Eulalee Thompson - BE WELL

Of course, I am a part of the generation that grew up on Michael Jackson's music and am enthralled by his sheer genius, talent, discipline and pain. Remember, "have you seen my childhood"? I wonder how the people around him couldn't hear his cries for help. It's more than just music. Take the lesson from this tragic, beautiful life.

There is physical and emotional pain all around us but do we see it? I have been in a space, for example, where I interacted regularly with young women, still in the prime of their lives, yet dying of cervical cancer. They lose their smile, their bodies rapidly shrink almost down to just skin and bones and their eyes recede into their faces. When they get over the bitterness of death and are close to the end, they stop fighting and decide to make peace with their Maker. These are life experiences that I will not forget. This is really no way for anyone to die.

And, the truth is, they really don't have to. That there is actually a vaccine against a type of cancer is a remarkable scientific achievement. It's even more remarkable, at least to me, that this vaccine is not on the national immunisation schedule. The vaccine was invented when scientists discovered that cervical cancer was actually caused by the human papillomavirus, commonly called HPV. The HPV is actually passed on to girls and women during sexual intercourse.

The immunisation schedule

I have written several articles on the cervical cancer vaccines but I am reminded of the topic with the recent launch in Kingston of one of the internationally available vaccines, called Cervarix. This vaccine by GlaxoSmithKline competes with Gardasil, another cervical cancer vaccine produced by Merck & Co Inc. Both vaccines are available here, at a cost, in private health care. Unless they are placed on the national immunisation schedule, they will not be widely available to girls and women in the lower socio-economic groups.

The health ministry indicated, last October, that before a decision is made on the vaccine, a study will be undertaken to define the overall prevalence of cervical HPV in an age cohort of sexually active women in Jamaica and to describe the epidemiological and other risk factors associated with the infection.

Cervical cancer is the second leading cancer (after breast cancer) among women in Jamaica. One of the pharmaceutical companies have been indicating that this cancer kills four women every week here. There are about 100 subtypes of HPV that cause warts including genital warts. Most of the subtypes are low-risk germs and health experts say that most people who acquire HPV will resist its effects but, in about one per cent of women, the cells become malignant. The vaccines offer protection against the HPV subtypes responsible for more than 70 per cent of cervical cancer and are indicated for girls older than 10 years old and women.

Precancerous changes

Currently, women are advised to do regular screening tests, Pap smears, to pick up early, precancerous changes in their cervix. Applying aggressive, time-consuming and expensive treatment, if the malignancy is detected in the precancerous stage, can actual see women recovering from this cancer.

However, local gynaecologists, such as Dr Wendel Guthrie and Professor Horace Fletcher, who were quoted in my earlier articles consistently say that most women do not do their Pap smears regularly or none at all. Guthrie, who was Jamaica's representative to Pan American Health Organisation (PAHO) technical group, said that in one year about 168 women die here from cervical cancer; the incidence is about 30 per 100,000 and the mortality rate is about 17 per 100,000, much higher than rates in developed countries. This cancer is estimated to kill about 300,000 women worldwide each year.

Research by Fletcher (published in Caribbean Health, April 1999) indicates that "the effectiveness of Pap smear screening depends on women's knowledge of and attitudes towards screening, the availability of this service, the adequacy of laboratory facilities to process the smears, staffing of clinics and laboratories, quality control, a system of recall of women with positive smears and economic factors".

Fletcher continues: "Most women have heard of the Pap smear, but believe its purpose is to detect rather than prevent cervical cancer. Screening rates are low among poor, uneducated women. As a result of staff shortages in government laboratories, there is a long delay before Pap smear results are returned. The problem of cervical cancer is severe enough in Jamaica to justify the reallocation of funds from less critical area."

Eulalee Thompson is health editor and a professional counsellor; email: eulalee.thompson@gleanerjm.com.