When Adriana
*
was 15 years old, she told her mother that she wanted to go to the gynecologist.
She had heard stories about women with problems in the ovaries, breasts, in the uterus, and she knew that both of her grandmothers had cancer: she was afraid.
“Have you had sex yet?
What do you want to go for?” Her mother replied.
She did not know how to seek help, she said in an interview with Noticias Telemundo.
"I wanted to be sure that I had nothing," she recalled, "but it's like a taboo: you can't talk about wanting to go to the gynecologist without being related to doing something wrong."
Now that almost a decade has passed, the young immigrant, a native of El Salvador, is 26 years old, has studied Political Science and has been living in Florida for years.
But she has never gone to a gynecological exam in the country, first because of the lack of health insurance and then because she did not have good options in the coverage that she was able to get or the time at work to go to the control.
Her last exam of this type was done in El Salvador, where she spent time in 2018.
If you don't go to the doctor regularly, the cancer can start today but you don't find out until years have passed."
Alejandra Soto Planned parenthood
Adriana has faced the barriers that usually prevent Latinos from accessing medical care for sexual reproduction issues in the United States and thus detecting a disease early.
This is particularly concerning, given that Hispanic women are 40% more likely to be diagnosed with cervical cancer and
30% more likely to die
from the disease compared to non-Hispanic white women, according to a review of 2014-2018 national statistics from the National Cancer Institute.
The Sea Mar Burien Clinic offers breast and cervical cancer screenings at a special event for women's health and wellness in Burien, Wash. Suzi Pratt / Getty Images for Hologic
More than half of the women who are diagnosed with cervical or cervical cancer in the country
have not had a routine gynecological exam
in the last five years or in their entire lives
, says Alejandra Soto, director of Communications for Planned Parenthood , an organization that provides reproductive health services throughout the country.
We consulted specialists from various organizations and doctors, as well as activists who work on the ground in access to reproductive sexual health, and these are five keys with their recommendations.
Let's talk about sex and going to the doctor's office.
Early detection greatly prevents the possibility of dying from cervical cancer.
But young women are afraid to get a gynecological check-up, they warn, in part because of the taboo of talking about sexuality.
PAP, HPV and other terms to learn.
The first preventive measure is to make regular visits to the gynecologist because there you can do Pap tests or vaginal cytology (PAP) and detection of human papillomavirus (HPV), which help prevent and detect the disease.
Shots as early as age 11
.
Families have an option to protect their children from adolescence with the vaccine against HPV and its associated cancers.
It was approved in the US in 2006.
A disease that progresses silently.
Controls should be done even if there are no symptoms.
"It advances without one realizing it," say specialists.
Many women do not go to the doctor, moreover, because they do not have time: they take care of everyone, but not themselves.
It's a right, and in your language: where to look for help.
Latinas face other fears.
"We want them to know that they have the right," says one activist, "to medical attention, to a medical interpreter and to decide what information about their immigration status they want to share."
1. Let's talk about sex and going to the doctor's office
"There is fear in young women to go to consultations, to seek contraceptives," Lucia Guerra-Reyes, associate professor at the Indiana University Bloomington School of Public Health, told Noticias Telemundo.
She has interviewed Latinas for her research on sexual and reproductive health access in the Midwest, and has seen that they face multiple barriers to accessing services.
This is the case of
taboos, which can completely stop
access to reliable and necessary consultation and information.
Many young Latinas "do not receive any sexual education in their families," says the researcher, "their mothers do not talk to them about issues such as sex, except to tell them not to do it.
This is compounded in states like Indiana, in which she, she points out,
"public sex education is abstinence
. "
A recent study by researchers at the University of Texas indicates that cervical cancer screening rates have declined in recent years for all groups, but most among Hispanics and Asians, as well as those living in rural areas, do not have health insurance, or identify as LGBTQ+.
In 2015, 14.4% of those consulted did not have an updated check-up;
in 2019, it was 23%, according to analyzed data from the National Health Information Survey (NHIS).
Of the Latinas surveyed, nearly
65%
said they did not take a test
due to ignorance
.
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Misinformation and taboos do not end there.
Many women of all ages do not go to the doctor because they feel embarrassed by what happens to their bodies, such as
"a change in vaginal fluids
- changes in smell, texture or quantity," says Guerra-Reyes, and those they can be signs of cervical cancer as well as an infection.
Families can find reliable online information in Spanish about cancer, its prevention and sexual health, as well as guides on how to talk about sexuality, in organizations and institutions such as the American Cancer Society (ACS) and the Centers for Disease Prevention and Control (CDC) and Planned Parenthood.
2. PAP, HPV and other terms to learn
The first preventive measure is to make regular gynecological visits because there you can do Pap tests or vaginal cytology (PAP) and detection of the human papilloma virus (HPV, in English), which help prevent cancer or detect it in order to treat it on time.
Women should start their Pap tests at age 21, experts say, and repeat them every three years, though this can vary by age and level of risk.
People between the ages of 25 and 65 should also get an HPV test every 5 years, according to guidelines from the American Cancer Society.
