Guest contributor Dr. José Jeronimo is senior advisor for women’s cancers with PATH’s Reproductive Health Global Program.
It may sound like an oxymoron, but I recently attended a very exciting medical meeting.
I don’t come away from all professional gatherings fired up, but this one was special, in part because it was the culmination of a decade of work to improve the detection and treatment of cervical and breast cancers in low- and middle-income countries. But mostly, it was exciting because I saw such heartening signs of progress in improving the health of women and girls in a part of the world I used to call home.
I am Peruvian, and for years I practiced as a gynecologist and oncologist in Lima before emigrating to the United States. In those days, the Pap test was the norm for screening for cervical cancer. It’s still a familiar test for women in the United States and many other countries, and in some places it still can be effective in detecting cervical cancer early and saving lives.
But in most low-resource settings, the Pap test doesn’t work very well. The test requires access to well-run laboratories and highly trained staff, both in short supply outside of urban areas in Peru and most developing countries. Pap is expensive and detects only about half of precancer cases. It’s inconvenient for women who must travel to health facilities miles from their homes and return several times for tests and treatment if their results aren’t normal.
As for screening for breast cancer, mammography simply isn’t available in many parts of Peru.
Detection and treatment
All of that is changing. Now there are safe, feasible ways to prevent cervical cancer and to detect and treat breast cancer in low-resource settings like the one I worked in.
At the meeting, sponsored by PATH and the Pan American Health Organization, representatives from nine Latin American countries met to learn about Peru’s innovative approaches to early detection and treatment of cervical and breast cancer, two diseases that kill nearly 120,000 women in the Americas every year.
Health leaders from Bolivia, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Paraguay, and Peru listened to the presentations. Then we spent hours brainstorming ways to replicate the most effective interventions in those countries.
A simpler solution
Trainers from the Peruvian Cancer Institute use a relatively simple and inexpensive method of screening for cervical cancer called visual inspection with acetic acid, or VIA. They treat the cases they uncover by freezing and destroying affected tissue. Precancer cure rates are very high.
Though their program has been running only a few years, master trainers have already taught their technique to more than a thousand health care providers in Peru. They’ve vastly increased the number of women screened, and they’ve expanded screening services to places it has never been available before.
But the Peruvian group didn’t stop at their own border. They’ve trained providers from Colombia, Bolivia, and Nicaragua, countries that have established their own national cancer programs. They’ve also built a web-based virtual classroom to support staff after training.
An exam for breast cancer
To screen for breast cancer, Peru uses clinical breast examinations, in which trained health care providers check their patients’ breasts for lumps or other changes. Clinical breast exams are a proven technique, and in Peru they’re being implemented through a standardized and validated training process using expert-reviewed educational materials.
The new system screens women in clinics and other facilities that are as convenient to their homes as possible. If providers find anything suspicious, they refer women for care. In the short time the clinical breast exams have been used in a small province in Peru, the team has found eight cases of breast cancer in women who otherwise would not have received timely care.
We all know that losing wives, mothers, and grandmothers is a serious blow to families and communities. It’s great to see us moving into a world where those deaths will likely become fewer as each year goes by.