Many Colombian women could be facing risk of death as a result of undetected cervical cancer -- despite having had Pap smears. Why? Ten percent of such tests are not accurate and therefore provide an incorrect diagnosis.
The Pap smear is a method used for early cancer detection by special staining of exfoliated cells. It can help reduce the death rate by 60% in patients who usually go asymptomatic.
The Instituto Nacional de Salud [11] (INS), the public scientific authority for health, revealed that about 120,000 Pap tests per year -- 10% of the total -- do not follow the scientific proceedings in taking the sample, its manipulation nor its interpretation.
The 2005 National Population and Health Survey (ENDS), the most rigorous research available on sexual and reproductive health in Colombia, showed that the cervical cancer death rate had increased from 54% in 1995 to 69% in 2000, among women aged 40 to 69. The survey was conducted by Profamilia [12], a private, non-profit health provider. It also revealed that among 20 to 49 year old women this rate had increased from 34% to 37% in the same period.
Moreover, according to Pan American Health Organization [13], annually 2,300 Colombian women die as a result of cervical cancer and about 5,000 are diagnosed with the cancer which attacks the womb.
Luis Eduardo Mejía, INS Director, explained that this situation is partially a consequence of the operation of bacteriological laboratories which do not meet the scientific standards. In fact, 70% of such laboratories have not been certified - that is to say, 294 across Colombia, Mejía pointed out.
In order to improve the
Pap tests, the INS, in conjunction with the Ministry of Social Protection,
developed a control guide of quality, which is a sort of protocol of
proceedings to follow in each step of the Pap process. In addition,
the INS is training laboratory and medical staff on such proceedings
in order to ensure that the guide is implemented. So far, 800 gynecologists
and pathologists have been trained. INS is also planning to train
indigenous people, whose women usually do not go for a test, because
of shame and fears about non-aboriginal healers. According to Mejia,
the prevalence of cervical cancer is increasing among indigenous communities.
What is being done with the laboratories which are operating without the INS certification? The Colombian authorities have yet to make a declaration in this regard.
How can a Colombian woman know if her diagnosis is correct? Neither of the health authorities have disclosed the laboratory's names which are not certified by INS, nor have called for a repetition of Pap tests.
It is evident that health authorities did not want to bring further public attention to this issue, maybe because such actions could have a negative impact in the motivation of Colombian women to have a Pap test, which would jeopardize its promotion.
In fact, local and national authorities have long been campaigning for the annual Pap test. A Pap test promotion campaign was launched two years ago in Bogotá, which included information, testing and educational components. TV advertisements and brochures were designed for public audiences. To provide sexual health education, a number of promoters were trained to carry out social work with groups of women who have never gone for the test. And the capital health authority implemented mobile health teams which use vehicles equipped to perform the Pap test in low income neighborhoods of Bogotá, as well as to start conversations highlighting the importance of self-care.
In addition, new health regulations state that both public and private healthcare providers are obliged to perform free tests without previous appointment.
In 2005, ENDS revealed that 85% of Colombian women have had Pap tests performed at some points in their lives, while only 48% go for them once a year. However, 99% of women aged 18 to 69 are informed about the Pap test.
Nevertheless, 14% of those who have never gone for the test said that cost is not what matters most. ENDS identified the reasons behind such a behavior: carelessness (32%), fear (30%), shame (17%), asymptomatic (15%), considering it unimportant or unnecessary (7%) and lack of money (5%).