Bible Study

Added: 2026-05-04

[00:00:00]Oh ye that the Lord, he is God.

[00:00:04]It is he that has made us and not we ourselves.

[00:00:11]We're his people and the sheep of his pasture.

[00:00:18]As Christians, uh sometimes we strive so hard to make changes in our lives.

[00:00:27]We're trying to fix this.

[00:00:30]We're trying to fix that.

[00:00:33]We're trying to be more of who we are not.

[00:00:39]We're trying to improve here and it goes on and on.

[00:00:46]But if we're trying to be a self-made person, to do it all on our own, we're not going to make it. We're going to struggle.

[00:01:00]Why am I still dealing with this?

[00:01:03]Why can't I get it together?

[00:01:06]If I just try harder.

[00:01:08]Why me?

[00:01:10]We're in a constant battle with ourselves.

[00:01:16]This causes us at times to be so hard on ourselves.

[00:01:22]We start feeling deflated, feeling like we're not enough.

[00:01:28]And sometimes we even start to wonder if God has forgotten us.

[00:01:36]But we as Christians, we have to be very careful not to allow these feelings to overcome us.

[00:01:44]This is the plan of the enemy.

[00:01:48]He'd love for us to stay feeling like we don't measure up.

[00:01:52]We don't deserve to be blessed. We're not loved by our father.

[00:02:00]These are some of the lies that he sets on our minds.

[00:02:07]But when these things happen, we must be aware that the enemy's trying to set up us set us up against ourselves.

[00:02:19]His intention is to limit our growth in Christ Jesus and to keep us from his plans for us.

[00:02:29]Rather than trying to fight the battle on our own, we need to let go and let God do his thing.

[00:02:37]He's our maker.

[00:02:39]We already belong to him.

[00:02:42]He has accepted and approved us as his children.

[00:02:48]And when we know that he's in control of the process of change, it takes away the pressure from us.

[00:03:00]So brothers and sisters, I encourage us all to be at peace with ourselves.

[00:03:08]Enjoy the journey knowing that God is in control.

[00:03:16]We need to allow our father to do what only he can do.

[00:03:24]Dear father, we are thankful that you are God and that you're unstoppable.

[00:03:34]You're unchangeable.

[00:03:36]You're incomparable and you're all powerful.

[00:03:42]You alone are worthy of all our praise, our honor, and our glory.

[00:03:51]Your love endures forever and we're forever grateful.

[00:03:58]Help us, Lord, to stop trying to fix things over which we have no control and to change things which only you can change.

[00:04:13]Lord, we deliver everything into your hands.

[00:04:21]And so, as we deliver everything into the hands of our father, we're going to allow him to take control this evening and to run things.

[00:04:35]We will be guided by his direction.

[00:04:41]At this time, I would like to ask sister Teslin to say a prayer for us.

[00:04:49]Pray for all of us and our session this evening this tonight.

[00:04:57]Sister Teslin?

[00:05:01]Hello, I'm here. Yes. Could you pray for us, please?

[00:05:06]Good everyone. Let us pray.

[00:05:11]Father God, we thank you.

[00:05:13]Thank you.

[00:05:14]We thank you for your love and your mercies.

[00:05:18]We thank you, God, that we are your children and we can always come to you.

[00:05:26]We can always call on your name.

[00:05:28]You know all about us and Lord Jesus, you has brought us unto you.

[00:05:36]You are the one who made us.

[00:05:41]We are your people and so Lord Jesus, we thank you for this opportunity that we can call on you.

[00:05:49]This evening we are here on this platform for a presentation. Lord, we are going to hear some information about our body and things that may happen to us.

[00:06:03]And so Lord God, I pray that you'll be the director of this um meeting. I pray Lord Jesus that you'll be with the presenter who will be giving us information, useful information.

[00:06:21]God, I pray that you'll bless him.

[00:06:25]Thank you for the organizers of this evening's meeting. I pray that you'll continue to bless them also. Be with everyone who will have something to do with this meeting. I pray Lord Jesus that you'll give us ears to hear and to be attentive attentive to the information that will be passed on to us so that we'll have useful. Lord, I pray that you'll have your own way this evening. Keep us, guard us, help Lord Jesus that we will have a good meeting.

[00:07:02]There be no problem with connectivity and that at the end of the meeting, we'll say it was good for us to be here.

[00:07:11]These are the mercies we ask in your son's name.

[00:07:15]Amen.

[00:07:18]Thank you very much, sister Teslin.

[00:07:21]I will now hand over to our women's president, sister Sharon Gabriel, to bring us welcome.

[00:07:34]Thank you, sister Valerie. Good evening, everyone.

