The battle against cervical cancer in the Philippines
Sahara Villanueva was 39 years old and single when she was diagnosed with cervical cancer.
"I asked, 'Lord, why me? What did I do to deserve this?," she asked herself after the doctor told her about her condition in January 2007.
She said she did not believe the doctor's words. Here she was, healthy and without an illness, and then all of a sudden, diagnosed with cervical cancer?
Villanueva was not the first one in her family to have cancer.
"My late mom had breast cancer in the 1990s," she said.
Numbers to remember
8 - A Filipina dies of cervical cancer every 8 minutes.
30 - Number of years that the incidence rate/mortality rates for cervical cancer has not changed.
2/3 - Most of the time, there is late diagnosis among patients.
1 1/2 - Years since Cervical Cancer Prevention Program (CECAP) was formed in the Philippines.
89 - Number of trained Single Visit Approach (SVA) providers.
14 - Number of clinical trainers.
73 - Number of trained barangay health workers for SVA.
90 - Number of barangay health researchers for SVA.
10,337 - Total number of Filipinas screened as of July 2008.
235 - Women who tested positive, treated and referred to secondary level of treatment after VIA..
7,277 - Number of cervical cancer cases in the Philippines as of 2005 (though according to Almaria, this is underestimated and is not representative of the whole population since survey was only done in Rizal, Cebu and Davao.)
30 - Women who have become sexually active should have themselves checked up by their obstetrician-gynecologist every 2-3 years before 30 and every year after 30.
500 - Number of kilometers that Team David's Salon will go through from Vigan, Ilocos Sur to Olongapo, Zambales as part of CECAP's cervical cancer information campaign in Luzon from Sept. 13-17, 2008.
She said that since she took care of her mother, she and other family members became more aware of living a health lifestyle. They ate organic food and simply lived healthy lives.
"I thought that I was immortal, and since I didn't got sick, I was healthy. That was a fallacy," she said, saying that until she was diagnosed with cancer, she entirely focused her life on her job of 18 years.
The realization, as is often the case, came late.
"I was pushing my body and pushing my body without realizing that my immune system was getting weaker."
Following the diagnosis, Villanueva stormed out of the doctor's office.
"What did I do?" she remembered herself asking.
"The tears were tears of shock, of disappointment, of fear and fear of knowledge that I wont be able to have a baby, ever. Gone was the foundation for a laughing baby. I won't be able to conceive birth and have my baby," she said.
30 years so far
Villanueva, said Dr. Cecilia Llave of the University of the Philippines-Philippine General Hospital's Cancer Institute (CI), is not alone.
She said that every eight minutes, a Filipina dies of cervical cancer in the Philippines.
"The incidence rate and mortality rate hasn't changed for the past 30 years," she said, adding that so far, only 12 percent of Filipinas are screened for cervical cancer.
As in Villanueva's case, the low screening rate can be traced to the fact that women claim they are too busy for tests plus the belief that a healthy lifestyle is enough to ward off illnesses.
There is also the tendency of a would-be patient to weather the pain or the symptom and stay at home rather than see a doctor.
However, as it turns out, a woman younger than 30 should be checked by her obstetrician-gynecologist three years after becoming sexually active. After she turns 30, the tests should be done every year.
"It's mandatory for a person, a woman, who had her sexual contact [to be checked up] after three years, and yearly before she reaches 30, and every year after 30," said Dr. Jaycee Almaria, program manager of the Cervical Cancer Prevention Program (CECAP).
The CECAP is a group of health professionals and non-government organizations in collaboration with the John Hopkins Program for International Education in Gynecology and Obstetrics, Cancer Institute Foundation (CIF) and UP-Philippine General Hospital (PGH) that has banded to promote cervical cancer awareness and treatment.
A must for every gal
According to Almaria, it is a must for every sexually-active woman to have a regular check up since cervical cancer shows no symptoms at its early stage.
"It has no symptoms, initially. The woman does not feel anything," she said.
In its advanced stage, there is abnormal vaginal bleeding, watery and foul-smelling discharge, pelvic pain and urinary or bowel problems, according to Almaria.
"This is when the cancer metastases, when the cancer reaches the bowel or urinary tract," she said.
And even in the advanced stage, some women may not feel any foreboding at all.
"Eighteen percent of the time, there are no symptoms when the cancer is in the advanced stage," Almaria said.
