In Latin America and the Caribbean, 33,000 women die each year as a result of cervical cancer, a disease caused by the Human Papilloma Virus (HPV). HPV infects 20% of women and men in this region, and up to 30% of young women 15-24 years old.

This data was revealed in a comprehensive report on the impact of the virus in the Americas, researched by the Pan-American Health Organization (PAHO) and the Sabin Vaccine Institute, among other relevant health organizations.

The report’s findings were so alarming that they deserved an international conference, organized last May in Mexico City by the World Health Organization (WHO), the Pan-American Health Organization (PAHO), the Sabin Institute, and the Centers for Disease Control and Prevention of USA (CDC).

The research highlighted the inequalities among the region – of the 86,000 women in the Americas with a diagnostic of cervical cancer, an astounding 72,000 live in Latin America and the Caribbean, and almost all the resulting deaths occurred in the LAC region.

Experts say universal access to prevention and treatment must be reached, otherwise the deaths caused by cervical cancer could reach 70,000 in two decades ahead.

The Papanicolaou test, or PAP as its most commonly known, is a method used for early cancer detection by special staining of exfoliated cells. It can help reduce the death rate by 60% in patients who usually go asymptomatic.

In Bogotá, the local health authority is developing measures to promote and facilitate PAP tests with the aim of preventing cervical cancer, since this has become the second cause of deaths for cancer, after breast cancer, in women aged 30 to 59.

Cervical cancer now ranks second because the breast cancer rate has grown, Elkin Osorio, a member of the Cervical Cancer Working Group of the Colombian capital, explains.

The 2005 National Population and Health Survey (ENDS), the most rigorous research available in sexual and reproductive health, showed that the cervical cancer death rate in Colombia had increased from 54% in 1995 to 69% in 2000, among women aged 40 to 69. The survey was conducted by Profamilia, a private, non-profit health provider. It also revealed that among 20 to 49 year old women this rate had increased from 34% to 37% in the same period.

Why Women Don’t Take the Test

ENDS 2005 revealed that 85% of Colombian women have had PAP tests performed at some points in their lives, while only 48% go for them once a year. However, 99% of women aged 18 to 69 are informed about the PAP test.

Fourteen percent of those who have never gone for the test said that cost is not what matters most. ENDS identified the reasons behind such a behavior: carelessness (32%), fear (30%), shame (17%), asymptomatic (15%), considering it unimportant or unnecessary (7%) and lack of money (5%).

Asked about the incidence of other factors like service quality, Juan Carlos Vargas, a scientific advisor of Profamilia, says that women believe it is important to respect their sexual and reproductive rights, including confidentiality. “That is why we use the ID number rather than the women’s name,” stresses Vargas.

“As the healthcare system is so fragmented — there are many kinds of service providers — some of them do it right and some others do not,” Osorio adds.

Ensuring Treatment Compliance

Many women do not undergo full treatment once they get a positive diagnosis of cervical cancer. ENDS corroborated that one third of positive women did not start treatment because of carelessness, and one out of every four women did not go back to the doctor for treatment because they did not have money.

“Ten to 15 out of every 10,000 sexually active women living in Bogotá face some cervical cancer risk, while the death rate stands at 40 to 50 women for every 10,000 women,” Osorio explains.

Women who begin their sexual lives earlier can be at higher risk, because they may have multiple partners and are therefore more exposed to HPV.

But there are other factors, too, including a lack of self-care. Self-care can be seen as a gendered problem because women are culturally trained to take care of the rest of the family, but not of themselves.

A PAP test promotion campaign was launched two years ago in Bogotá, which included information, testing and educational components. TV advertisements and brochures were designed for public audiences. To provide sexual health education, a number of promoters were trained to carry out social work with groups of women who have never gone for the test. And the capital health authority implemented mobile health teams which use vehicles equipped to perform the PAP test in low income neighborhoods of Bogotá, as well as to start conversations highlighting the importance of self-care.

In addition, new health regulations state that both public and private healthcare providers are obliged to perform free tests without previous appointment.

But, Osorio concludes, “We are still far from universal coverage for many reasons, including poor healthcare service management and cultural factors.”