Educating young women about cervical cancer

24 Jan 2018 19:15
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Dr Hemant raised the question of educating young women about cervical cancer. Talking about pelvic examinations, for example, is not considered an appropriate issue for young women to discuss. I wonder what they know about reproduction in general and sexually transmitted disease. Presumably nothing. But would parents who do know about these things feel it acceptable for their children to be uninformed until after marriage? If so, the ante-natal clinic would be the place where discussion about Cx cancer can be undertaken. Screening for Cx cancer is not, in any event, normally considered until the late 20s. There have been many studies relatijg to Cx cancer in India, and I assume these women are informed shortly before screening is done.

With regard to the same issue and breast cancer, it seems there is no issue here. Personally, I am not convinced that anyone has shown the value of clinical examination and breast self examination in the early detection of cancer. Thus, I am not sure that it is appropriate to do, although education that could be confined to a brief introduction to cancer and discussion of the value of early detection is, from Hemant's note, acceptable. I see no reason to suggest any form of "prevention" or early detection unless its value can be established - LMIC cannot afford to use unproven techniques when they do not have the resources for proven methods. Moreover, Pisani et al found that there were similar sensitivities in the population in the Philippines that they studied (Int J Cancer. 2006 Jan 1;118(1):149-54.) I believe the study had to be stopped for non-compliance. The closing sentence in the abstract was:

Previous studies have shown that most breast cancer cases in the Philippines present at advanced stages and have an unfavourable outcome. Although CBE undertaken by health workers seems to offer a cost-effective approach to reducing mortality, the sensitivity of the screening programme in the real context was low. Moreover, in this relatively well-educated population, cultural and logistic barriers to seeking diagnosis and treatment persist and need to be addressed before any screening programme is introduced.

There are studies which show that women do not adhere to regular self exam in other cultures, but if they take a shower, even intermittently, they may detect cancers and they need to understand something about breast cancer so that they seek aid at an early point in their disease.

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