I congratulate Inner Wheel Clubs of the Philippines Inc. for your great stride in coming up with projects that help save women from Cervical Cancer. The project that started 2 years ago, now in its third year, has now included through your hard work and dedication – TREATMENT, through the MEDICAL ASSISTANCE TO INDIGENT PROGRAM, or the MAIP Program through the kind Congressman Tony Golez. Congratulations po sa inyong lahat.
But this is TREATMENT. Prevention (HPV vaccination and Cervical screening) will always be better than CURE. Statistically, 1 in every 2 patients diagnosed with Cervical Cancer will not live in the next 5 years despite being given the treatment. Treatment cost depends on the stage of the disease but on average – about 200K to 300K each. With a budget (MAIP) of 2M, roughly only ten patients can be covered if you were to allot the fullest amount; or should you appropriate only a small portion of the MAIP funds to multiple patients, then the assurance of patients completing the full treatment is uncertain, and eventually, most will succumb due to incomplete and time-bound treatment. “Time-bound means sa cervical cancer is dapat mai-deliver yung buong treatment within 2 to 3 months after biopsy. Every day that passes after 2 to 3 months, the tumor will be resistant to treatment. Your role here is to decide how much to allot per patient is an emotional task. I bid you well.
For me, prevention will always carry a better stand. I would like to thank the Inner Wheel Club of Makati for donating 40 HPV 4 vaccinations to private schools. What we do is to provide HPV awareness lectures to private schools ( as hindi naman kasali and private schools sa libreng papabakuna ng gobyerno) and at the end of the day, we release flyers and posters from MSD, and secure consent. We will then vaccinate those who show up a consent weeks after.
Presently, I am an independent contractor to an international group LIVETOGIVEUFOUNDATION in the US along with the Rotary Club of South San Francisco California. They plan to provide 1000 individuals next year. Dr Jasmin and I will be talking to the country president of MSD – Mr Andreas Riedel about access to reduced HPV prices. I’ve shared this with you in the hope you would find it interesting and to join us at the table with Mr Andreas.
Cervical Cancer Screening is co-equally important in the prevention of cervical cancer. The goal of screening is the very early detection of cervical precancer – a stage which is NOT yet cancer, a stage which does not provide you symptoms so you won’t go to a doctor, but if not treated, will progress to cervical cancer in 5 to 10 years. The cost of treatment for cervical precancer is free using thermal ablation provided the patient, the doctor, and the hospital na gagawa has philhealth, compared to 200 to 300K for cervical cancer.
I have heard comments that the cost of Php 600 pesos for cervical cancer screening is mahal, or pricey. But price is subjective. What value it brings may justify the price.
HPV-DNA (the one that is being handled by JHPIEGO, Dr. Ingrid Magnata, Dr. Cecillia Llave, and the SUCCESS Program), is the best. Currently, the SUCCESS group is undergoing study, hence it is currently given free. Once it is approved, the cost of HPV DNA is 5,600 tests only. Even if it is the best test in the world, the cost limits availability to everyone. We need to find alternative solutions especially those in the provinces where there are no doctors. Privately it is available at Hi-Precision around 6 to 7K per patient. Once you are found to be positive. you will still need to undergo COLPOSCOPY. This guides the doctor on what part of the cervix needs treatment. The procedure of COLPOSCOPY is done in a similar fashion as when we conducted our screening using our device – CERVIRAY AI.
One problem of HPV DNA aside from the cost is patient compliance. Step 1 ipagawa mo, Step 2 babalikan ang resulta then if positibo – ischedule mo for colpsocopy Step 3. The colposcopy daw plus other diagnostic or treatment. Patient compliance will always be an issue.
For Pap smear, not much has changed. Magkasing tulad lang ito with Visual Inspection with Acetic Acid. Both are subjective tests. Subjective kasi sa Pap smear it is a pathologist who reads on it whereas sa VIA, it could be a doctor, or it could be a midwife or nurse.
Ang problem with Pap smear is the collection from the stick transferred to the slide. You can use liquid-based cytology, but still collection and detection of cervical cancer cells can still be an issue. However, kapag may nakitang precancerous cells ang pathologist, then reliably, tumpak si Pap. This is why a Pap is said to be of higher specificity.
VIA on the other hand has higher sensitivity but low specificity. Magkabaligtad sila ni Pap smear. The value of VIA is also dependent on the operator. While a Pap smear is read by a doctor, VIA can be read, and evaluated by a midwife. I’m not saying the examination will be inferior if a midwife does it but let us also look into the technicalities.
Using the naked eye to visualize the precancerous lesion, could you really see the cervix and assess the lesion visually? How can you refer what you saw to their medical center what documentation tool could you provide them? Ang ginagawa po sa province is they draw what they see.
Again, if you see positive patients, they will still need to undergo colposcopy and then the treatment. Again patient compliance will always be an issue.