January was Cervical Health Awareness Month

Dr. Arlene Calvo has been on the front lines of cervical cancer research in Panama for well more than a decade. A research assistant professor in the Department of Community and Family Health for USF Health-Panama, she began conducting cervical cancer research in that Central American nation while working on her doctoral dissertation in 2002.

 

Specifically, her ongoing research, which has morphed into numerous related studies, is anchored in social aspects that affect cancer screening among Panamanian women.

“There’s a very high prevalence of HPV in Panama,” Calvo said. “Over 56 percent of women are infected, and we’re seeing it more among younger populations. There are some pockets where it’s as high as 70 percent.”

According to estimates published by the Centers for Disease Control and Prevention, that figure is more than twice the U.S. prevalence, although the CDC cautions that the rate of new infections is on the rise. It also notes that fully half of new infections are in 15- to 19-year-olds, so the fact that teens are bearing the brunt of the increase evidently reaches far beyond Panama.

Calvo’s initial study led directly to an NIH grant for a quantitative study in San Miguelito, an urban city and district in the Panama City metropolitan area between Panama City and Colon in the province of Panama. The prevalence of human papillomavirus, or HPV, in San Miguelito is believed to be higher than anywhere else in Panama.

“We did a door-to-door survey,” Calvo said. “This is a very rough neighborhood, what we call in Spanish a zona roja, a red zone. We did 600 surveys among men and women regarding screening, behavior and vaccination.”

Panama, Calvo said, was the first Latin American nation to implement the HPV vaccine in its immunization program, making the vaccine available through the Ministry of Health free of charge to girls beginning at age 10.

“So, in the Ministry of Health school program, the nurses go into the schools and vaccinate the girls,” Calvo said.

The vaccine of choice heretofore has been Cervarix, she said, but the program is transitioning into Gardasil under the recommendation that it is more effective.

Vaccinating boys also is encouraged, Calvo said, but resource limitations have kept it from being added to the free national program, so boys’ vaccinations have to be paid for, presumably by their parents. In a zona roja like San Miguelito, things like vaccinations are luxuries that few can afford.

“So, strategically, they identified the work with girls,” Calvo said, “in theory before they begin sexual activity, and that way they are guarded against these types of HPV that are known to cause cervical cancer.

“With our study, there are several things that we have identified through the years in the different projects that we’ve been involved in related to HPV and cervical cancer,” she said. “One is importance of other female relations sharing information. So, from mothers, sisters, neighbors and co-workers, women get information related to cervical cancer.

“Another one is how we associate in literature among Latinas. Fear is something that we often see – fear of what’s going to happen, fear of test results, fear of death, fear of being sick, even fear of treatment. Some women don’t get tested because of that fear.”

A focus group in one of the studies revealed the power of that fear in several women who had never been tested, some of them after having had up to six children apiece. One woman, Calvo said, had been tested once. The result was labeled “irregular,” and accordingly, the woman was referred to the Oncology Institute.

“She didn’t go,” Calvo said, “because she was scared that she might have cancer, and she didn’t want to die. When we asked her when that had happened, she said it was over nine years ago. And she has continued to have babies.”

Calvo’s research endeavors have related variously to rural, semirural and inner-city populations within Panama, and she said there is much more to be done, much of it involving the preventive measure of simply informing a public that still needs to be informed.

“There’s not a lot of information out on HPV even though it’s so highly prevalent,” she said, “so that’s something that we need to work on – trying to get the word out and maybe doing more strategic health information campaigns targeting certain groups.”

Some of Calvo’s latest work with indigenous populations, a “train-the-trainers” project with health promoters, recently found its way onto a short documentary video. The Ngöbe-Buglé (en-OH-bay-boo-GLAY) is the largest indigenous group in Panama, with a population of more than 280,000, Calvo said.

“Years ago, I was collaborating with the Gorgas Memorial Institute. We started going to this community and just fell in love with it. That was 10 years ago,” she said. “The place is beautiful, the people are beautiful and very welcoming. They’re not used to having their voice heard, so giving them the opportunity to share their experiences with us was new to them. We did a lot of focus groups and interviews, and they liked that. So, we’ve developed a relationship with the community.”

That relationship, like the many others she has cultivated through her years of research, is based firmly in the social aspects, the human realities, of the health of Panamanian women, and likely will keep her on their front lines for many years to come.

Story by David Brothers, College of Public Health.