Preventing Cervical Cancer in Nicaragua

“Preventing cervical cancer in Nicaragua. Can vaccines and screens be means of solidarity?”

Speaker: Kaye Edwards, Associate Professor, Haverford College
Host: Jake Metcalf

Kaye Edwards will talk about why cervical cancer, which is largely preventable, remains the most common cancer among women in impoverished countries like Nicaragua. Her talk will cover the natural history of this disease to highlight potential points of intervention; the social, political and economic factors that help explain why cervical cancer mortality rates are up to 12-times higher in some countries than in the United States; and the larger issue of the need for community engagement in discussions about how to prevent and treat diseases.

A member of Haverford’s faculty since 1986, Edwards received her Ph.D. from the University of Colorado in molecular, cellular, and developmental biology and did post-doctoral research in tropical parasitology in Boston. She currently teaches courses that explore various facets of social justice, including how they are embodied in the health of communities and how they are informed by Quaker faith and practice.  She is the coordinator of Haverford's new interdisciplinary minor in Health Studies and currently serves as the faculty director of Haverford's Quaker Affairs Office. Edwards was Director of the Center for Peace and Global Citizenship from 2003-2006 and is the founder of Haverford House, CPGC’s post-baccalaureate community-action program in Philadelphia.  She is a convinced Friend and a member of Radnor Monthly Meeting; she serves on the Board of ProNica, a Quaker organization working in solidarity with community groups in Nicaragua, and on the Corporation of Haverford College.

May 28, 2014 | Engineering 2 Room 599

Kaye Edwards, "Preventing Cervical Cancer in Nicaragua: Can vaccines and screens be means of solidarity?"
SJWG Rapporteur Report
23 April 2014
Rapporteur Report by Lizzy Hare
Haverford University Professor Kaye Edwards spoke to the Working Group about her
efforts to reduce the mortality rate of cervical cancer in Nicaragua. Edwards was originally
trained in developmental biology in the same lab as Susan Strome (Professor of Molecular,
Cellular and Developmental Biology at UCSC) at University of Colorado, Boulder. As she
progressed in her academic career, Edwards became increasingly interested in pursuing her
interests in health and social justice. While many advancements in basic research promise to
eventually advance medical treatment, there is often less attention given to how those treatments
will be taken up in the world, and whether or not they will be available and feasible for those in
need. Edwards has been working with local groups to prevent, detect, and treat cervical cancer,
which has a very high mortality rate in Nicaragua.

Cervical cancer has a very strong link to Human papillomavirus (HPV), but as Edwards
explained, there are many other biosocial risk factors that play a role in determining who will
ultimately develop cancer. Many now believe that cervical cancer is best prevented through
vaccines, but this must happen before women (and increasingly, men as well) are sexually active.
Secondary prevention requires the identification and elimination of pre-cancerous legions. In
wealthier nations, this is often done with pap smears and extraction with LEEP, but these
techniques require multiple office visits and trained physicians. See-and-treat with acetic acid
(vinegar) and cryotherapy is a low cost option that requires only one office visit and less
equipment. Tertiary prevention of cervical cancer mortality includes surgical ablation,
radiotherapy, and/or chemotherapy, which is inaccessible to most women in Nicaragua. This
model of preventing, detecting, and treating cervical cancer is effective, but it is also highly
individualistic.

Rather than looking only at the individual, Edwards reminds us that we need to consider
an eco-social model of health that takes into consideration the relationships, community and
society that each woman is a part of. When Edwards first went to Nicaragua, she met Maria
Elena Bonilla, the founder and director of Centro de Mujeres Acahualinca, a clinic that started
with grassroots efforts in a low-income neighborhood of Managua. During that visit, Edwards
learned that the men in the community had not been particularly concerned with women’s
mortality rates. It made her realize that even community-led projects might silence a number of
voices. When she returned to the US, she tried to help them gain access to free-of-cost vaccines
for HPV, but encountered multiple roadblocks. She learned, yet again, that there are a number of
structural hurdles in place.

Edwards realized that the grassroots level of organization is useful for understanding
what the community wants and needs, as well as cultivating trust and respect. At the same time,
grassroots clinics struggle to gain access to adequate funding, space, training, pharmaceutical
supplies and technology. Instead of taking a charity approach to assisting grassroots efforts, she
advocates solidarity. For Edwards, being in solidarity means working with these women for a
common goal, rather than simply trying to help. With her final slide, Edwards asked the working
group “What could you do with your talents, expertise, skill sets, professional and personal
networks, and capacity to learn, to prevent premature suffering and undue deaths?”
The first questions after the break were about the efficacy of the vaccine and how it might
be distributed more effectively. While there are several suggestions for how it might be
administered to more young women, Edwards reminds us that because cervical cancer is such a
slowly progressing disease, and because the HPV vaccine could only prevent approximately 70%
of incidences of cervical cancer, there still needs to be a commitment to detection and treatment
of precancerous lesions and cancer. There are also a number of social factors that need to be
mitigated, such as stress-induced immunosuppression and early sexual activity. Vaccination
could have a tremendous impact, but it needs to be incorporated in a broader program of care and
education.

Luz asked if there might be other factors that are causing the extraordinarily high
mortality rate for cervical cancers in Nicaragua. Edwards reiterated that HPV is a necessary but
not sufficient factor for cervical cancer. She had already mentioned several social factors that
play a large role, such as early pregnancies and poor nutrition, among others, but there might be
environmental factors as well, such as pesticides. Part of the challenge of fighting cervical
cancer in Nicaragua is that there are very limited databases for tracking this kind of information.
Jenny mentioned that this touches on one of the issues that Science & Justice has been
discussing this year. If cancer is thought of as being caused by a virus, then it is a single-cause
illness that can have a single cure. Also, if a virus causes it, it is possible to ignore complicated
environmental or social factors. Edwards agreed, and added that most health initiatives take the
nation-state as the unit of analysis, which ends up obscuring other factors that regions might
share. This has tremendous implications for determining responsibility. If cancer is seen as an
infectious disease, then it is an issue belonging to the individual, to that women’s reproductive
health, rather than an issue mired in complex environmental and biosocial factors. With this, a
student from Strome’s lab spoke up, pointing out that she and her colleagues focus on the virus
because they are trained in molecular biology, not social science or politics. Edwards agreed that
the molecular biologists should be focusing on the virus, because that is the best use of their
training, but that they should have more opportunities to share that expertise with others working
in fields that might also be important for treating a complex issue like cervical cancer mortality.
It is exactly that kind of broad-based knowledge and openness to collaboration that Edwards has
been working to cultivate in her students at Haverford.