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At Large
A ‘two-pronged’ attack

By Rina Jimenez-David
Philippine Daily Inquirer
First Posted 21:49:00 05/16/2011

Filed Under: Medicines, Research, Health treatment

In fight against cervical cancer, there are two primary modes of ?attack?: vaccination and screening.

With the development and marketing of the HPV vaccine, it is now possible to protect women and men from the viruses that have been found to cause majority of cervical cancer cases as well as from HPVs that cause genital warts. The vaccine is generally thought to provide lifetime protection, although because it is just about 10 years old, more long-term studies need to be conducted to determine how effective it will be over the course of a lifetime.

But a big problem with the vaccine is that it is expensive, at least as compared with vaccines for other diseases. That puts the vaccine out of reach, for now, for majority of men and women at risk, especially in ?low resource? settings.

Screening, on the other hand, tests for pre-cancerous lesions in the cervix that may develop into cancer. The ?gold standard? in screening is still the pap smear, in which a clinician takes a sample of cells from the cervix and, under microscopic examination, determines if the patient needs further treatment. Another test, known as VIA or visual inspection using acetic acid, relies on a visual check of the cervix, since any lesions would turn whiter than the surrounding area when swabbed with acetic acid. Another method is screening to test for the presence of the DNA of cancer-causing viruses.

VIA is currently the method of choice in public health settings since it is relatively inexpensive and doesn?t require medical training. But it can also lead to ?false positives? and, if paired with cryotherapy (freezing suspicious-looking tissue) in the single visit approach, could lead to overtreatment. But because pap smears are more costly and entail some delay due to lab work, it doesn?t seem practicable if health authorities want to reach the large population of women at risk.

* * *

DURING THE ?Catching Cancer? forum on cervical cancer prevention and control held recently, Dr. Honorata Catibog of the DOH National Center for Disease Prevention and Control said they are being more ?realistic? by putting greater focus on screening (through VIA) as the means of reaching vulnerable women.

But she added that greater coordination and cooperation with local governments are necessary to bring screening down to the local level, to reach as many women as possible. Currently, screening campaigns have been able to reach only a limited circle of women at risk.

Catibog, however, had a piece of good news. In view of efforts to ?improve access to drugs? of poor people, the DOH has allocated P50 million on a pilot test that would provide the HPV vaccines for free to public school students age 13 and above. Even then, it would still be necessary to use both screening and the vaccine in the fight to eradicate cervical cancer.

* * *

IN 1986, on the occasion of the first visit to the United States of President Cory Aquino, the American Embassy sent 10 Filipino journalists on Fulbright scholarships not just to cover the President?s triumphant visit but also to get a taste of media coverage of US elections as the visit would coincide with the mid-term polls.

The group was composed of five men and five women. Of the five women, there were myself (then with Veritas newsmagazine), Ellen Tordesillas of Malaya, Cristina Pastor, Vina Paredes, and Chit Estella. I can only remember three of the men: Jess Diaz, Marlen Ronquillo and Ding Marcelo of the Bulletin.

Some of the photos from that visit were shown during the memorial service organized by media colleagues of Chit last Sunday. Ellen and I couldn?t help marvelling at how young we all looked, and how many pounds lighter we were.

I was also wistful at the thought that the trip to Washington, D.C. and then to several other American cities was the last time Chit and I had any sort of extended contact. We would meet from time to time, usually on media-related events, but eventually we lost touch. I was even quite surprised when Yvonne Chua, who with Ellen and other journalists had founded the investigative web site Vera Files, told me that Chit in fact had worked for a few months on the news desk of the Inquirer.

But friends and colleagues who worked much more closely with Chit confirmed my clearest memories of her. ?Walang drama sa buhay (No drama in her life)? was the consensus, with most everyone agreeing that while she might have kept secrets or harbored passions, she wasn?t one to dwell on them or display them. She kept a calm, placid exterior, but she gave rare glimpses of her steely will. It was clear that on issues she deeply cared for, Chit could be stern and unyielding.

* * *

THE MANNER of her death also underlined how random life could be. That one could be on one?s way to a dinner with old friends and meet one?s untimely end by way of a wayward bus brings home the arbitrary nature of our existence.

But far from making us question the meaning of life?if it has any meaning at all?so sudden a passing as Chit?s convinces us instead that we must all lead lives of meaning and consequence. That never knowing when it?s our time should make us ready to go anytime, all debts settled, apologies uttered, errors corrected, loved ones assured that they will not be forgotten.

Friends say that some years back, Chit had decided that teaching journalism students in UP would be her main line of work, and judging from the reactions of her students and the accolades paid her, she did a pretty good job of shaping the next generation. This then is how Chit will be remembered: as a principled journalist who refused to compromise her standards and sought to instill those very same values and skills in those who would follow in her footsteps.

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