, are the most significant risk factor. HPVs are a group of over 100 types of viruses that are very common and, for the most part, harmless. However, certain genital HPVs — HPV 16 and 18 — are the leading cause of cervical cancer.
If a Pap test shows any signs of abnormalities, explains Dr. Feldman, a specific test for HPV can be performed if requested by a patient or recommended by a doctor.
But more often than not, Dr. Feldman says, those tests are not cost-effective for younger women, largely because most HPV infections are harmless.
“HPV infections are so common in young women that it’s not particularly useful to have the specific tests,” Dr. Feldman says. “But they can provide a double reassurance in women over the age of 30.”
Other risk factors include STDs, HIV — the virus that causes acquired immunodeficiency syndrome, or AIDS — and other conditions that compromise the immune system, such as organ transplantations.
Even smoking is considered a factor. Women who smoke are roughly four times as likely as nonsmokers to get cervical cancer. It is believed that harmful substances found in cigarette smoke are carried through the bloodstream to all parts of the body. Tobacco byproducts have been found in the cervical mucus of women who smoke.
Another risk factor for cervical cancer is diethylstilbestrol, or DES, a drug prescribed to pregnant women in the 1940s to prevent miscarriages. However, in the 1970s, it was found that females born of women who used DES were at increased risk for cervical cancer. DES is no longer made or marketed in this country.
In the initial stages, cervical cancer is silent — it has no symptoms. In advanced stages, the cancer can cause abnormal vaginal bleeding or vaginal discharge and pain.
For her part, Rodriguez said she is just thankful that her cancer was detected — and treated — before it got worse.
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