By the time Victelia Guillen walked into a clinic last summer, the pain that had begun a year earlier flared through her body. Within days, she received grim news. Doctors at the Caridad Clinic, a facility west of Boynton Beach that serves low-income Hispanics, diagnosed Guillen, 52, with advanced cervical cancer.
Uninsured and wary of doctors, the Guatemalan mother of 10 had never before had a Pap smear -- a screening test that has drastically reduced cervical cancer rates in the United States over the past 50 years. Today, cervical cancer is highly curable if detected early. But women such as Guillen, who hesitate to seek help, represent a challenge for doctors combating a disease that affects Hispanics disproportionately and remains a leading cause of death among women in poor countries.
Hispanic women, about a third of whom are uninsured, have a higher incidence of cervical cancer than any other ethnic group, according to the National Cancer Institute. They have the second-highest rate of cervical cancer deaths, after black women.
Gardasil, a vaccine that the Food and Drug Administration approved in June, protects girls and women against strains of the sexually transmitted human papillomavirus, or HPV, that cause most cervical cancers. A federal advisory panel recommended Thursday that doctors routinely vaccinate 11- and-12-year-old girls. The panel also voted to include the vaccine in a federal vaccination program for uninsured children.
But poor access to health care, cultural taboos about sex and a widespread reluctance to go to the doctor remain steep obstacles in the fight against cervical cancer among Latinas.
"When I told my mother that I had cervical cancer, she started laughing," said Guillen, who remains ill despite months of chemotherapy. Her illness provoked disbelief and embarrassment among family members back home.
Guillen, of Lake Worth, Fla., had never been to a gynecologist, which she says is typical of women in Guatemala. She moved to the United States seven years ago, leaving behind her children, ages 10 to 30, in the maize-growing state of Huehuetenango.
When the pain first struck, she fought it with stoicism and prayer. Guillen had no insurance and saw no other choice. The pain worsened, led to vomiting and caused her to collapse at work.
Caridad Clinic physicians diagnosed her illness and arranged for her to receive free treatment. One of her sons moved to Lake Worth from Huehuetenango to help her cope.
"I never went to the doctor before this started, because I never felt there was anything wrong," Guillen said. "In Guatemala, only those with money get checkups. The rest of us don't do it."
Like Guillen, 35 percent of Hispanics in the United States lack insurance, compared with 11 percent of non-Hispanic whites.
"My own mother won't go to the doctor unless she's sick," said Hector Tarraza, chief of obstetrics and gynecology at Maine Medical Center in Portland and a board member of the Chicago-based Gynecological Cancer Foundation. "It's an accepted pattern. There isn't the concept of wellness checkups. Hispanics think of doctors as `There's a problem,'" said the Puerto Rican native.
The result, with an insidious disease such as cervical cancer, which shows no symptoms in its early stages, is that many women show up at the doctor's office when the cancer has spread and survival is uncertain. That reality is avoidable, experts say, in a country where cervical cancer is more than 90 percent curable if caught early.
Unsettling qualms about Pap tests also keep women away from gynecologists, experts say. "They feel it's a violation, and that's a big obstacle to obtaining a sample," said Joseph A. Lucci, head of the University of Miami's division of gynecological oncology.
To get around those hurdles, university researchers are developing a self-sampling device that would allow women to screen themselves at home. But the tampon-shaped device is limited as a cancer prevention tool, Lucci said, so the medical community needs to work harder at getting women into the doctor's office.
Peeling away the myths and fears is often half the battle.
"There's this whole taboo about having conversations about sex," said Ysabel Duron, the head and founder of Latinas Contra Cancer in California. "Young married women are being infected with HPV by their partners, but it'd be ungodly to have Latino men talk about extramarital affairs and the need to use condoms."
Ellen Feiler, health education director of the Broward County Health Department, said some Hispanic patients have husbands who prevent them from being screened or seeking treatment.
"I've had women tell me their partners don't want them to get medical exams." Feiler said. "When they get diagnosed with advanced cancer and need a hysterectomy, a husband will say `No way, you're not doing that,' because there's the perception that if a woman has a hysterectomy she can't have sex anymore."
Tal Abbady writes for the South Florida Sun-Sentinel.