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I never talk about it.
Like the proverbial elephant in the
room, it looms over us and we ignore it. We press on, talk about
treatments and medications and menopause. We review stages and
explain surgery, radiation or chemotherapy. We wonder how to explain
all this to her children. I never talk about it and she never asks;
the fact that this cervical cancer could have been prevented.
Cervical cancer affects 30 women per
year in Newfoundland and Labrador, an incidence rate that is double
that seen in Britain. What’s worse is that the mortality rate is far
higher than the rest of Canada. I have gained more experience in the
treatment of advanced disease than many of my peers in the developed
world.
Dr. George Papanicolou devised the
cervical cytology test “Pap” smear as a means to pick up abnormal
cells on the cervix before they became malignant. No screening test
is comparable in terms of cost and efficacy. Since its introduction,
rates of incidence and death have plummeted. Large contrasts in
death rates between neighboring Scandinavian countries were seen
when one introduced the screen while the other across the border did
not. This test works. And, it costs $20.
In this province, only 33 per cent of
women annually have a Pap smear. Why? We have low rates of women
requesting Pap smears and low rates of physicians recommending
yearly screening. We have no mechanism to identify or recruit women
who have not had a Pap. We have no system in place to detect
abnormal results that are not followed up appropriately. The
literature shows that the key to successful reduction in rates is
the development of an organized screening program. Currently, we
have a fledgling program that survives on a budget of $300,000.
We know that the province spends more
money treating cervical cancer than it would to prevent it.
Likewise, the economic impact on society, time lost at work or taxes
not paid, is huge. The bigger costs, those of the human losses that
we see, are unfathomable. I have done a radical hysterectomy on a
23-year-old that yearned to have kids. I have sat with a brilliant
46-year-old with awful pain and given enormous narcotic doses on the
night she died. I don’t know if we helped her pain.
Right now I’m caring for a mother of
four with Stage IV disease.
Studies show that at least 50 per cent
of women with cervical cancer have not had a Pap in the last five
years. We are currently researching that number in Newfoundland and
Labrador. I feel it will be worse. There is an urgent need for more
attention to this issue. Attention from media, who could make a
difference with good publicity, and from government who could save
lives and save money. Most importantly, there is an urgent need for
attention from family physicians; you have the most power to prevent
this cancer. Research has shown that the single most important
trigger that gets women to have a Pap is a prompt from a family
doctor.
We know it’s not easy to fit Pap smears
into a busy practice. We know that there is no support for
preventive medicine. It is unacceptable that the fee schedule has
just decreased the payment for a Pap. We know that gender issues and
geography and fear of malpractice make it hard. We also know that
doctors in Newfoundland and Labrador care about their patients and
do their best. Right now, our best is not working.
The rate of cervix cancer can be
lowered very effectively if we each make a small effort.
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Ask the next women you see about
her last Pap.
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Get a chart-flagging kit from the
Cervical Cancer Initiatives program.
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If Paps are hard to fit in the
clinic, separate a time for a Pap-only clinic.
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Get a Pap record book from the
Cervical Cancer Initiatives Program.
Government will not effect change
without pressure from us. I’m sure Premier Danny Williams would
support prevention wholeheartedly if he could see the damage, both
economic and human, that a simple test can prevent.
Dr. Lesa Dawson is a gynecologic
oncologist at the Dr. H. Bliss Murphy Cancer Centre in St. John’s. |
