CERVICAL CANCER Cervical Cancer and Hispanic/Latina Women Melissa Gavidia ITRODUCTION: Cervical cancer is when there are malignant cells present in the cervix; it is developed in the lining of the cervix. A cervix is a narrow opening located at the bottom of the uterus that leads into the vagina. Cervical cancer mostly affects women between the ages of 40 and 55. This cancer can be prevented by screening for precancerous cells, and it can also be cured if it is detected at an early stage. Over the past few decades the number of cervical cancer cases has declined dramatically due to a more widespread screening of the disease.
Today, it is estimated that 10,000 new cases of cervical cancer are discovered annually in the United States. Also, the American Cancer Society estimates that about 3,700 women die each year from this disease. Cervical cancer is the second most common in women worldwide, and it is the leading cause in cancer related deaths among women in underdeveloped countries. Worldwide, there is an estimated 500,000 new cervical cancer cases each year. Before cancer develops, the cells of the cervix become abnormal, and that is known as dysplasia.
Abnormal cell changes of the cervix can be detected through a test known as a Pap smear, and if left untreated, some types of cervical dysplasia can lead to cancer. On the other hand, dysplasia is very treatable. In most cases, cervical cancer develops slowly over a period of years. CAUSES AND RISK FACTORS FOR CERVICAL CANCER: The cause of cervical cancer is unknown, but the major risk factor for it is an infection with human papillomavirus (HPV). HPV is a group of viruses, and it is spread through sexual intercourse. The risks that increase the chances of a woman being infected with HPV are having multiple sexual artners, or having sex with a partner who has had multiple partners, having a history of sexually transmitted infections (STI’s), and having sexual intercourse at a young age. Even though HPV infections are common and rarely lead to cancer, medical researchers believe that other factors are involved in the development of cervical cancer. Repeated or constant HPV infections raise the chances of developing the cancer. Precancerous cell changes of the cervix are more common among women who become infected with more than one type of HPV.
Moreover, women who smoke cigarettes are twice as likely to develop cervical cancer than those women who don’t smoke. Other risk factors include race, the cancer is less likely to develop in women younger than 15, and race, Hispanic, African Americans, and Native Americans have a higher risk of developing cancer. Having a weak immune system due to human immunodeficiency virus (HIV) also increase the risk for developing cervical cancer. Of course, there are those women who have a high risk of having cervical cancer due to a history of cervical cancer among the women in their family.
SIGNS AND SYMPTOMS: Early cervical cancer often does not produce any symptoms. With women who regularly have screenings, the first sign is an abnormal Pap test result. Some symptoms of cervical cancer are abnormal vaginal bleeding, abnormal vaginal discharge, lower back pain, pain during sexual intercourse, and painful urination. Cervical cancer that has spread to other organs may cause constipation, blood in the urine, abnormal opening in the cervix, and blockage in the tube that carries urine from the kidney to the bladder. DIAGNOSIS:
The best tool for diagnosing abnormal cervix cell changes and cervical cancer is the Pap smear, named after its developer, George N. Papanicolaou. It is recommended for women to have annual Pap smears at the age of 18, or when they start having sexual intercourse. The Pap smear is a simple test where cells are removed from the outermost layer of the cervix with a spatula, cotton swab, or a brush. The cells are then examined under a microscope for precancerous cell changes. For more accurate results, a Pap smear should be given two weeks after the end of a menstrual period, or 48 hours after having sexual intercourse.
If the Pap smear test results reveal abnormal cell changes, a physician will recommend for a women to undergo a colposcopy. A colposcopy is a procedure where a physician washes the cervix with a diluted vinegar solution and uses a microscope-like tool known as a colposcope to have a magnified view of the surface of the vagina and cervix. If the physician sees any abnormal areas, such as lesions on the cervix, then tissue samples are taken for examination under a microscope. Other than the Pap smear, a pelvic exam may be performed. In a pelvic exam, the vagina, along with adjacent organs, is examined visually and manually.
A speculum, and instrument that separates tissue, is inserted into the vagina for visual examination. After, the organs are felt with the fingers by inserting one hand in the vagina, and putting the other hand on the abdomen to feel for any abnormalities. If invasive cervical cancer is suspected, or if the colposcopy and the Pap smear have different results, then other tests may be conducted. One test that may be performed is a cone biopsy. In a cone biopsy, a larger, cone shaped sample of cervical tissue is taken and examined for cancer cells. Another test that may be performed is endocervical curettage.
During this procedure, the lining of the cervix is scraped and examined for cancer cells. Once a diagnosis of cervical cancer is made, then the cancer is staged, classification of the cancer. Staging involves a pelvic exam, blood tests, and imaging procedures. TREATMENT: Treatment of cervical cancer depends on the stage of the cancer. In cases where there are precancerous cells present, abnormal tissue is removed using loop electrosurgical excision procedure (LEEP). During a LEEP, and electric current wire is passed through to remove the abnormal cells. Abnormal cells can also be removed with a cryosurgery.
This surgery uses liquid nitrogen that is circulated through a probe, which is put on the area where the cancerous cells are, and the freezing temperature destroys the precancerous tissue. Other surgeries include laser surgery, known as laser ablation, and a cone biopsy. During a laser ablation, a beam of concentrated light and intense heat is used at close range to remove dangerous tissue, and in a cone biopsy, a cone shaped piece of tissue containing the cancerous cells is removed from the cervix. If the tumor is large, or if the cancer has spread, more invasive surgery, radiation, or both of these techniques may have to be used.
