Wednesday, July 20, 2011

Women's Health: Cervical Cancer and Pap Smear Exams in Peru and Ecuador

Cervical cancer is the most frequent cancer contracted by women in Peru. It is the number two cancer killer of women in Ecuador; in the USA, it doesn't even crack the top 10. Women in Peru and Ecuador are 3-4 times more likely to be diagnosed with cervical cancer than women in the USA. The likelihood of mortality exacerbates the problem: the mortality rate for women in Ecuador and Peru is 5 times higher than for women in the USA.

The statistics explain enough: cervical cancer is a big problem in Peru and Ecuador. What is MEDLIFE doing to stem this epidemic?

Offering free pap smear exams. The Pap smear is a screening test that detects warning signs of cervical cancer and pre-cancerous changes in the cervix. It is used extensively worldwide, and is generally recommended that women ages 18 and up receive an annual test. MEDLIFE hires a gynecologist or nurse-obstetrician to conduct pap smears during our Mobile Clinics. The exam is performed on site in a private gynecology tent, and the samples are analyzed at a local laboratory the following week. Individual results are then delivered to our patients by MEDLIFE patient follow-up coordinators.

Reaching women in need. Hiring a gynecologist is easy -- getting local women to show up and take the test is the real challenge! There are many financial, educational, and cultural obstacles which prevent or discourage women in Ecuador and Peru from receiving regular Pap smear exams. MEDLIFE removes many of these barriers by physically bringing the Mobile Clinic directly into communities in need, and by offering the exam free of charge. On all Mobile Clinics, MEDLIFE conducts an educational program aimed at explaining the how the exam is conducted and enlightening women as to its importance. In the past two years, MEDLIFE has provided Pap smear exams to approximately 2000 women in Peru and Ecuador.

Following up. The most essential part of our program is not the conduction of the exam, but rather the follow-up efforts that accompany it. Results are delivered to our patients 1-3 weeks after the Mobile Clinic ends. Prescriptions and medical recommendations are provided to women who show signs of minor infections or inflammation. Women who have severely abnormal results -- for example, whose pap smear sample presents possible pre-cancerous lesions -- are contacted directly by our patient follow-up coordinators, who ensure that they receive the proper treatment. For a better idea of how patient follow-up works, check out our blog post about a former MEDLIFE patient in Lima.

Enacting greater educational and cultural awareness. As mentioned above, women in Peru and Ecuador aren't always willing to take a Pap smear exam, even when it's provided free of cost. The reason for this is often cultural: many women will tell our gynecologist that they won't take the exam without their husband's permission. Younger women may not wish to take the exam, as it may be seen as an admission that they are sexually active. And some women fear that the exam will make them sterile or produce other unwanted consequences. These issues are rooted in a lack of education and understanding regarding the exam and its necessity. In all of our projects (Mobile Clinics, community development projects, and health education seminars), MEDLIFE strives to highlight the need and functioning of the Pap smear exam to men and women alike.
Educational brochure about cervical cancer and Pap smear screenings
This education may be viewed as the most effective part of our program. In recent years, pap smear exams have been made more available to women in Peru and Ecuador via government-run health clinics.  By working to remove cultural and educational barriers, MEDLIFE is supplementing the work performed at local health clinics by encouraging more women to receive an annual pap smear exam, at whatever source or clinic available to them.

Addressing the root cause. The high cervical cancer rates in Ecuador and Peru may be directly attributed to another epidemic: Human Papilloma Virus. It is estimated that 70% of cervical cancer worldwide is caused by HPV types 16 and 18, the two types preventable by vaccine. Ecuador and Peru have exceedingly high rates of HPV (13.2% of women in South America are estimated to harbor an HPV infection at a given time), and as a result have high incidence rates of cervical cancer.

MEDLIFE has bigger plans for our Pap smear, gynecology, and women's health initiatives. We want to extend the services we provide so that we are involved in HPV detection and vaccination campaigns, allowing us to tackle the root cause of this grave health concern. Similarly, MEDLIFE is working to expand its educational program to include STI- and HPV-specific educational components. As we reach more women in Ecuador and Peru with greater medical and educational services, we stand to stem a deadly epidemic and help all our patients lead happier, healthier lives!

Stay tuned for more updates on MEDLIFE's women's health program!

All statistics and data cited in this article is sourced from:
Ecuador: World Health Organization -- Human Papilloma Virus and Related Cancers: Summar Report, Ecuador 2010
Peru:  World Health Organization -- Human Papilloma Virus and Related Cancers: Summary Report, Peru 2010
USA:  Centers for Disease Control and Prevention -- Cervical Cancer Statistics

Post by Tommy Flint, MEDLIFE Director of Operations

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