HPV immunisation back on Guyana’s agenda

When a woman hears about being screened or taking a pap smear, she cringes inwardly – not because of the painful procedure but of the thought that she could have cancer. Truth is, we are fearful of the truth… that harsh reality of living with cancer.

Dr Vikash Chatrani, Obstetrician/Gynaecologist, Gynae-Oncologist attached to the Queen Elizabeth Hospital in Barbados
Dr Vikash Chatrani, Obstetrician/Gynaecologist, Gynae-Oncologist attached to the Queen Elizabeth Hospital in Barbados

So, instead of rushing to the cancer institute for early screening, we wait for tomorrow and soon after tomorrow becomes next year. So, despite half of the cancer cases in Guyana dying within the last 10 years – most of them women, persons are seldom doing check-ups or self-examinations.
In an interview with Guyana Times, a 32-year-old woman stated that she has never done a pap smear in her life because she was fearful of the outcome. “There is a lot of reasons of me not doing it. One of my friends did it and she said it was painful and so I’m waiting until I’m (sexually) active again to do it. But all in all I’m afraid of what the result would be,” she said. This woman’s grandmother died of cancer several years ago.
Another woman indicated that she stopped being examined several years ago, because she became complacent. “I guess I got lazy… besides it isn’t easy. It feels like someone is scraping my inside,” she said.
However, when asked why she would be complacent about such a deadly disease, the woman said: “You think about the possibly of having cancer and not fully understanding how to deal with that. I don’t wanna deal with that. I haven’t been exposed to a lot of women education and support systems to make me want to, either.”

Programme relaunched
On Friday, the Public Health Ministry relaunched its Human Papillomavirus (HPV) immunisation programme to prevent cervical cancer. The aim of the programme is to target preteens prior to the start of sexual activity, since the cancer is believed to be transmitted through sexual contact and school health surveys show that by age 14 about 61 per cent of girls have already had sex.
Although the HPV vaccines have attracted negative attention, HPV has been found to cause cervical cancer. It is said to be the most common sexually transmitted infection that can be spread from one person to another through vaginal, anal or oral sex, or through other close skin-to-skin contact during sexual activities; even the use of a condom may not protect against this infection, according to the Centres for Disease Control and Prevention (CDC).
Subsequently, the Ministry pitched the relaunch of the programme to Finance Minister Winston Jordan and he signed onto it. At the launch, Pan American Health Organisation Country Representative, Dr William Adu Krow endorsed it, stating that there were about 140 HPV strains and out of that figure, 40 of them affected the genital area. “Ninety-nine per cent of cervical cancers are linked to the variant HPV strains,” he said.
PAHO is seeking to procure the vaccines at a cheap price.
Head of the Health Sector Development Unit, Dr Morris Edward stated that there were 10 million new cases of cancer every year and that figure was projected to climb further in 2030 to 27 million. He zeroed in on Guyana, revealing an annual incidence rate of 27 per 100,000 persons.
Stating that cancers have consistently been rising in terms of morbidity and mortality, Edward emphasised that Guyana hardly diagnosed persons in the early stages of cancer, with less than one per cent of cases being diagnosed in the first stage.
“Unfortunately, almost a third of all the cases were not staged, and we would like to find out why,” he said.
Subsequently, he highlighted that more than 80 per cent of the cases had no treatment recorded, “…that is really worrying. Why are we not providing treatment to 8 in 10 of the persons with cancers,” he questioned, adding that more than half of the cases within the past 10 years have died, leaving the country with a crude mortality rate of 454.6 per 100,000 persons.
He stated that over the years, Guyana has lost more than 30,000 lives because of cervical cancer. Therefore, he contended that the absence of treatment was atrocious and lobbied for a comprehensive cancer programme to be established.
Dr Vikash Chatrani, a gynaecologist attached to the Queen Elizabeth Hospital in Barbados, said there was no need to justify why the Government should invest in the HPV vaccines, since the financial strain cancer placed on a society was greater.
He stated that while most women have accepted pap smears as part of their DNA, there was not a lot of awareness taking place. “Her private parts are private and they do not have the awareness. Cervical cancer is a stigma that a woman is promiscuous,” he said, adding: “You don’t realise, but some of the misconceptions out there is what we tell them (about) and then they take that and add to it and come with a different conclusion.”
He posited that it all boiled down to the health policy in a country. He said if there was poor access to screening and treatment services, that was reflective of bad policy.
“That is poor policy and that is why it needs to be improved and it is actually costing the Government more, because if they don’t spend the money to get the vaccine, then they will have more people coming in with cancer that require more expensive treatment like surgery, chemotherapy. That’s poor economics,” he said.

Prevention
PAHO also believes that a comprehensive prevention programme is necessary in the fight against cancer. According to the Health@50 in Guyana: Progress Health Report 1966-2016 released by the organisation, Guyana has no comprehensive cancer prevention, treatment and control programme, despite the disease being the third leading cause of death.

PAHO has supported the Public Health Ministry to conduct a situation analysis of cancer prevention, treatment and control as a pre-condition to the development of a National Cancer Plan. The second step is for the statistics collected from the consultancy to be utilised, and for the key stakeholders assembled to develop the plan and proceed with the establishment of the comprehensive programme.
Chief Medical Officer, Dr Shamdeo Persaud acknowledged the need for such a programme, whilst asserting that Guyana should put an end to cervical cancer.
“I think all of us here who have daughters and nieces and sisters know how important it is to offer protection to these persons. Even though prostate cancer is high, breast and cervical cancer is challenging us majorly,” he said, adding that still they find a lot of women coming forward in the latter stages of cancer, when the disease has ravaged their bodies.
“We can do very little sometimes and we still have persons dying from these types of cancers. We would like to see the end of that; we would like to see all our women and girls protected from this un-eventual happening, which is linked to the exposure of the HPV,” he added. (Jeanna Pearson)