Months before the wedding of TV host Andi Manzano and businessman GP Reyes, the bride’s mother, Rose, had been bleeding continuously.
A test showed a mass in the cervix, the lower part of the womb that opens to the vagina. A biopsy revealed that the cancer was slowly advancing with the tumor growing to over 4 cm. But it remained in the cervix.
Rose bravely underwent three months of chemoradiation, pelvic radiation and chemotherapy, and brachytherapy, a kind of radiation therapy directed at the tumor. Still, questions arose: How could a healthy and happy woman with an active lifestyle like Rose get afflicted with cancer?
“Cervical cancer patients often ask what were the causes and how to prevent it. The health screening is extremely low in the Philippines because there is no national program,” says Dr. Julieta Germar, secretary of the Society of Gynecologic Oncologists of the Philippines.
Early stages
Although cervical cancer can be prevented and treated in its early stages, it is unfortunate that most of Dr. Germar’s patients come to her only in the ailment’s advanced stage.
She cites the early warning signs—bleeding after sex or to a near anemic stage, smelly discharge and pelvic pain.
“They come here only when the bleeding is excessive and the pain is extreme,” she says.
Only nine percent of Filipino women undergo regular health screening, Pap smear and get vaccinated for the human papillomavirus (HPV), the virus that triggers most cases of cervical cancer.
“It’s anti-virus, not anti-cancer, that prevents infection,” clarifies Dr. Germar.
HPV is usually acquired through sexual penetration or even skin-to-skin genitalia contact. Not even a condom can prevent the infection. HPV can be transmitted even when an infected person, the carrier, shows no signs.
Dr. Germar points out the misconception that cervical cancer afflicts women with multiple sex partners and those who had early sex. There have been many cases of women in monogamous relationships who developed cervical cancer in their senior years.
Many HPV infections eventually clear up. However, an infection that goes on for a long time can increase a woman’s chance of developing abnormalities in the cervical cells or pre-cancerous cervical lesions.
Cervical cancer grows slowly and quietly. It can take a decade for a pre-malignant lesion to progress into an invasive cancer.
Younger
The gynecologic oncologist observes that her patients have been getting younger. A 21-year-old patient was in her first pregnancy when she met Dr. Germar. She was referred by a gynecologist who discovered a mass.
Since the fetus was less than 20 weeks old, radical hysterectomy was performed. This procedure, which includes the removal of the womb, is done in the early stages of cancer when the cervical tumor is less than 4 cm.
The case was guided by the principle of Double Effect, a Christian doctrine that allows an action with severe consequences to be carried out for a good cause.
“The death was unintended. It was not an abortion. We had to treat the mother first,” says Dr. Germar. (Some details of the case have been altered to protect the patient.)
Then again, patients who are in the latter stages of pregnancy undergo chemoradiation after delivery.
Regular tests
Dr. Germar recommends regular pelvic examinations and Pap tests that spot the irregularities in the cervical cells. When detected at an early stage, the condition can be remedied so that it does not develop into cancer.
“The cervix is palpable. Unlike other organs that require technology for diagnosis, the doctor can look and feel if the cervix is smooth or if there’s a mass,” she says.
Although medical checkups can be costly, Dr. Leah Cheryl Manio, GlaxoSmithKline (GSK) medical affairs manager, says the pharmaceutical company has been organizing programs to make health awareness more accessible to lower income groups. GSK and doctors have gone to rural areas to train midwives on how to provide health screening such as cervical inspection and the use of acetic acid as the substitute for Pap smear.
The acid is applied on the cervix. When the woman is tested positive, as shown in the whitening of the cervix, she is referred to a health facility.
Since 2008, GSK has been making HPV vaccines accessible by reducing the price by as much as 70 percent, says Jackielyn Cortez, GSK associate product manager.
In the past two years, GSK has been promoting the Power Over Cervical Cancer campaign. Preventing this disease has been the last thing on the minds of most Filipinos who tend to put their family’s needs first.
“This year’s theme, ‘You Can & You Will,’ aims to motivate women to take care of themselves, and that they have the power to do so,” says Cortez.
GSK sets up booths that hand out fliers to educate women on the risks, burden and prevention of cervical cancer.
Affirmation
Meanwhile, image consultant Abbygale de Leon has been spreading the word in her capacity as president of Bravehearts Coalition of the Philippines, a nonprofit organization that raises awareness on cervical cancer.
“I have three messages: The first has to do with numbers 2, 80, and 7. Cervical cancer is the No. 2 killer disease among women in the world. Eighty percent of women will be exposed to the HPV virus. Hence, we need to strengthen our immune system. Seven of 10 women die of cervical cancer in the Philippines,” she says.
Her second message underscores the importance of pelvic screening, not taking them for granted and getting vaccinated early. “It’s the first cancer that has a vaccine for immunization,” she adds.
The third message is an affirmation for women to be vigilant. Says de Leon: “I promise my children that I will take care of myself.”
She observes that Filipino women tend to be overdo their self-effacement: “If you love your family, you need to look after yourself as well.”
In many of her workshops, De Leon includes the topic of cervical cancer awareness. “In the end,” she says, “the women ask each other: ‘Have you had a Pap smear lately?’”