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It's Time To Pay Attention To 'Below-The-Belt' Cancers

Kenyan women visit an outreach team from Marie Stopes, a reproductive health organization that can screen for and treat cervical cancer.

When an email arrived the other day promoting an "Interfaith Service Focused on Below the Belt Cancers," I was intrigued.

It turns out Thursday, June 18, is the start of the third "Globe-athon to End Women's Cancers," two days of events in New York City dedicated to making people more aware of the cancers that strike more than 1 million women a year and figuring out the best strategies for diagnosis and treatment.

Events include a service at the House of the Lord Church in Brooklyn, N.Y., (featuring a performance by the rock band N.E.D., or No Evidence of Disease) and a U.N. symposium to raise awareness of gynecological cancers, which include uterine, cervical, ovarian, vaginal and vulvar.

There's a particular emphasis on getting the message out in the developing world, where cervical cancer rates are on the rise.

To learn more, I spoke with Dr. Larry Maxwell, founder and executive director of the Globe-athon, a nonprofit dedicated to fighting gynecological cancers around the world, and a gynecological oncologist at Inova Fairfax Hospital in Virginia.

I was a bit surprised by the term "below the belt cancers." I've never heard that phrase before. It's referring to gynecological cancers, correct?

"Gynecological cancers" is a mouthful. "Below the belt cancers" provides a less intimidating way of conveying what we're focused on.

Cervical cancer is a big killer. How many cases are there each year?

Over half a million women each year get cervical cancer worldwide. About half of them are dying.

Why is cervical cancer a growing problem in parts of the developing world?

There's a lot of speculation. In sub-Saharan Africa, where rates of HIV and AIDS have been historically high, we now have control of [HIV/AIDS] through retroviral treatment of women.

But a lot of these women are now succumbing to the effects of AIDs-related diseases like cervical cancer. In parts of Asia — again this is speculative, we don't have strong epidemiological evidence — people speculate [that the reasons for the increase in cervical cancer] may be environmental effects, such as high rates of smoking and pollution.

But we need to not only try to understand what environmental influences may be affecting cancer rates but get out on the front end and do what we can to prevent cervical cancer through vaccine.

In the case of cervical cancer, a vaccine for human papillomavirus would presumably keep them safe.

I would say 90 percent of patients at risk for developing cervical cancer could have it prevented by the vaccine. Countries around the world are trying to roll out national vaccination programs. The age range in some countries is 11 to 13, in others 9 to 11.

Can older women be vaccinated?

You can give it to women until they're age 26, but preferably before age 21.

How many doses do you need?

Three. But there's data being presented tomorrow at the U.N. that indicates two may be enough. There's even data speculating that one may be enough. The reason this becomes such a hot issue in developing areas of the world is the economic impact of the difference between three vs. two or two vs. one.

Does the vaccination against human papillomavirus have any negative effects?

In the U.S. there've been over 70 million doses. Although there have been adverse effects reported among women receiving the vaccine over six months [after inoculation], there's not any data to date that show causal relationship between those adverse reported events and the vaccine.

If a woman is diagnosed with cervical cancer, what's the treatment?

If it's caught early, surgery is an option. If there's advanced disease, surgery is usually not performed. Chemotherapy with radiation is an option.

How often?

If it's advanced cervical cancer, chemo and radiation are given five days a week over five weeks.

That must be hard on the patient, especially if they live far from the treatment center.

In the developing world, it may be an hour and a half bus ride each way on a daily basis. That's logistically a nightmare. So compliance rates with even getting treatment are less than ideal.

You've traveled to different countries as part of your work with Globe-athon. What kind of reactions to cancer have you seen?

If women have symptoms suggestive of cancer — spotting blood, malodorous discharge — they say, "You know what, if I got cancer, I'm dead. I can't get to [a facility to] have treatment, my husband's going to kick me out of the house. I've got nothing to live for."

So I guess the stigma means they're not inclined to go in for exams and tests.

It really is going to take a lot of input from sociologists in addition to physicians to bring [cancer awareness] to the attention of health care providers, laypersons and policymakers.

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