[00:07:38]For those who may just be joining, you might be wondering who are these people.

[00:07:44]We are from the Mandeville New Testament Church of God and we see the need to share with others about our body, our health.

[00:07:58]You know, our health is in our hands.

[00:08:01]We have a part to play and God will do the rest. So we are here this evening to have a discussion on awareness of cervic- cervical cancer.

[00:08:15]And so I welcome everybody on this platform tonight, my brethren, visitors, our guest speaker, the um Dr. Miller, Paul Miller, and all of you.

[00:08:30]Please just be attentive.

[00:08:38]Take your notes.

[00:08:40]Write down your questions because after the presentation, we'll be having questions and answers.

[00:08:48]So have a good evening, everyone, and God bless you at this time.

[00:08:56]Over to you, sister Valerie. Thank you very much, sister Sharon, and we're going to jump right into the meat of the matter.

[00:09:05]We're going to ask Dr. Lincoln Robinson to introduce our guest speaker, Dr. Paul Miller.

[00:09:17]Dr. Rob?

[00:09:31]Dr. Robinson?

[00:09:34]He's muted.

[00:09:36]All right, let me unmute. Okay, unmuted.

[00:09:38]Uh good evening, everyone. Good evening, one and all. Good evening, sister Valerie.

[00:09:43]>> Wonderful.

[00:09:46]So, uh welcome to the talk. It's awareness talk on cervical cancer and uh our presenter is Dr. Paul Miller.

[00:09:57]It is my pleasure to introduce this gentleman who is my friend. So, Dr. Paul Miller is an obstetrician and gynecologist in private practice.

[00:10:10]He's currently employed at Central Gynecological and Pregnancy Care Limited, which is the only group OBGYN practice in Central Jamaica, with his head office in Mandeville and branches in Spalding Junction and Santa Cruz.

[00:10:28]Dr. Miller completed his basic medical training in 2009 and pursued specialty training in obstetrics and gynecology, which he completed in 2017 at the University of the West Indies, Mona.

[00:10:46]He further enhanced his expertise with subspecialty training at the World Laparoscopic Hospital in India.

[00:10:54]With a special interest in minimal invasive surgery and fertility, Dr. Paul Miller is dedicated to advancing obstetric and gynecological care through through innovative techniques.

[00:11:10]He has previously worked with the Southern Regional Health Authority and the University of the West Indies, bringing a wealth of experience to his role.

[00:11:22]In addition to his professional endeavors, Dr. Miller chairs the Health and Wellness Committee of the Lions Club of Mandeville and he serves on the board of Moreland Estate Residential Committee.

[00:11:39]Outside of work, he's an avid domino player. I can attest to that.

[00:11:44]He enjoys traveling and he loves playing football, cherishing time spent with and chatting with and connecting with friends.

[00:11:54]He's happily married to Carleen, who is his light and compass, and is a proud father of two boys, Andrew and Xander, who are his world. And I can tell you that Dr. Miller is a good cook.

[00:12:16]He cooks and he shares. He cooks the best pot of soup you can imagine.

[00:12:20]And he, above and above all things, Dr. Paul Miller, my friend, he loves the Lord and he loves people. So, brother Paul, without anything added, it is my pleasure. Let us welcome this gentleman, my friend, to the stage to speak to us this evening.

[00:12:40]Paul, over to you, sir.

[00:12:46]Thank you. Thank you so much, Sir Lincoln, for that kind and colorful introduction.

[00:12:56]>> [laughter] >> Thank you so much. And >> Thank you all for the invitation, for giving me the opportunity to share in this very, very important topic, cervical cancer.

[00:13:19]Are you seeing my screen?

[00:13:23]Not yet.

[00:13:54]Are you seeing my screen now?

[00:13:56]No. Mhm.

[00:13:59]No. No. What is it?

[00:14:03]Is the Is the Is he able to share?

[00:14:06]Yeah, he has sharing whole rights. Yeah, he's co-host.

[00:14:12]It's coming up. Yeah, it's coming up.

[00:14:14]Yeah, mhm.

[00:14:18]Seeing it now?

[00:14:20]Yes, sir, it's coming up. Yes.

[00:14:28]Yeah.

[00:14:30]There. All right.

[00:14:32]So, thanks again, Sir Lincoln, and thanks for inviting me to to to share in this very important topic, cervical cancer.

[00:14:45]So, just an outline as to what to expect. We'll start with an introduction.

[00:14:51]Then I will go into some detail as to how cervical cancer develops.

[00:14:58]Then we will talk about cervical cancer prevention, which I think it will be the bulk of the presentation and the most important part is really how do we prevent this thing from happening.

