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

The most frequent reason for an endometrial biopsy is suspicion of endometrial cancer. Older women, usually postmenopausal, often present with severe, chronic vaginal bleeding. In this age group the most common cause would be cervical cancer, so referral facilities usually rule this out before patients come to see our medical partner. By the time patients come to our medical partner, the major possibility is endometrial cancer (cancer of the lining of the uterus). Uterine cancer, or endometrial cancer, is a slowly progressive cancer. It is almost always easily treated simply by removing the uterus. However, access to the necessary resources to make the diagnosis is not readily available in Guatemala. Many women, by the time they come to see our medical partner, have been suffering from anemia and chronic vaginal bleeding for many years.

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

Women with endometrial cancer can experience heavy bleeding and pain, which leads to daily discomfort, difficulty working, and difficulty caring for their families. Because many Guatemalan women take care of their children and do the tasks around the home, it is extremely debilitating on both them and their families to live with these symptoms.

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

The rate of endometrial cancer is lower in Guatemala than in the United States. However, Guatemala has one of the highest rates in the developing world. The reason the rate is higher in the US is probably because more cases are diagnosed early. In Guatemala, more cases are likely to be diagnosed at a late stage.

What does the treatment process look like?

Treatment for this condition is straightforward. Removal of the uterus if a cancer is diagnosed is almost always covered free of charge by the national health system. Our medical partner coordinates the workup with several cancer specialists. Essentially, the patient requires a preoperative workup, such as basic bloodwork, since the biopsy is a surgical procedure. Once this is done, the biopsy is performed and our medical partner receives the report within a week or two. The whole experience usually takes less than one month. If anemia is a problem, patients are provided with iron supplements, and if a cancer is diagnosed, our medical partner arranges surgical removal of the uterus for them.

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

This treatment saves lives. Without access to this biopsy/workup procedure, women develop advanced endometrial cancer, which can no longer be cured with a simple surgery. With facilitated access to the cancer workup, which this treatment provides, our medical partner can take care of women before they are no longer treatable. Often the typical patient is still working in the fields or in the market, and may often still have young children. Therefore the treatment stabilizes and protects families and young children as well.

What potential side effects or risks come with this treatment?

There are very few risks associated with performing an endometrial biopsy. Pain or cramping can occur, but this typically subsides after the procedure. Other less common risks include feeling faint or light­headed, possible infection, bleeding, and rarely, perforation of the uterus.

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

This treatment is not easily accessible. Most patients come to our medical partner after many months or years of misdirection and frustrated attempts to get care. Our medical partner works with them to advocate for them, cover their expenses, and get them through the process quickly.

What are the alternatives to this treatment?

There are not many alternatives. It would be possible to proceed directly to removal of the uterus, but this subjects many women to an unnecessary invasive procedure and still does not solve the problem of ruling in or out the cancer diagnosis.