Agnes Winarti , The Jakarta Post , Jakarta | Mon, 03/17/2008 12:07 PM
Fifty-year-old Prapti recalled the day decades ago when her friends had to bring her step-by-step to a gynecologist, but on the doctor's doorstep, she changed her mind and ran away.
For Prapti, fainting every month during her period was more bearable than facing a stranger examining her private parts.
Years later, when Prapti turned 35, she eventually went to a gynecologist and took a Pap test because the pain had outgrown her fear, and a tumor was found which forced Prapti to have her uterus removed.
"Back then, I thought it was shameful to have your private parts examined by a stranger. Now, I can say the shame is nothing compared to the health risks (of not getting tested)," said the former journalist, who will turn 50 this year.
Most educated women know the Pap smear is an affordable and simple method for early detection of cervical cancer, the second biggest killer of cancers among Indonesian women.
Many, however, remain reluctant to undergo regular Pap smear screening due to psychological blocks.
"Most women realize cervical cancer is deadly. They also know about Pap tests, but are they willing to take the test? That is another matter," an oncologist specializing in anatomy pathology at the Dharmais Cancer Hospital, Dr. Evelina Suzanna, told The Jakarta Post.
Dr. Evelina said women should take Pap tests two years after their first sexual contact at the very latest. Women who have had sexual contact involving penis penetration into the vagina should take the test, she said. Penetration of any other kind, for example fingers which had previously touched a penis, could also pose a risk.
A thirty-something mother of two, who requested anonymity, said she was totally aware of the dangers of cervical cancer.
"I also know my family history of cancer puts me at a higher risk. But for now I would rather ignore it -- I'm not ready for the results if I ever take the test."
"You know what? None of the female officials at the Health Ministry, responsible for the reproductive health campaign, have taken Pap tests," Dr Evelina said.
"Less than 2 percent of female doctors at Dharmais Hospital have ever come to me for a Pap test," the oncologist said.
Between 1993 and 2000, cervical cancer patients made up 13 to 15 percent of the total number of cancer patients at Dharmais Cancer Hospital, making it the number one cancer killing women in Indonesia. During that period, breast cancer came second with 11 percent.
Since 2001, cases of cervical cancer which result in deaths have declined and are now less common than breast cancer.
"However, the occurrences of cervical cancer have increased 15 to 20 percent among all cancers found in Indonesia," said Dr. Evelina, also the coordinator of the future National Cancer Data Center at Dharmais Cancer Hospital, West Jakarta.
A 2006 report from four main hospitals in Jakarta (Dharmais, Sumber Waras, Persahabatan and Pasar Rebo) reported that cervical cancer accounted for 15 percent of the total number of cancer cases (in both male and female patients), second to breast cancer which stood at 30 percent.
"Good education is no guarantee women are aware of cervical cancer. These women may have extensive knowledge in other fields, but many don't understand their own organs," Obstetric gynecology consultant Dr. Dwiana Ocviyanti (known as Dr. Ocvi) said Friday at the Annual National Cancer Symposium.
Data from one of the Indonesian Cancer Foundation (YKI)'s early detection clinics showed promising signs for Pap test's popularity.
"Around 45 percent of patients coming to get Pap tests done at our clinic each month are first timers," YKI's central clinic (Menteng) head, Dr. Utari, told the Post on Monday.
The clinic receives some 400 patients for pap smear screening each month.
Pap tests are currently available in all hospitals, most clinics and eight public health centers (Puskesmas) in the city. The tests cost between Rp 35,000 and Rp 150,000 depending on the location and doctor.
Pap tests are still the most affordable way to deal with cervical cancer.
There is a new HPV vaccine, approved by the U.S. Food and Drug Administration in June 2006. The vaccine is still costly, however, selling for between Rp 900,000 and Rp 1 million each shot. A patient needs three shots to complete the vaccination.
Dr. Ocvi said "Screening is still important. Vaccines do not negate screening. Ideally, women should have both."