This latest study is requested because cervical cancer "is almost always the result of an HPV virus infection, which can be transmitted by contact and sexual intercourse," explains Dr. John P. Diaz in an interview with Noticias Telemundo. , Chief of Gynecologic Oncology, Miami Cancer Institute.
It is a very common virus: more than 80% of people living in the US, regardless of gender, will have it at some point in their lives.
But when it can't be cleared by the immune system in women, he explains, it can lead to a cancerous lesion.
"You can do everything."
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Pap tests can be done for free or at low cost through the National Breast and Cervical Cancer Early Detection Program.
There is an online search engine to find a local help center.
Planned Parenthood also offers reproductive health services across the country.
Another option is to check with local community health clinics and state health departments.
Doctors stress that an abnormal pap smear does not mean a person has cancer, but only allows them to start investigating if something is going on.
3. Shots as early as age 11
Families have an option to protect their children as early as adolescence: the vaccine against HPV and its associated cancers, which was approved in the US in 2006. "We already have more than 15 years of experience with this vaccine, and we know it works and that the risks are minimal,” says Dr. Diaz of the Miami Cancer Institute.
The vaccine has been shown to be very effective in preventing both infection and the development of cervical carcinoma.
It is recommended from 11 to 12 years of age, since people can start their sexual activity at different ages.
Its protection lasts more than 10 years and booster doses are available.
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Diaz explains that there are many cancers that are associated with having had an infection with this virus, so "the vaccine can protect women and men."
They are also offered to people after adolescence, typically up to age 26.
About 36,000 women die each year in the country from cervical cancer, which is the deadliest for this gender.
But a similar number of people also die from anal and throat cancers that are also related to the HPV virus.
4. A disease that can progress silently
An important point is to do the controls, whether there are symptoms or not, since early detection of cervical cancer substantially reduces the possibility of dying from this disease, and because there may be no signs.
"Cervical cancer
is a disease that progresses without one realizing it
: you can have lesions and not have any symptoms or have some that are not so complicated," explains Guerra-Reyes from Indiana University Bloomington.
Diaz also emphasizes not waiting until there is a symptom to do a check: "If women wait for some abnormal bleeding or some abnormal flow, many times that can be an indication of a cancer that may be a little more advanced."
Many women also postpone visiting and taking care of their health because they have dependent families.
“
They are taking care of everyone but they are not taking the time to take care of themselves
,” says Diaz.
The risk for them is very high.
“When we give a woman a diagnosis of uterine cancer, she often says, 'Doctor, I haven't seen a gynecologist in five years because I haven't had the opportunity or the time,' ' she says.
5.
It is a right, and in your language: where to seek help
Latinas face multiple other fears when going to the doctor: if it will affect their immigration status, if they will be able to make themselves understood (because of language or culture) or if they will be treated well, as well as shame and stigma due to religious beliefs, indicate specialists.
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“There is a historical pattern in which our communities have been denied access to health care in general, and in which they have lived through traumatic experiences at the hands of unethical doctors and have even survived forced sterilization,” he says. LuzHilda Campos, co-director of policy for the organization Bold Futures, which works with women and people of color in New Mexico.
Immigrant Latinas are the most unprotected when it comes to seeking help on sexual health issues as they often have difficulty accessing health insurance or services in their native language.Damian Dovarganes / AP
Not knowing where to access reproductive health care and not having insurance or qualifying for discounts, all too common in the Latino community, makes prevention even more difficult.
Then time is needed.
"Some don't have the opportunity to take the exams because they have to work and they don't have days," Paula Saldaña, field coordinator for the National Latina Institute for Reproductive Justice in South Texas, told Noticias Telemundo.
Adriana, the young Salvadoran, has lived it for years.
When she arrived in the United States, she tried to get health insurance to go to the gynecologist.
"They were too expensive, they didn't give me the bills," she says.
Now, he has a new job and coverage, but getting to see a doctor is still an odyssey: "They only make appointments during working hours and unfortunately at work they don't give me vacation or sick days."
The National Coalition for Sexual Health (NCSH), in partnership with other groups, has a free, easy-to-use bilingual guide and website called Take Control of Your Sexual Health.
But experts and activists encourage seeking organizations and resources at the local level as well.
"We want people to know their rights," says Campos, who works in campaigns for access to health, "that they have the right
to medical attention, to an
authorized medical interpreter and
to decide what information
about their immigration status they want to share." .
Other factors: tobacco, multiple pregnancies and contraceptives
Although HPV is a major risk factor, there are others, the American Cancer Society reports, such as not eating a healthy diet with fruits and vegetables and smoking.
"When someone smokes, both the smoker and the people around him are exposed to many carcinogenic chemicals that affect other organs, in addition to the lungs," explains the institution.
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It also increases the risk of having a weak or compromised immune system and having an infection with chlamydia (which is sexually transmitted, often has no symptoms, and can also cause infertility).
There is also evidence that the use of oral contraceptives (birth control pills) for long periods of time increases the risk of cervical cancer.
Having had three or more full-term pregnancies and having had a first child at age 20 or younger, among other factors, can also increase the probability.
*The identity and real name of the young Salvadoran woman is not included in this report to protect her privacy.