Carmélite, 68 years old and mother of 8 children, after many hesitations, arrives for consultation this Monday at the hospital. She, who has never been ill, and who gave birth to her eight children in good health, has been feeling pain in her lower abdomen for some time and notices an abnormal passage of blood through her vagina. After certain evaluations, including a pap test, the gynecologist’s diagnosis was clear: cancer of the cervix at an advanced stage. Unfortunately in Haiti, there is no systematic screening program for cervical cancer, let alone a treatment center for this type of cancer. Carmelite and her relatives, victims of the system, without recourse, will have to be content with the palliative care offered to her by her attending physician in order to accompany her in her last days. This is the ordeal of many of our compatriots in Haiti, whose mortality rate from cervical cancer is among the highest in the world (570/100,000) in 2019 according to the WHO.
January is Cervical Cancer Awareness Month in Haiti. This cancer is the second most affecting women in Haiti after breast cancer. On the Health 9 program of Tuesday, January 17, 2022, broadcast on Magik 9 radio, Dr. Joseph Bernard Junior was able to emphasize the importance of this cancer which continues to cause mourning in many Haitian families.
Cervical cancer is usually diagnosed in women between the ages of 35 and 50. Cancer is primarily the abnormal development of cells in the body. In the context of cervical cancer, these cells will multiply at the level of the cervix, which is located immediately after the vagina. The virus most often responsible for this cancer is HPV (Human papilloma Virus) which is transmitted during sexual relations. Men are healthy carriers of this virus.
According to Dr. Bernard, currently head of the department at Saint-François de Salles Hospital, several factors can increase the risk of developing cervical cancer, including early sexual intercourse, multiple sexual partners , having multiple children (multiparity), smoking, oral contraceptives, and being a person living with HIV.
According to the WHO, from the age of 30, all women should benefit from a screening test every 3 years in order to detect cases of cervical cancer as early as possible and thus effectively treat the disease.
Dr. Bernard goes on to explain that this cancerous mass that develops in the cervix is very invasive. It will spread to nearby organs like the uterus, vagina, bladder and rectum. This is responsible for the many signs and symptoms such as severe pain during sex, passages of blood through the vagina, pain during defecation and in the hip. Symptoms may begin with small whitish discharge that is often attributed to a small infection, but which remains persistent despite antibiotics. The gynecologist will have to examine using a speculum, this instrument which makes it possible to better see the external appearance of the cervix.
The most important thing in the context of cervical cancer is that it can evolve for 10 or 15 years without any clinical manifestation continues Dr. Bernard. The slow progression of cancer explains the importance of screening tests to detect the presence of the virus on the cervix. The Pap test is the most common, but there are others such as the Acetic Acid Visual Inspection (VIA) to name a few. Prevention of cervical cancer should be intensified in Haiti given the limitations in the therapeutic choices. Vaccination of young people (girls and boys) from 9 to 14 years old, alone, considerably reduces the occurrence of cervical cancer in women. According to Dr. Bernard, we should advocate for these vaccines to be available in Haiti, which is the country with the highest percentage of women with this cancer in the Caribbean.
The therapeutic approach depends on the stage of cervical cancer. In the early stages, surgery remains the treatment of choice for these patients. The intervention consists of the removal of the uterus, cervix and ovaries. However, radiotherapy has not been available in Haiti for several years, chemotherapy alone is not enough to treat some advanced cases of cervical cancer in Haiti, according to Dr. Bernard. And palliative care only helps to support patients with dignity in their last days of life.
In the light of this information, an appeal is launched to all sexually active women and of childbearing age, get tested by your gynecologist, by a pap test, which must be repeated every 3 years, according to the doctor’s advice. Throughout the month of January, cervical cancer screening activities are carried out at the Saint-François de Salles Hospital. The goal is to allow more women to get tested.
Dr. Nathalie Edema
