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South Florida Sun-Sentinel
(MCT)
FORT LAUDERDALE, Fla. - By the time Victelia Guillen walked into a clinic last summer, the pain that began a year earlier flared through her body. Within days, she had grim news. Doctors at the Caridad Clinic, a facility west of Boynton Beach, Fla., that serves low-income Hispanics, diagnosed Guillen, 52, with advanced cervical cancer.
Uninsured and wary of doctors, the Guatemalan mother of 10 had never before had a Pap smear - a screening test that has dramatically reduced cervical cancer rates in the United States over the past 50 years. Today, cervical cancer is highly curable if detected early. But women such as Guillen, who hesitate to seek help, represent a difficult challenge for doctors combating a disease that affects Hispanics disproportionately and remains a leading cause of death among women in poor countries.
Hispanic women, about a third of whom are uninsured, have a higher incidence of cervical cancer than any other ethnic group, according to the National Cancer Institute. They have the second highest rate of cervical cancer deaths after black women.
Gardasil, a vaccine the Food and Drug Administration approved in June, protects girls and women against strains of the sexually transmitted human papillomavirus, or HPV, that cause most cervical cancers. A federal advisory panel recommended Thursday that doctors routinely vaccinate 11- and 12-year-old girls. The panel also voted to include the vaccine in a federal vaccination program for uninsured children.
Merck's vaccine is considered a victory for preventive medicine. But poor access to health care, cultural taboos about sex and a widespread reluctance to go to the doctor remain steep obstacles in the fight against cervical cancer among Latinas.
"When I told my mother that I had cervical cancer, she started laughing," said Guillen, who remains ill despite months of chemotherapy. Her illness provoked disbelief and embarrassment among family members back home. "She's 74 years old, and she's never been checked."
Before her ordeal, Guillen, of Lake Worth, Fla., had never been to a gynecologist, which she says is typical of women like herself in Guatemala. She moved to the United States seven years ago, leaving behind her children, ages 10 to 30, in the maize-growing state of Huehuetenango.
In Palm Beach County, she has picked peppers on a farm and packed plants at a nursery. When the pain first struck, she fought it with stoicism and prayer. Guillen had no insurance and saw no other choice. The pain worsened, led to vomiting and finally caused her to collapse at work.
Caridad Clinic physicians diagnosed her and arranged for her to receive free treatment. One of her sons moved to Lake Worth from Huehuetenango to help her cope.
"I never went to the doctor before this started because I never felt there was anything wrong," Guillen said. "In Guatemala, only those with money get checkups. The rest of us don't do it. When I went to the clinic, I never thought I'd be told I have this disease."
Like Guillen, 35 percent of Hispanics in the United States lack insurance, compared with 11 percent of non-Hispanic whites. That disparity and an unwillingness to visit doctors for regular checkups are barriers for doctors and advocates.
"My own mother won't go to the doctor unless she's sick," said Hector Tarraza, chief of obstetrics and gynecology at Maine Medical Center in Portland and a board member of the Chicago-based Gynecological Cancer Foundation. "It's an accepted pattern. There isn't the concept of wellness checkups. Hispanics think of doctors as `There's a problem,'" said the Puerto Rican native.
The result, with an insidious disease such as cervical cancer, which shows no symptoms in its early stages, is that many women show up at the doctor's office when the cancer has spread and survival is uncertain. That reality is avoidable, experts say, in a country where cervical cancer is more than 90 percent curable if caught early.
Unsettling qualms about Pap tests also keep women away from gynecologists, experts say, even in areas where public health programs offer free screening.
"Many women are concerned about having a pelvic exam. They feel it's a violation, and that's a big obstacle to obtaining a sample," said Joseph A. Lucci, head of the University of Miami's division of gynecological oncology.
To get around those hurdles, university researchers are developing a self-sampling device that would allow women to screen themselves at home. But the tampon-shaped device is limited as a cancer prevention tool, Lucci said, so the medical community needs to work harder at getting Latinas into the doctor's office.
Peeling away the myths and fears is often half the battle.
"Latinas are not supposed to be familiar with themselves," said Ysabel Duron, the head and founder of Latinas Contra Cancer in California. "There's this whole taboo about having conversations about sex. Young married women are being infected with HPV by their partners, but it'd be ungodly to have Latino men talk about extramarital affairs and the need to use condoms."
Ellen Feiler, health education director of the Broward County Health Department, said some Hispanic patients have husbands who prevent them from being screened or seeking treatment.
"I've had women tell me their partners don't want them to get medical exams." Feiler said. "When they get diagnosed with advanced cancer and need a hysterectomy, a husband will say `No way, you're not doing that,' because there's the perception that if a woman has a hysterectomy she can't have sex anymore."
To help save lives, advocates have planned publicity campaigns styled after Spanish-language soap operas or telenovelas.
Redes En Accion, a national advocacy and research group, will use focus groups, illustrated booklets, Spanish-language radio and television ads to educate Hispanics about cervical, breast and colon cancer screening. The campaign will launch in 2007 in Miami, Houston, San Antonio and other cities with large Hispanic populations.
The National Cancer Institute's Cancer Information Service plans to educate farm-worker women in Homestead, Fla., and Orlando, Fla., about breast and cervical cancer screening, officials said. Those efforts follow a campaign launched in May by the Gynecological Cancer Foundation and National Alliance for Hispanic Health. Other groups plan Spanish-language outreach around the newly approved vaccine.
Guillen brightens when she speaks of her daughters, ages 10, 16, and 22, back home. She hopes they'll be spared her fate.
"I would take my daughters to get vaccinated. But there's no vaccine in Guatemala," she said.
She knows her own battle with cervical cancer is beyond the reach of any doctor's needle.
"God gives us life," she said. "Only he knows when he'll take it away."
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(c) 2006 South Florida Sun-Sentinel. Distributed by Knight Ridder/Tribune News Service.
