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By Lea Manto-Beltran and Katherine Mae M. Lopez
LIFE begins at 40, but for this professor,
mother, and now a cervical cancer prevention advocate, her life
almost took a downturn at what was supposed to be the prime of her
life.
Prof. Josefina de la Cruz, former chair of
English and Mass Communications Departments at the University of
Perpetual Help System in Cavite, was diagnosed with cervical cancer
when she was 41. It was on August 23, 2001, ten years after her
mother died of the same disease.
“At first, I kept it a secret,” de la Cruz
said. “The whole day, I was just crying. When I told my husband,
he cried the whole night.”
Cervical cancer is considered a silent killer,
showing little or no symptoms at its early stages. “I felt no
pain. But my menstrual period got longer. There was bleeding during
intercourse as if you’re always being devirginized,” de la Cruz
says.
De la Cruz regularly visits her gynecologist for
pap smear test every year. “My mother’s doctor told me I was at
high risk. My pap smear every year revealed nothing,” she says. In
fact, de la Cruz says nothing showed in the results of her pap smear
in 2000, that was why in 2001, she was surprised with the results.
“When I had transvaginal ultrasound, the
doctor said I had myoma. After the biopsy, that’s when I learned I
had cervical cancer,” de la Cruz says.
It was very hard for de la Cruz to think that
she was afflicted with a disease that could cause her death.
“Should I die just like my mother? What about my kids? They’re
too young. What about my students,” she asked herself at that
time.
To make matters worse, her doctor told her she
had to shell out more or less P100,000. “My husband was a mere
driver. I was a professor at a provincial university. Where would I
get that amount?” de la Cruz shares. “I lost my house and my
car. My kids almost stopped studying.”
Because of cervical cancer, de la Cruz underwent
radical hysterectomy, six sessions of chemotherapy, and branchy
therapy, which she says was the most painful of all. But that was
just the physical pain, because de la Cruz also had to deal with the
pain and fear of having her daughters die of cervical cancer.
“Lord, spare my daughters,” she prayed that
time. “Let me be the last in the family to have this disease.”
An active member of the Couples for Christ, de
la Cruz held on to her faith to help her battle the big C. “This
is just God’s way of telling me to evangelize,” she says.
Her being afflicted with cervical cancer also
brought her and her husband closer. “Our faith was our refuge.”
Also, she adds that it was their parish priest who helped her
explain to her children what she was then undergoing.
Having resigned from her professorial job as
advised by her doctor, de la Cruz spends her time in her advocacy
pushing for cervical cancer prevention and awareness. Even if the
human papillomavirus is transmitted sexually, de la Cruz believes
that there is no “shame” in the disease as the virus can be
transmitted through genital contact even if there is no sexual
intercourse.
“As I say, it’s not that you’re flirting
around when you get the virus. It calls an intelligent mind to
realize that,” she says.
Now on her seventh year as a cervical cancer
survivor, de la Cruz had her two daughters vaccinated. They already
got the first two doses and would soon get the third and last. “I
usually tell them to take care of their lives,” she says.
The silent killer
This is just one of the inspiring stories on how
women struggle to win the battle against the Big C despite the fact
that each year, there are about 400,000 new cases of cervical
cancer—80 percent of which occur in developing countries.
Worldwide, every two minutes, a woman dies of
cervical cancer. In the Philippines, according to the 2005
Philippine Cancer Facts and Estimates, 7,277 new cases and 3,807
deaths due to cervical cancer were estimated to have occurred. This
meant that there were approximately 10 Filipino women dying each day
due to cervical cancer.
In fact, “the burden of this disease has been
unchanged in the country for the last two decades mainly because it
is detected late and awareness of cervical cancer is low or none
among women and their families,” says Dr. Cecilia Ladines-Llave,
UP PGH Cancer Institute chairman who is one of the prime movers in
eliminating cervical cancer in the country.
Cervical cancer, according to Cecap website, is
a disease that forms a tumor and spreads to other parts of the body.
The cervix, located in the lower part of the womb and connected to
the birth canal (vagina), is where a tumor or cervical cancer can
develop. Cervical cancer occurs when normal cells in the cervix
change into cancer cells. It is usually caused by a chronic and
persistent cancer-causing type of Human Papilloma Virus infection
that leads to pre-malignant lesions and progress to cancer.
This condition usually takes ten to thirty years
to happen. Thus, there is a long window of opportunity for cervical
lesions to be screened, detected and treated early, long before it
leads to cancer.
“Indeed, the truth is, this kind of cancer is
highly preventable,” Dr. Llave insists. Healthy lifestyle and
regular screening can help women from developing cervical cancer.
Light at the end of the tunnel
According to Llave, “Efforts are being done to
stop the increasing number of cervical cancer cases in the country
but studies showed, according to Llave, existing cervical cancer
screening service like Pap smear may not be enough to combat the
disease especially for the less privileged.”
She also adds, “The lack of equipment and
cytotechnicians in the public health facilities are limitations to
make this a sustainable screening service.”
But Llave, wo has been the chair of the
University of the Philippines-Philippine General Hospital (UP-PGH)
Cancer Institute and concurrent chair of the PGH Tumor Board since
2001, and has been in the service for 25 years, is hopeful that
there’s hope to eliminate this dreadful disease that is the second
most common cancer among women, the first being breast cancer.
