​What kinds of symptoms do patients experience before receiving treatment?

Most patients are asymptomatic, but occasional patients may have bleeding and pain in the pelvic region. Wuqu’ Kawoq runs a large center for screening for cervical cancer with pap smear tests. When a pap smear is positive, or when a woman comes into clinic with an obvious lesion on her cervix, she needs additional follow-up in the form of colposcopy and/or a cone biopsy. Often this can be done through a colposcopy, a straightforward procedure in which a specialist examines the cervix and sometimes takes a tissue sample to test for cell abnormalities and cancer. When the abnormal cells cannot be sufficiently examined through a colposcopy, a cone biopsy is performed. In it, a cone-shaped area of tissue is removed from the cervix and tested for abnormalities. The cone biopsy is often curative for small cancerous or precancerous lesions of the cervix. Occasionally, if the biopsy shows abnormality, the patient does need to be referred on for more advanced treatment. Often, however, the cone biopsy is both diagnostic and curative.

​What is the impact on patients’ lives of living with these conditions?

These are cases picked up in our medical partner's screening program for cervical cancer, so most of the women don’t have any symptoms at all. This is exactly how a screening program is supposed to work, picking up cases that need treatment when treatment is still easy and curative. If left untreated, many of these women would go on over a period of months to years to develop life threatening invasive cervical cancer.

What cultural or regional factors affect the treatment of these conditions?

Thanks to broad access to screening and treatment, cervical cancer is very rare in the US and other developed countries. In Guatemala, however, it is the most common cause of cancer-related death among women of reproductive age. This is because of poverty and poor infrastructure.

What does the treatment process look like?

After an abnormal pap smear or colposcopy, or when cervical cancer in suspected, a patient is referred to a specialist who performs the cone biopsy. In this procedure, the specialist removes a cone-shaped section of tissue from the patient's cervix. This sample is sent for pathology testing. If testing indicates all abnormal cells have been removed, no additional follow-up is required. In these cases, the procedure is curative, and women can return to their regular lives with regular medical follow-up. Usually the entire process can be completed in about two weeks. If abnormal cells are found in the edges of the sample, an additional cone biopsy may be performed to remove those cells, or, if necessary, a hysterectomy may be recommended. If the pathology testing reveals cancer deep in the cervical tissue, additional treatment such as radiation, chemotherapy, or surgery may be recommended.

What is the impact of this treatment on the patient’s life?

This treatment saves lives. Without access to this procedure, many of these women would eventually develop severe, invasive cervical cancer and die of the disease after much financial drain paying for ineffective and costly treatments. Cervical cancer attacks early in life, frequently robbing women of decades of life and leaving their families alone.

What potential side effects or risks come with this treatment?

This condition is very treatable. At this stage, lesions can be removed easily at relatively little cost, and lives can be saved. Risks are rare but include: serious bleeding requiring further treatment, difficulty reading future cone biopsies due to cervical scarring, increased risk of miscarriage or preterm delivery, and potential narrowing of the cervix which can cause infertility.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There are several public and private clinics in Guatemala that offer this treatment. However, indigenous women, especially those who don’t speak Spanish, are often frightened of the strange procedure and the environments in which it is offered and as a result often do not follow through with testing. Our medical partner provides these women with the case management, counseling, translation services, and financial support they need to complete the procedure and participate in their own care.

What are the alternatives to this treatment?

Most women with a positive pap result are scared and not sure where to turn. Instead of seeking help, they often go home and don’t seek care until many years later when the cancer has progressed and is no longer treatable.