Deadly cervical cancer is a preventable disease that is the most common cancer to strike Vietnamese American women. In fact, female immigrants and their daughters are five times more likely to be diagnosed with this disease than are their Caucasian counterparts, National Cancer Institute statistics show.

Why are so many Vietnamese American women diagnosed with cervical cancer?

The average Caucasian woman gets regular Pap smears, simple tests that can detect a treatable pre-malignant condition, yet few Vietnamese American women do the same, experts say.

Women from countries such as Vi?t Nam, where Pap smears are not routine, generally do not know to ask their doctors about the tests and their doctors do not mention them, said Jacqueline H. Tr?n, program manager of the nonprofit Orange County Asian and Pacific Islander Community Alliance,  which, among its various programs, educates women about the need for pap smears and helps those with low incomes  access screenings at little or no cost.

“Mothers, knowing nothing about pap smears, in turn fail to teach their daughters about their importance, and the cycle continues,”she said.

Another reason many Vietnamese immigrants fail to get Pap smears involves health practices and beliefs. “They will have prenatal screening at home and here, but Pap smears are a modesty issue and a provider issue,” involving doctors who fail to tell them to go to a gynecologist for the test, and thus “people aren’t getting screenings,” she said.

Even though family values are very important to the Vietnamese, Pap smears, known as cervical cytology, often do not “seem relevant to the Vietnamese mother, so why teach her daughter? Good family values would predict good health practices, but in this case, they fail,” said Dr. John Morgan, a cancer epidemiologist and professor of epidemiology for Loma Linda University in Loma Linda, Calif.

“Cervical cancer is not hereditary, unless you consider a mother who doesn’t know about testing not telling her daughter to test,” Morgan said.

“For women migrants from Southeast Asian countries, (where) the Pap test is not available, it’s not on her radar screen, and if it’s not on her radar screen,” she could become another victim of the disease, he said.

For “Asian women coming from Japan, where they have cervical cytology, as in the U.S., cervical cancer is not a problem. It is not a hygiene issue. It is the lack of available screening tests,” he said, adding that “Southeast Asian women in general are part of the high-risk group.”

Is cervical cancer possible if a woman is a virgin?

Overall, “cervical cancer is a sexually transmitted disease — it is probably 95 percent a human papilloma virus infection or HPV infection, (which usually) is sexually transmitted (but) these women are at high risk because they are not getting early detection,” not because of their sexual habits, he said.

“In the non-Hispanic, white women in California, there is more testing and they are finding the pre-malignant condition. Among women not participating in cervical cytology, the disease is being detected as cancer,” Morgan said.

Sexual practices, he said, are not the issue.

With Pap testing, the condition that gives rise to cervical cancer (can be found). It is pre-malignant. The difference in risk is not because of a different number of sexual practices. It is lack of testing, and is the result of a virus, an HPV. “All women who are sexually active are at risk for this virus,” he said.

According to the ACS, HPV is not something women should be scared about, as almost everyone has had HPV at some time in their lives.

It also “is common for Vietnamese to think that women who get cervical cancer (are promiscuous),” Tr?n said. “This is very common. Lots of people never in their lifetime get exams.”

How does HPV lead to cervical cancer?

HPVs are a group of more than 100 types of viruses that cause warts and some types of HPV cause genital warts while others, called “high-risk” HPVs, cause cancer of the cervix, according to the American Cancer Society.

HPV is spread through sex and it can cause a cervical infection that usually does not last long because the human body is able to fight the infection, but if it doesn’t go away, the virus may cause cells in the cervix to change and become pre-cancer cells.

The precancerous cells are not cancer, and most of the cells with early pre-cancer changes return to normal on their own, but sometimes they may turn into cancer if they are not found and treated. The Cancer Society notes, however, that few HPV infections lead to cervix cancer.

How successful are Pap smears in preventing cervical cancer?

“There is no cancer screening test that is more successful in saving lives (than a Pap smear). Not an x-ray mammography for breast cancer, or colon cancer screening or screening for prostate cancer,” Morgan said.

“Unquestionably, (Pap smears) save lives. Identifying (pre-malignant cases) early (is the key). No woman will ever die of pre-cancerous condition for cervical cancer. About 4,000 women this year will die of cervical cancer, and every one of those cases was preventable,” he said.

 “Cervical cancer is a really slow growing and completely preventable disease for those being tested and treated,” echoed Ellen Eidem, M.S., acting director of the Office of Women’s Health in the Los Angeles Department of Health Services. “You can’t say that for breast cancer.”

“Pre-stage is nowhere near cancer,” Eidem said. “Women are dying so unnecessarily from this disease. For low-income people, we have places they can go for care. No one should have to die of cervical cancer. We have facilities where low-income women can be referred, and we have three people on staff who speak Vietnamese” among other languages.

What if Vietnamese Americans prefer or need to speak in their native tongue?

