Interviewee: Dr. Vilma Perez, former assistant consultant Cancer Institute of Guyana
GR: How high is the incidence of Cervical Cancer in Guyana?
Dr. P: It is the leading cancer in females in Guyana. The correct figure is difficult to determine since we don’t get all the figures from the private and public sector institutions, but the figure is high. We are detecting the cases very late. When the Institute was opened we were getting most of the patients in the very late stage – that is stage 4. Now we are getting cases at an earlier stage – at Stage 2. But we can do better if we can detect the cases very early when they have only the abnormal cells and the patients do not have to go through the harsh treatment they have to undergo when the cancer is advanced. The prognosis for survival decreases when the cancer is more advanced.
GR: Why is it so important to know about cervical cancer?
Dr. P: It is well known that it is linked to the HPV (Human Papilloma Virus) infection. It is known to be sexually transmitted. It affects the female reproductive years. It also affects the family. Early detection is very important.
It is important to let people know that it can be prevented if it is detected early through pap smears before the cancer develops. At this point more education needs to be done. It’s better to prevent it than have to treat it.
GR: What is the treatment like?
Dr. P: It depends on the stage of the cancer. If it is detected very early through a pap smear the treatment is very simple. It can be chemotherapy which is a local treatment. Some patients have to get surgery (where the uterus is removed.) and they may not require further treatment.
If they have Stage 2a it needs radiation. From 2b to stage 4A cancer they will need radiation, chemotherapy and internal radiation. That is more costly. Radiation treatment is a long treatment (5 weeks). Chemo is done every week with the radiation, then 3 weeks after is internal radiation; internal radiation for 3 days and patient has to be hospitalised and cannot get visitors.
Stage 4 treatment is not to cure it. It is palliative treatment which is just to stop the bleeding so as to prolong life. It is not curable. The full treatment can be done in Guyana at the Cancer Institute since it has all the resources and facilities – equipment, oncologist, chemotherapy and radiation. It can be treated from the early to the last stages. Our focus is to let people know that these resources are available in Guyana. If you do the pap smear and the abnormal cells are detected early you may not have to go through this treatment.
GR: How much of a problem is this cancer in Guyana and what type of advice would you give to women in terms of early checks etc?
Dr. P: It is a problem in Guyana. I have some figures from the Cancer Registry for 2000-2007 which I will give to you. We don’t have all the figures especially from the regions. This information comes mostly from the Georgetown Hospital and some private hospitals. Even though Regions 3 and 4 have the most, the figures could be misleading since we don’t have all the figures from the other areas. The total is 692.
GR: Is it customary for women to go to the Institute for checks?
Dr. P: No it is not. It’s a concern. Most of the patients who are conscious about getting regular checks are those who may have lived overseas and know about the importance of having regular checks.
GR: Shouldn’t we be sending a message out there saying that you need to do this?
Dr. P: Now we have the VIA (Visual Inspection Acetic Acid) test which is done free at Health Centres and the G’Town Hospital. We are now getting more females coming for checks. I think that it is important that we have to get all females from 18 years who are sexually active to do pap smears or VIA. It is done at hospitals, health centres and labs.
Why it’s important that we get them coming in early is that we are getting people with the disease in the late stages. If you do the pap smears you will catch it early. It will tell you if you have abnormal cells and not that you have the disease itself. We want to detect it from this early stage. You don’t have to wait for the tumour to form. It is a slow growing cancer. It goes first from the normal change in cells before forming the tumour. And it will take years. Regular checks will help to detect it early. When you see the tumour means that the disease is already there. Because of the closeness of the cervix to the rectum it will spread.
GR: It seems to me that there is a need for a more aggressive campaign to urge women to come and check themselves.
DR. P: Yes. There are a lot of working women and they don’t make time to check. You don’t see symptoms at the beginning. When you detect symptoms means that the tumour is already there. A very early symptom is spotting after sex. Some people don’t pay attention. You have to be aware that bleeding after sex is not necessarily normal. Even bleeding after menopause. If one gets bleeding at 66 years infrequently that needs to be checked. That is not normal. It is not menstruation. You must go and see a doctor.
GR: I am sure that the situation is quite worse in areas outside of the city where some women don’t go to the doctor for any reason whatsoever. What do your studies tell you of the trends? Do more women come from rural areas?
DR. P: You don’t have to wait for them to come to you. You have to go and tell them that they must come and see the doctor.
GR: Do you think that this is what the medical system is trying to do? Is there an outreach programme to teach women about the importance of getting checks? Many people don’t know of the Cancer Institute so any information on it would be helpful.
DR. P: Yes. The Pap smear is a very simple test. Any health centre can do the VIA tests. You can get the results almost immediately while the Pap smears results take a couple of weeks since they have to be checked by a pathologist.
GR: Does the Institute go into the interior areas?
Dr. P: No it doesn’t. To me people need to be made aware of the fact that the facilities are available to do the tests and provide treatment.
GR: Do you find that women here are not as conscious as they should be in terms of checking their health regularly?
Dr. P: I stopped working there in November. I am not a specialist in cancer but worked at the Cancer Institute as Asst Consultant. I am trained as a family physician.
GR: What can you tell us about cervical cancer that we haven’t asked you?
Dr. P: We need to do more education. Let women know that the tests are simple and that the disease is preventable.