The lack of knowledge and information about cervical cancer, said Llave, may be one of the reasons why the disease is not detected at an early stage, similar to what happened to Villanueva.
"Two-thirds of the time, our women are diagnosed very, very late," she said, adding that not many Filipino women know about the disease, that it is preventable and can be cured when detected at the onset.
Live the life
Villanueva said that in hindsight, she thinks that her work of 18 years took its toll on her body.
"What I realized was that I have been in sales and marketing for the past 18 years, and the high pressure and stress contributed to the having a lowered immune system to the point that I became susceptible to cervical cancer," she said.
As a reaction, Villanueva sought a second opinion. Other doctors told her the same: she had cervical cancer.
Instead of coping, Villanueva chose to focus on doing what she does best -- continue working as head of the sales and marketing department of her company.
It turned out, however, that her defense mechanism, was detrimental to her condition.
"I also only told a handful of people of my condition because I didn't want to be pitied," she said.
Finally, the secrecy and burden of having cervical cancer caught up with Villanueva.
"I couldn't take the stress [anymore] and started being absent from work," she said.
She said that in those trying times, her Maker made a wake-up call.
"He went to my sister and Dr. Llave, and it was Dr. Llave who told me to quit my job, relax and be happy," she said.
Villanueva said she is fortunate to have a sister and a family who were supportive of her condition.
"They just told me to quit my job and be happy, they would take care of all my needs," she said.
Fortunately, Villanueva survived.
Her survival, however, has a deeper meaning for her.
"Because of my personal experience with cervical cancer, I hope that I have enlightened everyone with early detection, early prevention and surviving cervical cancer," she said.
Which is what CECAP, CIF and the UP-PGH have been advocating at the grassroots level, said Llave.
"We've been doing that through secondary prevention, through using the Single Visit Approach (SVA) as an alternative to the Pap smear," she said.
The SVA is a way of detecting cervical cancer at its infancy.
SVA is done when a woman goes to the municipal health center. At the health center, a qualified practitioner such as a doctor, nurse or midwife counsels, screens and treats a patient if she tests positive for the cancer-causing type of Human Papilloma Virus (HPV).
The SVA combines both screening and treatment in one session by using an effective, low-resource screening method called the Visual Inspection using Acetic Acid and then offering on-the-spot treatment using cryotherapy.
And did you know that the everyday kitchen condiment natural "suka" (vinegar) can be used to detect HPV?
This is done with the VIA or the Visual Inspection using Acetic Acid.
"VIA is looking at the cervix to detect abnormalities after applying a dilute solution of acetic acid, which is the most common ingredient in household vinegar," said the CECAP Web site (www.cecaphil.org).
The acetic acid (about three to five percent) found in vinegar is dabbed on the cervix.
"In just one minute after dabbing ascetic acid, you will know the result. In PAP smear, it takes from a week to six weeks for the result," Llave said.
An ounce of prevention...
Because of this, the Department of Health has been advocating the SVA method to test for cervical cancer among Filipino women.
A woman who tests positive is immediately counselled and referred to for treatment.
Treatment, however, shall only be done if there is a criteria for such.
"If the patient has cancer, we refer them immediately. If the lesions are large and cannot be treated with cryotherapy, we refer them to partner institutions," said Almaria.
At the site, the woman is treated using cryotherapy, which involves freezing the cervix, using either compressed carbon dioxide or nitrous oxide gas as the coolant. The aim is to destroy pre-cancer lesions discovered during VIA.
If the equipment is not available on site, the patient may be referred to the UP-PGH in Manila, Vicente Sotto Memorial Medical Center in Cebu and Northern Mindanao Medical Center.
Despite the efforts, still a lot more work needs to be done, said Llave.
She said that they are seeking the support of the local government units and the people themselves to disseminate information about cervical cancer awareness.
"We need your support so that we can save more women's lives," she said.
Almaria said there is still hope, though it would still be best for Filipino women to open up, go to the doctor and have themselves checked.
"The irony is, it's really bad when it's there but it can be prevented. It may not even occur, if we treat ourselves and go to the doctor," she said.
(Information for this article came from the September 4 launch of "Tour of Hope: Going the Xtra Mile to X-Out Cervical Cancer", a 500-kilometer bike tour from Ilocos Sur to Zambales from Sept. 13-17, 2008 in the hope of promoting cervical cancer awareness among women. Additional information may be obtained at www.cecaphil.org).