In some cases Chemotherapy may be used. Surgical treatment for cervical cancer is radical hysterectomy, which is the removal of the uterus, fallopian tubes, ovaries, adjacent lymph nodes, and part of the vagina. Radiation can also be used either alone, or after surgery or chemotherapy. Radiation is delivered by a machine outside of the body, or by radioactive “seeds” implanted in the uterus and vagina. After surgery, radiation is used to reduce the risk of cancer forming again. Side effects of radiation are fatigue, swelling, and skin reddening. Chemotherapy is the use of toxic drugs to destroy cancer cells.
Chemotherapy is given through injection, or by pill form. Side effects of chemotherapy are severe and include nausea, vomiting, diarrhea, leucopenia, low white blood cell count. PROGNOSIS: Cervical cancer can often be cured, but if it is detected early. The prognosis depends on what stage the cancer is in. Women diagnosed with cervical cancer confined to the outer lining of the cervix have a five year survival rate of almost 100%. Women diagnosed with invasive cervical cancer have a five year survival rate greater than 70%. If the cervical cancer is diagnosed at an early stage, the survival rate rises to more than 90%.
PREVENTION: Due to cervical cancer beginning with infection with HPV, preventing HPV can prevent cervical cancer. On June 2006, the Food and Drug Administration (FDA) approved a cervical cancer vaccine for girls and women between the ages of 9 and 26. This vaccine is called Gardasil, and it was developed by Merck & Co. , Inc. The vaccine is given in a series of three shots. However, the vaccine does not protect against all types of HPV. There are over 30 different types of HPV, and Gardasil only protects against 4 types of HPV. Therefore, Pap smears are still recommended.
Also, the use of condoms during sexual intercourse has some protection against spreading, and preventing HPV. Avoiding sexual activity that increase the risk for HPV infection, not smoking, and having regular Pap smears can prevent cervical cancer. In addition, limiting the number of sexual partners, and not having sex at a young age can also prevent cervical cancer. CERVICAL CANCER AND HISPANIC/LATINA WOMEN: In the past fifty years. Pap smears have dramatically reduced the number of new cervical cancer cases. Despite this fact, there are still women in the United States who are not being screened properly.
This means that these women are being diagnosed with a disease that is very preventable. Most cases show that cases of cervical cancer occur in women who have never had a Pap smear, or have not been screened within the past five years before they are diagnosed with cancer. Hispanic/Latina women are affected by cervical cancer the most among other women from other ethnic groups. There is and estimated 2,000 Hispanic/Latina women who are being diagnose with cervical cancer each year. Their death rate from cervical cancer is 40% higher when compared to other groups of women.
Most of these women have had a Pap smear at some point in their lives, but many of them do not get a Pap smear on a regular basis. As a result, a large percentage of these women are diagnosed with cervical cancer at an advanced stage and this number increase as age increases. There are reasons why Hispanic/Latina women are not being screened regularly. Some women may experience many barriers that prevent them from getting regular Pap smears, for example, not having a regular physician, or knowing very little about what a Pap test is. Other Hispanic/Latina women may feel embarrassed to have a physician examine their cervix.
Some of these women may also feel that a Pap test is painful, or they feel that they don’t need to be screened because they feel healthy, are monogamous, or are postmenopausal. There are also other issues that are preventing these women from getting screened for cervical cancer, such as, problems with communication with the physician due to language barriers, problems accessing care because they don’t have medical insurance, and the lack of female physicians in the health care system; some women are not comfortable with a male physician administering a Pap smear.
It is very important for these women to have regular Pap smears done. For one, Pap smears can prevent cervical cancer, but it can also detect HPV. It is critical to detect HPV because it causes cervical cancer. By detecting HPV early, Hispanic/Latina women can treat abnormal cells in the cervix before they become cancerous cells. Culture issues also prevent Hispanic/Latina women from receiving proper screening for cervical cancer. In the Hispanic/Latino culture, sexuality is not talked about freely.
There are many Hispanic/Latina women who do not talk to their daughters about how to sexually protect themselves, or how to receive medical attention after they become sexually active. As a result, many young Hispanic/Latina women do not know how to take care of themselves from getting an STI, or that a Pap smear should be done on a regular basis after they turn 18 or they become sexually active. The Hispanic/Latino community is rapidly growing in the United States, and it is becoming the largest minority group in the nation.
The current Hispanic/Latino population is estimated to be 41. 3 million people. The growth rate of this population is about 3. 6% each year, therefore it is predicted that the Hispanic/Latino community will reach 60 million by the year 2030, and 88 million by the year 2040. This means that if there is not a change in the barriers that prevent Hispanic/Latina women from getting properly screened for cervical cancer there will be more and more women who will continue being diagnosed with cervical cancer. Also, more women will die from this cancer.
There are solutions to this problem that Hispanic/Latina women are facing. The health care system can provide professional interpreters when there is a language barrier between the patient and the physician. Many women act like they understand, and are too afraid to ask physician questions whey they do not understand something. When these women have all their questions answered about their sexual health, they are more informed, and that could lead to a decrease in the amount of Hispanic/Latina women who are being diagnosed with cervical cancer each year.
Also, physicians should take their time talking to their patients when there are any complications, for instance, in free clinics, physicians leave out a lot of detail when a woman runs into complications in their health. It seems that these physicians are more concerned with serving as many patients as they can than explaining any complications that a woman may have in detail. Moreover, by having more women in the medical field, and administering Pap smears, more Hispanic/Latina women will be more comfortable with having a Pap smear.
Many of these women are not comfortable with a male doctor examining there genitals. Women are more comfortable with other women. More importantly, Hispanic/Latina women should be talking to their daughters about sex, about how to protect themselves whenever they decide to become sexually active, about getting Pap smears, and about being tested for STI’s. If the Hispanic/Latino community becomes more comfortable with talking about sex, and all aspects of sex, then Hispanic/Latina women will be more informed on how to protect themselves, and how to reduce their risks from getting cervical cancer.