If you only have time to read three lines, let them be these:

GET VACCINATED against HPV.

GET CHECKED (screening through “pap smear” starts at age 21).

PROTECT YOURSELF against cervical cancer.

Sometimes we stop talking about important things, whether it be because of shame, ignorance, or because we keep waiting for the "right" moment to do so. It happens to be this way with matters relating to our health, and even more so if we have answered our own doubts with myths spread by media or have decided that "it does not relate to us". In this way, the topic of cervical cancer is mentioned very little, and has been stigmatized for years, because we still do not dare to talk openly about sexuality, our bodies, and what happens in gynecologist’s office.

In Puerto Rico, cervical cancer was the seventh most commonly diagnosed cancer among women in 2008-2012. On average, 53 women died of cervical cancer each year. This CAN be avoided. 

With January being Cervical Cancer Awareness Month, we have taken up the task of sharing with you a list of reliable sources of information, answers to common questions about cervical cancer, and the invitation (for both men and women) to raise our voices to educate others, while taking care of our health and that of our loved ones.

 1. What is the cervix?

The cervix, or the neck of the uterus, is the lowest, narrow part that serves as the entrance to the uterus, connecting it to the vagina. The uterus (or womb) is where the baby grows when a woman is pregnant. Viewed from the outside, the cervix has been compared to a small pink donut, with a central orifice that does not reach 1 cm in diameter, but can expand up to 10 cm at the time of delivery to let a baby pass through. (Image)

  2. What causes cervical cancer?

In most cases, cervical cancer is caused by the human papillomavirus (HPV), which, being a DNA(the material that makes up our genes) virus , can alter the behavior of the ce

lls which it invades. These infected cells can be transformed into intraepithelial lesions or cancer, upon replication. There are approximately 100 HPV types, and about 30 of them infect the anogenital tract. Of those, approximately 15 of them are associated with cancer and are known as high-risk HPV. Most cancers are caused by types 16, 18, 31 and 45. It is worth mentioning that many infections with HPV are transient, meaning that the body itself manages to fight them and eliminate the virus. However, when the body loses the battle and the virus remains lodged in our bodies, it can lead to cervical cancer.

  3. What is CIN?

These are the initials for "Cervical Intraepithelial Neoplasia". A neoplasm involves abnormal formation of a new tissue. CIN is an injury that could develop (but doesn’t always) into invasive cancer. If detected by screening tests, it can be effectively treated, before it progresses.

  4. What increases my risk of developing cervical cancer?

•  SMOKING: The risk is 3.5 times higher in smokers than in non-smokers
• Being immunocompromised: HIV/AIDS patients, patients who have received organ transplants, patients with chronic renal failure or a history of Hodgkin lymphoma, or those who have received mmunosuppressive therapy for other reasons.
• Having sex before age 18: during adolescence, there is increased transformation of the cells of the cervix.
• Having more than one sexual partner or a male sex partner who has had several sexual partners: Because of the increased risk of getting HPV. Most people who are infected do not know it.
• Take birth control pills for a long time (five years or more).
• Have given birth three or more times.

 5. Then, how can it be prevented?

To reduce your risk:

• Get Vaccinated: It is recommended that children 11-12 years old receive the first dose of the vaccine along with their other school required vaccines, since it is understood that the body will have a better immune response. A second and third dose is then given at 2 and 6 months of the first dose. For those who did not receive the vaccine at that time, it is still recommended that any woman between the ages of 13 and 26 be vaccinated. With the development of the HPV vaccine, we can help our bodies fight a possible infection, and thus reduce the possibility of developing cervical cancer. You can find a vaccination clinic in Puerto Rico here.
• Get checked: Getting a pap smear, also known as papanicolau, is extremely important for detecting early lesions, when the treatment is most effective. In this screening test, a light scraping of the cervix is performed and the cells collected are then analyzed under a microscope. If you are over 21 and have not had a pap smear yet ,or if it has been more than 3 years since the last time you did, make an appointment with your gynecologist NOW.
• Protect yourself: Don’t smoke. Use condoms *. Visit your gynecologist annually and talk to them about reducing your risk. See your doctor if you have any unusual bleeding, vaginal discharge, changes in urinary habits, pain during intercourse, or pelvic pain, as they may be symptoms of cervical cancer or other gynecological diseases.

*HPV infection can occur in male and female genital areas that are covered or protected with a latex condom, as well as in those that are not covered. Although the way condoms can prevent HPV infections is unknown, condom use has been associated with a lower rate of cervical cancer.

6. How can I learn more?

• To learn more about the disease, you can visit the CDC page here.
• To keep up with what’s happening in Puerto Rico during this month, learn more about the disease, join the cause or find answers to your doubts about vaccination, you can follow VOCES by facebook o twitter. They will be posting the whole month.
• Get to know the story of Rhaiza Vélez, a young Puerto Rican mother who was a victim of cervical cancer at age 32, and used her last few months to raise awareness about this disease. (The video is in spanish)
• Get to know the story of other survivors.

You can join the cause using this link, to change your facebook profile photo to include the cervical cancer ribbon. Dress up in teal on January 27 and spread the word, so that the women in your life get vaccinated, get checked, and protect themselves.

References:

B., Beckmann, Charles R., Herbert, William, Laube, Douglas, Ling, Frank, Smith, Roger. Obstetrics and Gynecology,  7th Edition. Lippincott Williams & Wilkins, 03/2013. VitalBook file.

https://www.cdc.gov/cancer/cervical/basic_info/

http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/HumanPapillomavirusHPV

Vocespr.org

Zavala-Zegarra D, Tortolero-Luna G, Torres-Cintrón CR, Alvarado-Ortiz M, Traverso-Ortiz M, Román-Ruiz Y, Ortiz-Ortiz KJ (2015). Cancer in Puerto Rico, 2008-2012. Puerto Rico Central Cancer Registry. San Juan, PR.http://www.rcpr.org/Portals/0/Informe%202008-2012.pdfDate Last Accessed: November 12, 2016.

Fernández ME, Le YL, Fernández-Espada N, Calo WA, Savas LS, Vélez C, et al. Knowledge, Attitudes, and Beliefs About Human Papillomavirus (HPV) Vaccination Among Puerto Rican Mothers and Daughters, 2010: A Qualitative Study. Prev Chronic Dis 2014;11:140171. DOI: http://dx.doi.org/10.5888/pcd11.140171.

Romaguera J, Caballero-Varona D, Tortolero-Luna G, Marrero E, Suárez E, Pérez CM, et al. Factors Associated with HPV Vaccine Awareness in a Population-Based Sample of Hispanic Women in Puerto Rico. J. Racial and Ethnic Health Disparities (2016) 3:281–290 DOI 10.1007/s40615-015-0144-5