Doctor urges women to get tested to combat cervical cancer

Dr Vanessa Harry, senior lecturer and head of the Obstetrics and Gynaecology Unit at the Faculty of Medical Sciences at UWI, St Augustine, says TT has about 200 cases of cervical cancer a year, and most of those cases present at stage 2 or 3 because there are no symptoms during stage 1.

She said many of those women either skipped their Pap smears or never had one and only went to the doctor when they noticed something was wrong.

Harry believed that TT needed a national screening programme. The programme would invite women to have their first Pap smear at 20 and remind them, either electronically or through the post when their next one was due.

She pointed out that an abnormal Pap smear did not automatically mean cancer. It meant there were abnormal cells that may be easily treated and removed, preventing cancer from developing in the future.

“Currently, in TT, screening is opportunistic. If you know about it, or you heard about it somewhere, you just go and do it. And then you might forget about it and you don't do it again for another ten years. It's very haphazard and very sporadic.

“If you wait for people to turn up and do a test, the majority will not. It's estimated the coverage for Trinidad for screening tests is probably less than ten per cent of the population that needs it.

“The coverage is probably less than that when it comes to Pap smears because people view Pap smears as, and it is a very intimate test. They are scared of it and embarrassed. They prefer to not even think about it, much less do it.”

However, Harry said there were newer ways to screen for cervical cancer, such as the liquid-based cytology test – a cervical cancer screening test which was introduced in the mid-1990s.

It involves collecting cells in a liquid instead of directly on a slide. It can separate blood and other materials that might make it difficult to interpret the sample and allow for additional testing, such as for human papillomavirus (HPV).

HPV is a viral infection with more than 100 varieties. It is a DNA virus that people primarily get through skin-to-skin and sexual contact. The infection usually shows no symptoms and goes away by itself, but some types can cause genital warts or certain cancers, including cervical cancer.

Harry said another medical advancement was HPV testing. She said, in the 1940s, it was discovered over 90 per cent of cervical cancer was caused by HPV.

“When we discovered how to do HPV testing scientists thought, ‘If we know what's causing cervical cancer, why can't we prevent it?’ And they developed the vaccine, which is the first ever anti-cancer vaccine, and it is highly effective.”

She recalled working in Scotland, which pioneered the early trials of the vaccine in the UK. She said the country was vaccinating its boys and girls around age 12 before they were exposed to sex and HPV.

Since the programme started in Scotland in 2008, no cervical cancer cases were detected in fully vaccinated women up to January 2024.

She said the HPV vaccine was on local childhood vaccination cards, but it was not mandatory. So it was the parent’s responsibility to know about it and have their children take it or not.
According to the Ministry of Health, 167,676 HVP vaccines were distributed between 2013-2023. To be fully vaccinated meant two doses, six months apart. It is available at all health centres, free of charge.

Harry believed the vaccine uptake in Trinidad was low and needed to be much higher to get wider coverage as cervical cancer was the most common gynaecological cancer in TT. It was also the third most common type of cancer in women after breast and lung cancers.
She believed it should be mandatory at the primary school level.

“I think (the reluctance) stems from not having the proper exposure and education for the parents, the caregivers and the guardians. This is a very safe vaccine. It's highly effective, and it prevents cancer in later life. To me, it’s a no-brainer.

“And the connotation that giving a young person the vaccine means they're going to go out and have sex... First of all, that’s pretty outdated. I'm a gynaecologist. I see everything in my office. The reality is young people are going to go out and have sex anyway.

“So parents who still think teenagers are going to wait until marriage, that is not being realistic, much less in this day and age. So it's more important to talk to your children, to make sure they feel comfortable speaking to you, to be open with them, to advise them accordingly.”

She said further long-term studies needed to be conducted to determine other issues, for example, if people needed to be re-vaccinated. But, she said, so far, the results were promising.

Harry said it took ten-15 years for cervical cancer to develop, and noticed a trend in TT in which most women developed cervical cancer in their 30s or 40s. She said women needed to take their health more seriously and make time for medical check-ups and screenings.

“Women here definitely put themselves and their health last. They look after their kids, they look after the family, and they go to work. They care about everybody else, and then they remember, ‘Oh maybe I should have a checkup.’

“When you get somebody with stage three cervical cancer in their early 40s, that is the most heartbreaking thing. They have young children and partners. They are a workforce. It’s a devastating diagnosis for advanced disease at such a young age, especially when I know this could have been prevented.”

She believed a combination of HPV testing, cervical cancer screening and HPV vaccination went a long way to cutting the cases of cervical cancer in TT by more than half by the next generation.

According to the Canadian Cancer Society, there are five stages of cervical cancer.

Stage 0 is precancerous and describes abnormal cells that do not spread beyond the surface of the cervix. Stage 1 is a small cancer between five millimetres and two centimetres deep.

In Stage 2, the tumour grows outside the cervix and the uterus but not into the walls of the pelvis or the lower part of the vagina. In Stage 3, the cancer spreads into the lymph nodes or the tumour grows into the lower part of the vagina and the walls of the pelvis.

If the cancer spreads to other parts of the body, it is considered Stage 4.

Be HPV heroes

Earlier this month, Soroptimist International National Association of TT (SITT) launched its Cervical Cancer Prevention Campaign for Cervical Cancer Awareness Month in January.

Using the theme “Let’s Be HPV Heroes. End Cervical Cancer. Get Vaccinated,” the campaign aims to increase awareness of the HPV vaccine and its critical role in preventing cervical and other HPV-related cancers.

According to a press release, the campaign will engage in educational awareness, community engagement and vaccination advocacy.

It will address common questions about the HPV vaccine through social media content and broadcast messages; encourage parents and caregivers to get their girls and boys, ages nine-26, the HPV vaccine; and launch the graphic novel, HPV Heroes: Defenders of the Future, that showed children the importance of vaccination.

The World Health Organization’s 90-70-90 targets for 2030 included 90 per cent of girls being fully vaccinated with the HPV vaccine by age 15; 70 per cent of women screened for cervical cancer by age 35 and again by age 45; and 90 per cent of women identified with cervical disease receiving treatment.

It said SITT wanted to contribute to the international goal of eliminating cervical cancer by increasing vaccination rates.

Dennise Demming, SITT president said, “Cervical cancer is a preventable disease, and vaccination stands as one of our most effective defences. The awareness campaign is about empowering our parents, caregivers and children with the knowledge and resources they need to protect their health and the health of future generations of women and men.”

Cervical Cancer Prevention Week will be observed worldwide from January 21-28.