Cervical cancer initiative begins in Guatemala

	A patient receives a Visual Inspection with Acetic Acid as part of PIH/ETSEC's weeklong training session.

Women living near Santa Ana Huista, Guatemala, now have unprecedented access to cervical cancer screening and treatment at two local clinics. During the program’s launch week in March, 160 women from this rural department were screened for the disease. Cervical lesions were removed from nine women who tested positive for abnormal cervical cells using cryotherapy--a simple procedure that removes those cells by freezing them with nitrous oxide. 

The screenings were performed by three nurses and one doctor--two from the local public clinic and two from a private NGO clinic in the region--working under the supervision of two gynecologists from Basic Health International in El Salvador. Both the screenings and the trainings were organized by PIH and the local nonprofit Equipo Técnico de Educación en Salud Comunitaria (ETESC), longtime partners in the region.

The visiting clinicians taught the local staff how to screen for cervical cancer employing visual inspections with acetic acid (VIA). In the relatively simple procedure, a health care worker swabs a small amount of acetic acid--common vinegar--across the cervix. Normal cervical tissue remains unaffected by the acetic acid, but damaged tissue found in pre-cancerous or cancerous lesions turns white.

This team of local nurses and physicians were taught VIA, but they also learned how to remove abnormal cells using cryotheraphy.

Both procedures will now be added to the range of permanent services offered at two of the region's local medical centers.

“The main advantage of VIA is that it gives immediate results,” says PIH’s project coordinator in Guatemala, Lindsay Palazuelos. “When you add cryotherapy, most women can be treated for pre-cancerous lesions during the same visit. This pairing is often called the ‘single visit approach.’”

“This is in contrast to pap smears, which may take months to return results, and require the woman to make a chain of several visits: to get the pap, to get results, and typically a third time to get treatment,” continues Lindsay. “In rural areas where a trip to the clinic is a huge investment of time and money, this chain often breaks.”  

“We are working to make this clinic a holistic center for women of the region, a place where a woman can come for all of her care,” says Dr. Humberto Hernandez, director of Santa Ana Huista's public clinic.

“We are the first health center to be able to provide this service of cryotherapy. Guatemalan public health protocols call for VIA, but this is the first time we’ll be able to include treatment with cryotherapy as well.”

“This training was a beautiful and valuable experience to better help and serve our local women,” recalls Rosalva Hernandez Lemus, the nurse who runs the region's private clinic. “After the first day or so we joked to the trainers, ‘You go rest at home and we’ll take it from here.’ They helped us refine our skills a great deal.”

	A patient receives her test results (top); the team of physicians and nurses who received training, along with the trainers from El Salvador (bottom).

In Guatemala, cervical cancer is the leading cause of cancer-related deaths among women of reproductive age, with 3.77 million Guatemalan women currently at risk for this potentially fatal cancer. The disease accounts for nearly 60 percent of female cancer cases seen at Guatemala’s National Cancer Institute--far more than breast, skin, ovarian, and stomach cancers combined.

Because cervical cancer grows slowly, regular screening and accessible treatment save women’s lives by significantly reducing incidence and mortality rates. Too often screening and treatment programs in resource-poor countries like Guatemala are unable to reach many rural women; as a result hundreds of Guatemalan women continue to die unnecessarily each year.

“This has been a lovely experience,” says Dr. Dalia Saravia, one of two El Salvadorian gynecologists from Basic Health International (BHI) who facilitated the training. “I didn’t think the patients would agree to come to the exams so easily, but they chose to come, even with some male providers. In fact the number of women that came increased [as the week went on]. So that tells me the people want this care.”

“I am filled with satisfaction that the women felt empowered, they asked questions, and had the capacity to do so,” says Dr. Gerardo Zelaya, also from BHI. “I’m very satisfied and happy that the reach of this work has been extended.” 

The National Cancer Institute estimates that at least 75 percent of the women living in Guatemala’s rural areas and poor urban communities have never been screened for cervical cancer.

VIA has been proven to be as sensitive as pap smears. Cryotherapy has almost no risk, goes about 1mm deep (sufficient to get the lesions, but in no way damaging the integrity of the cervix), and healthy cells regenerate within about 3 months.  

ETESC is also conducting educational outreach to rural communities to educate men and women about cervical cancer risks, and the benefits of VIA.

Learn more about PIH’s work in Guatemala.

Read about PIH’s cervical cancer work in Haiti.

PIH’s Guatemala project is run in collaboration with the nonprofit Equipo Técnico de Educación en Salud Comunitaria, Spanish for Technical Team for Education in Community Health. Refugees of the Guatemalan civil war, a conflict that ran from 1960-1996 and resulted in 200,000 deaths, founded the project in the 1990s. PIH/ETESC seek to revitalize and repair the social fabric in rural communities of Huehuetenango, Guatemala, through legal accompaniment, health promotion, and HIV/AIDS education.