Both the Office of Women’s Health in Los Angeles and the OCAPICA help low-income women access affordable medical care and have staff members who speak the various languages spoken by the women with whom they deal, they said.

The OCAPICA’s staff promotes cervical cancer education through community groups and organizations, providing research information on the disease to women in Orange County and identifying resources where they can get access to screenings, she said.

“It all starts with education and in some cases we have patient navigators who interpret for and help (the women) get through doctor visits. They are bicultural and bilingual. They bridge the gap of knowledge and awareness of information and linking providers to patients,” Tr?n said.

“We go out to county sites and do presentations, we have written articles in various ethnic media and we do outreach to nail salon workers. They are women who not only are influenced, but they talk to other women,” adding that “people are definitely becoming more aware.”

Who needs to get a Pap test?

All women age 18 and older (or women under age 18 who are sexually active) should have a Pap test and pelvic examination once a year.

Where do I get a Pap test?

At your family doctor’s office, an obstetrician’s or gynecologist’s office, at clinics or hospitals.

How is a Pap test performed?

Before a Pap test is performed, the doctor will ask you about your medical history and menstrual pattern. The doctor will ask questions such as: At what age did you start menstruating? Are your menstrual periods regular? How long does your period usually last? How often do you have your period? Do you feel pain? When was the last time you had your period? The more information you give, the easier it is for the doctor to diagnose disease. Do not think, “This doctor is too curious; this is so embarrassing.” Please remember that this is the doctor’s daily work, and the doctor needs this information to understand your health status.

During the Pap test

First of all, you remove your clothes and put on a hospital gown. Then you lie down and put your feet up. The doctor examines the outside of the vagina for abnormalities. He/she then puts a small instrument shaped like a duck’s beak into the vagina to examine the cervix. The doctor gently takes a sample of cells from the cervix with a small brush, then puts this sample on a slide and sends it to a medical laboratory for analysis. Then the doctor does a pelvic examination to check for abnormalities of the uterus, fallopian tubes and ovaries. This is done by putting two fingers into your vagina and pressing on the lower stomach with the other hand. This may feel a little uncomfortable, but the doctor will do it very quickly and gently.

Pap test results

If the results of your Pap test are normal, then you don’t have cervical cancer. If your Pap test is normal, you should make an appointment to have another one done next year and remember to keep that appointment. If you have three years of normal results, your doctor may recommend less frequent screenings.

Abnormal results

If the results of your Pap test are abnormal, the doctor will let you know right away. An abnormal Pap test doesn’t necessarily mean that you have cervical cancer but may simply indicate that you have a viral or other infection. If your Pap test is abnormal due to infection, your doctor may treat the infection and then perform another Pap test. But if your abnormal Pap test isn’t due to infection, your doctor will examine your cervix and vagina by a technique called “colposcopy” and may remove a small sample of cells from the cervix (biopsy) for analysis. You should follow your doctor’s advice because such tests help the doctor to detect the disease early.

Who can get cervical cancer?

Any woman can develop cervical cancer, but the following factors increase the risk of getting cervical cancer: Having sexual intercourse before the age of 16; having many sexual partners, or having a sexual partner who has had many sexual partners; having genital human papilloma virus or other sexually transmitted disease; having sex with partners who have human papilloma virus or another sexually transmitted disease; having had an abnormal Pap test in the past; not having regular Pap tests; smoking cigarettes or being exposed to second-hand smoke. Vietnamese women are especially at risk because the incidence of cervical cancer in Vietnamese women in the United States is higher than in any other ethnic group.

What are the symptoms of cervical cancer?

At the beginning there may be no symptoms. Later, you may experience: Vaginal bleeding after intercourse; a menstrual period that lasts longer than usual or is heavier than usual; vaginal bleeding occurring between periods; vaginal bleeding (even scanty) after menopause; pains in the lower part of the abdomen (not related to your menstruation); white vaginal discharge.

It’s so expensive to see the doctor; how can I afford it?

If you have health insurance, it can help pay some costs. If you qualify for Medicaid, you may not have to pay for a visit to the doctor and a Pap test. For more information on Medicaid, call your nearest medical assistance office. If you are age 65 or older, Medicare helps pay for Pap tests, generally once every three years. For more information about Medicare coverage for Pap tests, call (800) 633-4227. Those who are low income or have no insurance can go to public hospitals or clinics for Pap tests and pay depending on their income.

Do those who are over age 50, those who are post-menopausal or those who rarely or never have sexual relations need to get Pap tests?

According to the medical studies, 80 percent of those who die from cervical cancer are age 50 or older. Therefore, the older you are, the more important it is for you to make sure to get regular Pap tests.

Do those who have had hysterectomies need to get Pap tests?

Women who have had hysterectomies, especially those who had them because of cancer, still may need to have regular Pap tests and should talk to their doctor.
 
Source: National Cancer Institute