Fighting Cervical Cancer in Cuba

Screening is widely available, although mistakes still happen.

Cuba offers cervical cancer screenings to all women over the age of 25, and statistics from recent years suggest the survival rates are good. Some say, however, that inefficiency and staff shortages can lead to misdiagnosis.

In June 2014, 30-year-old Ana González was horrified when she was told she had cervical intraepithelial neoplasia (CIN) grade three, an abnormal pre-cancerous growth on the cervix.

"My world collapsed," she said.

However, after further tests including another cervical smear, doctors realised that the original results were not hers.

At the other end of the spectrum, 26-year-old Rosa Gutiérez received a false negative from her screening.

"I had the bad experience of receiving the wrong result…. I tested negative [for cancer] when in reality everything was going wrong," she said.

Gutiérez later realised something was badly wrong after she began experiencing severe pain in the lower abdomen.

"I decided to take some tests which diagnosed me with CIN one, and an infection that would make me sterile if it wasn't treated in time," she said.

Yamila Martínez, 42, is a technician at the Ángel Arturo Aballí maternal hospital. She believes that misdiagnoses are due to staff shortages resulting from the government policy of sending medical missions abroad.

Foreign minister Bruno Eduardo Rodríguez Parrilla has said that more than 50,000 Cuban doctors are on international missions to 67 countries around the world.

Cervical screenings are offered at all Cuba's polyclinics and hospitals, with results taking up to three months. But Martinez said that although her hospital had 20 technicians, "12 have left on missions, and we don't have enough staff to keep all the results up to date."

She said staff were overstretched and stressed out by their own financial difficulties.

"In a polyclinic, you work eight hours a day Monday to Friday and in a hospital, 24 hour [shifts]," Martínez said, adding that medical staff "live their daily lives worrying about when they'll be lucky enough to go on a mission so as to guarantee a better standard of living for their families."

According to the Granma newspaper, nurses and technicians receive a monthly salary of 940 pesos (35 US dollars) while a specialist can earn up to 1,460 pesos. On international assignments, they earn much more.

In a story published last year by Martí Noticias, a diaspora Cuban broadcaster, a medic based in Miami said a Cuban doctor sent to Brazil could expect to be paid 1,000 dollars a month. This was divided into 400 dollars for subsistence in Brazil, and the remainder deposited in a bank back home awaiting their return.

However, despite concerns about screening services, other interviewees reported positive experience.

"Thanks to the cervical screening test, I got medical attention before it got worse," said Blanca Ortiz, a 40-year-old resident of the 10 de Octubre neighbourhood in Havana. "Now I'm recovering from an operation… the doctors say I won't need radiation."

Tatiana Álvarez, 51, was similarly pleased with her treatment.

"After receiving a positive result for CIN two, the follow-up by the specialists was great. Now I am scheduled for an operation in ten days," she said.

In 2012, cancer became the second leading cause of death in Cuba after cardiovascular disease. And according to a February article in Granma, the Communist Party's official newspaper, cervical cancer has become the fourth commonest type of the disease since 1995.

The Pan-American Health Organisation reported that Cuba recorded 9,368 female deaths from cancer in 2010. Of that number, five per cent were due to cervical cancer.

However, the official website Cubadebate quoted the British medical journal The Lancet as saying that the survival rate for cervical cancer rose between 2005 and 2009. Over that period, the percentage of women free of cervical cancer five years after diagnosis was over 60 per cent, a figure comparable to those in developed countries.

María del C. Quintana Hechavarría is a freelance reporter in Cuba.