Thus, the creation of Cervical Cancer Prevention
(Cecap) Network Program that aims to empower Filipino women against
cervical cancer by increasing their awareness about the disease and
providing them access to treatments. A collaboration of the
Department of Health; Jhpiego, an affiliate of Johns Hopkins
University; University of the Philippines Manila, Philippine General
Hospital and Cancer Institute, Cecap is an alternative approach to
saving women from cervical cancer.
Llave, who is also the director of Cecap,
further explains, Cecap promotes healthy lifestyle through education
and information campaigns; conducts training on cervical cancer
prevention with emphasis on screening through Visual Inspection with
Acetic Acid (VIA) linked to treatment (cryotherapy) in a single
visit approach (SVA) and undertake research on cervical cancer
prevention including other effective and practical screening methods
and country preparedness for HPV vaccination.
VIA is looking at the cervix to detect
abnormalities after applying a dilute solution of acetic acid, which
is the most common ingredient in household vinegar or suka.
On the other hand, cryotherapy involves freezing
the cervix, using either compressed carbon dioxide or nitrous oxide
gas as the coolant. The aim is to destroy precancer lesions
discovered during VIA.
CECAP is also striving to develop centers of
excellence for service, training, and research for healthcare
providers and advocates. This center shall be a model for the
prevention of cervical cancer especially for the underserved.
It only takes a minute
Dr. Llave is certain, it only takes a minute to
save women’s lives through Single Visit Approach (SVA), the best
approach that can benefit Filipino women because it immediately
provides results through screening using VIA or Visual Inspection
with Acetic Acid linked to treatment using cryotherapy.
“Using DOH-endorsed screening service
called VIA acid a woman can go to health centers with trained health
providers to avail of the service. VIA is a practical alternative
for healthcare professionals in developing countries because it is
safe, easy to perform, and inexpensive,” explains Llave.
In a matter of one minute, the woman will get
the results of the test. If abnormalities were found, the health
providers can give immediate treatment through cryotherapy
especially if the woman is eligible for this treatment option.
In one single visit, a woman who might have
precancerous cervical lesions will be screened and treated.
Empowering health providers
Cecap, according to Llave, is not only working
to establish community based cervical cancer prevention programs but
also into building and strengthening the local capacity of doctors,
nurses and midwives through training and monitoring. This will
ensure that public health providers are competent and proficient
implementers of cervical cancer prevention program.
Taytay, Muntinlupa and Minglanilla, Cebu were
chosen as the CECAP initial pilot sites. In all these sites, a total
of 6,988 women underwent VIA and 208 women have received cryotherapy,
or waiting for the schedule of their follow up treatment or
referrals to a secondary or tertiary hospital for further diagnosis.
Today, these areas serve as models of a functional cervical cancer
prevention program in a community.
The other thrusts of the program are promotion
of healthy lifestyle and information awareness on available
prophylactic vaccinations.
Medical breakthroughs
In year 2007, two pharmaceutical companies
launched vaccinations for cervical cancer that gives hope to both
mothers and their daughters.
GlaxoSmithKline vaccine branded Cervarix is a
vaccine against certain types of the human papillomavirus (HPV types
16 and 18) which currently cause about 70 percent of cervical cancer
cases.
The vaccine, which GSK claims to be for 15 to 55
years old, is to be taken for three periods, with the second taken a
month after the first shot, and the third six months after the
second shot. The cost per shot is about P6,000.
On the other hand, pharmaceutical firm Merck
Sharp & Dohme Philippines developed a vaccine to combat HPV that
is said to be effective for women aged 9 to 26 years old.
Branded Gardasil, the vaccine involves three
shots, with the second shot being administered two months after the
first, and the third shot being administered six months after the
second. The vaccine costs P6,000 per shot depending on the
doctor’s fee.
Meanwhile, Llave advises, “At this point,
where the vaccine remains unaffordable for a mother who can barely
put food on the table to feed five kids, screening is the initial
best option, to detect cervical cancer early. Also, vaccination
should work hand in hand with screening, as it prevents the
infection that causes the cancer.”
Non-stop campaigns
Alongside its goal, Cecap also launched
Bravehearts, a multidisciplinary crusade for cervical-cancer
prevention. Bravehearts means if we bond together we create a
stronger impact for the benefit of women’s health and in saving
women’s lives.
This May, Babae, Mahalaga Ka campaign also
commenced the first national celebration of the Cervical Cancer
Prevention Month which is spearheaded by DOH in partnership with the
Cancer Institute Foundation, Inc. (CIF), the Cecap, and MSD that
intends to encourage Filipino women to consult their doctors and ask
about cervical cancer screening and prevention methods
Though a lot has been done, the war against this
silent killer has just begun. Llave believes that with everybody’s
support cervical cancer can eventually be eliminated in the county.
“We need not only women but also men who will realize that there
is much at stake if we don’t act now and help in saving women’s
lives.”
She also warns, “Don’t wait until you
experience losing a woman from cervical cancer. Let this month long
celebration of cervical cancer prevention awareness be a time to
encourage your wife, your daughter or even your mother to consult
their doctor and learn more about preventing the disease.”
For more information about Cervical Cancer
Prevention (CECAP) Network Program located at CECAP Office, Cancer
Institute UP-PGH Compound, Padre Faura Manila, you can visit its
website: www.cecaphil.org and contact 523-3274 or e-mail: cecap_phil@yahoo.com
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