Amazon Promise’s Cervical Cancer Screening and Treatment Program
Cervical cancer is the leading cause of cancer deaths in Peru among women aged 15 to 44 who live in low resource areas, including the Peruvian Amazon.
Although preventive screening is inexpensive and available through the Ministry of Health, the majority of women have never been screened. Of the women who are screened and found to have cervical dysplasia or cervical cancer, many never receive treatment and succumb to this disease that is highly treatable in its earliest stages.
Dr. Andrew Goldstein (standing with his wife, Dr. Gail Skovronsky Goldstein) is the driving force behind our Cervical Cancer Screening and Treatment Program
FACT: EARLY DETECTION SAVES WOMEN’S LIVES!
The most common barriers to screening utilization include poor understanding of the disease and the rationale for screening, poverty, distance/access to a medical facility, and anxiety/fear. Our program improves screening utilization by bringing cervical cancer education and screening and treatment to women living in impoverished and remote sections of the Peruvian Amazon.
In 2015, Amazon Promise screened 329 women for cervical cancer in both the city of Iquitos and remote jungle communities. Thirty-six women (over 10%) tested positive for cervical dysplasia.
All women received proper treatment and follow-up care by our Peruvian medical staff, including two women who required hysterectomies, and several needing biopsies.
In 2017, 250 women living in the Amazon basin were screened using a hand-held digital colposcope, based on smartphone technology (EVA tm system, MobileODT, Israel). All women who tested positive during screening had biopsies. Women suspected of having low-grade lesions were treated with cryotherapy, and those suspected of having high-grade lesions were treated with LEEP.
Results: 26 women screened positive during colposcopy. Of the 20 women who were suspected of having low-grade dysplasia, 15 had CIN 1, and 5 were negative for dysplasia. Of the 6 women suspected of having high-grade dysplasia, 1 had cervicitis, 2 had CIN2, and 3 had CIN3. Of the 4 women suspected of having invasive carcinoma, 3 had invasive cancer and one had severe cervicitis.
Andrew Goldstein, MD FACOG IF Director, The Centers for Vulvovaginal Disorders Washington, New York, Annapolis Immediate Past-President,
The International Society for the Study of Women’s Sexual Health, is the driving force behind the Amazon Promise Cervical Cancer Screen and Treat Program, and
we thank him for his dedication to improving women’s health worldwide.
The Alliance for Cervical Cancer Prevention has endorsed the “Screen and Treat” approach as the most effective way to reach the greatest number of women, particularly in remote areas, at least once in their lifetime. The “Screen and Treat” approach uses vinegar (acetic acid) to stain the cervix, looking for abnormal cell growth seen in the pre-cancerous and early stages of cancer. A colposcopy is a procedure to closely examine the cervix, vagina and vulva for pre-cancerous changes. If abnormal cell growth is found, a sample of tissue can be obtained for pathologic testing (biopsy). Those identified with pre-cancerous changes are treated using cryotherapy, either in the same visit or within the week. Women found to have more advanced stages of cancer are referred to the Regional Hospital in Iquitos for treatment. In these cases, Amazon Promise provides follow-up care, and/or travel assistance to Lima for more advanced treatment.
Patient Story, written by Rosa Aranzabal, former AP Administrative Coordinator. During the last day of our cervical cancer campaign, in October of 2016, two women who were selling candy nearby came to ask about our cervical cancer screening program.
I explained the services we offer, but they were afraid and declined. I was persistent and emphasized how important, quick and easy the testing is. They eventually agreed to screening. While one woman (Genith) entered the clinic, her friend stayed back to guard their stand. As it turned out, one of the women had advanced cervical dysplasia (CIN 3) which would very likely turn into cancer left untreated!
After further testing and treatment financed by the Amazon Promise Cervical Cancer Screen and Treat Campaign, Genith is now healthy and out of danger. We were with Genith and her husband during our February 2017 medical clinics when her final results came in. I feel so blessed that we were able to help her.
- Approximately 1,836 cervical cancer deaths occur annually in Peru (estimates for 2018)
- About 4,103 new cervical cancer cases are diagnosed annually in Peru (estimates for 2018)
Information sourced from: https://hpvcentre.net/statistics/reports/PER.pdf
Amazon Promise provides medical care to between 1500 and 2000 women over the age of 14 every year (1537 for the year 2018) in Loreto, Peru’s largest and poorest province.
Cervical dysplasia and cancer frequently go undetected in this population. Even when cervical cancer is diagnosed, women must travel to Lima at great expense, as there is no access to cancer treatment in Iquitos. With the additional cost of housing, meals and transportation, this is not an option for most women. Instead, they are forced to stay home and seek alternative traditional medicine treatments. In turn, many will die of this very treatable disease.
Our program’s focus is the early detection and treatment of cervical dysplasia. This program benefits poor women living in underserved areas of the Peruvian Amazon, specifically in the Loreto Provence of Peru. In order to reach as many women as possible and prevent more deaths from cervical cancer, we need your help.
Your support will enable us to continue our neighborhood outreach and education in impoverished neighborhoods and remote jungle communities; create educational materials; provide screening and treatment; and enable women with later-stage cervical cancer to receive the appropriate testing and treatment in Lima.