AT 26 years old, Dr. Jane Adevoso was pregnant with her first child. It had been a routine test but her doctor gave her the good news—and also some jolting news. The fetus was steadily growing, but she was also diagnosed to have developed a tumor in her cervix. When her doctor was telling her this, she didn’t need much explanation. “I understood that there was a possibility that I might have cervical cancer. I had mixed feelings and couldn’t react; the only thought that ran in my head was, ‘Is my baby healthy?’ It’s as if I ignored what my doctor was trying to tell me.”

But the choice was inescapable: it was a risky pregnancy and surgery was necessary. “I felt that strong urge to be a mother to my son. So my thoughts were on how we can survive together. Even when he was just in my womb, I was already talking to him, telling him to be strong and that we can do it together.”

Through her guided pregnancy and treatment, Dr. Jane miraculously went through her pregnancy and gave birth to a healthy son they named Gabby. But again, the happiest day of her life had also been one of her saddest moments. “I was still feeling groggy when the doctors showed me my son. I was teary-eyed when I saw him. But after that, I remember barely recovering from the epidural and being whisked off from the recovery room back to the operating room, this time to get a radical hysterectomy [where the womb is removed to ensure the cancer tumor is gone]. My body was numb, I felt immobile, especially with the thought that after this, I will never have another child again.”

Almost a year-and-a-half later, Dr. Jane has controlled her Stage 1 cancer at a manageable condition. Her adorable son, who is now discovering the joyful world of language, is turning out to be an amiable and smart boy who loves books. “It’s been a learning experience for me—and I feel blessed that I’ve had good doctors and the cancer was detected early. Today I’m enjoying motherhood a lot. I don’t regret what I’ve gone through if only to be with my son.”

Preventable and curable

DR. Jane’s experience with cervical cancer has a lesson to be learned by women today who still think that cervical cancer—like most other forms of cancer—“just happens.”

The truth is, says UP PGH Cancer Institute chairman Dr. Cecilia Ladines-Llave, “in the Philippines, every eight minutes a woman dies of cervical cancer and the overall survival rate has not improved in the past 20 years.

“But it’s one of the forms of cancer that can actually be detected through early diagnosis and cured. And it only takes a minute to save your life from the disease.”

Dr. Llave is also one of the pioneers behind the Cervical Cancer Prevention Network Program, or Cecap, an alliance composed of various organizations from the government, private sector and health professionals. Its aim is to eliminate the disease in the Philippines through training seminars among health workers, public-awareness campaigns and wellness workshops, such as this one we went to a few weeks ago. Alongside its goal, Cecap has also launched Bravehearts, a multidisciplinary crusade for cervical-cancer prevention. This month the alliance is observing Cervical Cancer Awareness Month.

“Did you know that it is one of the forms of cancer wherein the cause is known?” notes Dr. Llave. “It is caused by the human papillomavirus [HPV] or genital warts, or what is commonly called as kulugo. All women are at risk of this virus. About 50 percent to 80 percent will acquire HPV infection in their lifetime, and 50 percent of that will have the oncogenic or cancerous type. Persistent infection with the oncogenic HPV can progress to cervical cancer. But as I’ve mentioned, it is now preventable through a vaccine.”

“Prevention is always better than cure. Visit to your ob-gyn now,” underscores Dr. Sarah Grace Tan. “A healthy lifestyle, screening and vaccination are key. ”

In screening through pap smear, cells from the cervix are scraped and stained on a glass slide, which is then evaluated by a cytologist. The cost of a regular procedure may range from P1,000 to P2,000 and may be steep for most women. There is an alternative to this, however, says Dr. Tan. For low-resource settings, Cecap and the Department of Health are promoting visual inspection with acetic acid, or VIA. Unlike getting a pap smear test, no invasive medical procedure is required in VIA. A trained health worker swabs an acetic acid (vinegar) solution (about 3 percent to 5 percent of vinegar) on the cervix and is inspected with the naked eye. Dr. Tan explains that the solution gives the precancerous or cancerous lesion a whitish hue. “Early detection and immediate treatment can save your life. Talk to your health-care provider about options for cervical-cancer screening, treatment and vaccination.”

HPV vaccine

“IT’S that foul-smelling discharge that the woman will never forget for the rest of her life. In most cases, even before she has told us her other symptoms, the discharge already tells us that she may have cervical-cancer,” Dr. Jaycee Almaria notes.

“Thus the Single Visit Approach is important in cervical cancer prevention. In this case, early screening will not be effective if it is not linked with treatment.”

Cryotherapy, which has an 85-percent to 95-percent cure rate for mild to moderate lesions, is a preferred treatment for a precancerous lesion. It literally entails freezing cells using a liquid coolant and only takes about 11 minutes. Some may cringe at this idea of “blast-freezing” the lesion but Dr. Almaria assures us that there is no pain, and therefore no anesthesia is needed because the cervix has no nerve endings. Healing usually takes a year after therapy.

“Cervical cancer is not hereditary,” says Dr. Jovelle Fernandez. “It may be that your mother or a relative may have been afflicted with it but that may mean you generally have a weak immune system. HPV is acquired by skin-to-skin contact in the genital area, though intercourse is not necessary for general infection. Even virgins can get it! Persistent HPV infection is the cause of cervical cancer, and HPV types 16 and 18 are the most dangerous viruses.”

Recently, a cervical-cancer vaccine by GlaxoSmithKline was introduced in the country. Its ASO4 adjuvant (its Latin meaning is “to help”) is said to target the said types of virus. Dr. Fernandez cites a study that began in the 1980s showing that the adjuvant system induced a strong and sustained immune response. “Studies show that the vaccine provides long-term protection of about 5.5 years to all women.”

The vaccine 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 cause per shot is about P6,000 but the benefits—a healthy and cancer-free life—are well worth it.

***Learn more about cervical cancer and the HPV vaccine. Contact Cecap Coordinating Center Cancer Institute, UP-PGH, Padre Faura Street in Manila. Call 523-3274 or e-mail cecap_phil@yahoo.com.

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