[00:15:11]Then we'll talk a little about cervical cancer treatment and then we will give a short summary.

[00:15:20]So, just to put this topic into perspective, cervical cancer is the third most common cancer to affect all women and the third most fatal cancer for women in Jamaica.

[00:15:35]Just a little statistics here.

[00:15:37]So, in 2023, for the island of Jamaica, we had a total of 486 cases of cervical cancer and in that same year, we had 247 women dying from the disease.

[00:15:55]To take this locally, during my time at the hospital, we usually my my recollection around that for that time, we usually at any instant in time, we usually have at least two to three advanced cancer cases, advanced cervical cancer cases on the ward.

[00:16:16]And that is just for for Mandeville and and and and the vicinity of of Mandeville. So, this disease is real and it is indeed fairly common as as we're seeing here.

[00:16:32]One of the important thing about cervical cancer is that it is considered to be almost entirely preventable.

[00:16:42]And I always say, if there's a good cancer, I think cervical cancer would be that good cancer, simply because it gives us so much opportunity to prevent it.

[00:17:00]Why Why is this so important to us?

[00:17:03]It actually affects our young, healthy women.

[00:17:10]And it carries with it a significant psychosocial impact on the woman, her family, her community, and the country.

[00:17:18]So, when someone is diagnosed with cervical cancer, this person is usually a mother, a wife, a caregiver, a daughter, a member [clears throat] of the church, a member of the community.

[00:17:33]So, the impact goes beyond the woman herself.

[00:17:37]The diagnosis of cervical cancer usually disrupts so many things. It disrupts a household, it disrupts a marriage, it disrupts a family.

[00:17:49]These women are usually in their their prime years, in the peak of their their productive years. So, it also has an impact on the country.

[00:18:01]And as a matter of fact, a good measure of the country's health care and quality of health care is really how well we can prevent cervical cancer and how well do we treat those persons who for some reason or the other actually ends up with the disease.

[00:18:25]Just to put everything in perspective as to exactly what do we refer to as the cervix.

[00:18:37]So, this schematic that you're seeing here is a representation of the female reproductive system.

[00:18:47]So, this pear-shaped organ that I'm this pear-shaped organ that I'm circling is actually the uterus, more commonly called the womb.

[00:18:58]So, this is the safe haven where babies are babies are grown. This is This area is where menstrual flow comes from.

[00:19:09]So, the period starts here, comes through the cervix, and ends up in the vagina.

[00:19:16]Babies are developed here and during labor, it goes through the cervix and ends up again and then goes through the vagina. So, what is the cervix?

[00:19:26]The cervix is actually a part of the uterus.

[00:19:29]The larger part of the uterus is in the tummy, but there's a part that goes down in the vagina that tends to feel like a little nose. That is what we call the cervix.

[00:19:41]So, the cervix is really the gateway to the uterus.

[00:19:46]And one of the reason why it is susceptible to cancer is because it it serves as this barrier.

[00:19:55]So, the cells here tend to reproduce very very rapidly. And these cells here are changing constantly. And hence, they're prone to mistakes and the development of cancer. So, the area that we're talking about, the cervix, is that part of the womb that is in the vagina.

[00:20:17]So, the vagina is here, the body of the cervix, which is in the tummy, and the neck.

[00:20:24]The body of the womb, which is in the tummy, and the neck of the womb is is what we refer to as the cervix. And that part comes down in the vagina.

[00:20:36]So, how how do we get cervical cancer?

[00:20:39]How is it developed?

[00:20:41]One of the fundamental understanding is that it is actually caused by a virus, the human papillomavirus.

[00:20:50]So, greater than 99% of all cervical cancers are you are associated with infection from human papillomavirus.

[00:21:01]It is pivotal to to the development of cervical cancer.

[00:21:06]Importantly, the human papillomavirus that causes cervical cancer is typically sexually transmitted.

[00:21:16]So, we can even extend the argument to say that cervical cancer is a sexually transmitted disease.

[00:21:24]Since 99% of all cervical cancers are caused by a virus that is transmitted through sexual intercourse.

[00:21:34]So, the human papillomavirus is extremely extremely common.

[00:21:40]If we should get a group of 100 sexually active females, the prevalence will be greater than 80.

[00:21:50]So, once you're sexually active, there's greater than an 80% chance that you will contract HPV at some point in time.

[00:22:03]There are about 150 to 200 different subtypes of HPV.

[00:22:11]But about only 40 of these actually affect the genitals.

[00:22:16]Of this amount, about 12 types are associated with cancer.

[00:22:22]And these are the types that we refer to as the oncogenic types or the high-risk subtypes.

[00:22:28]It is all also important to note that the human papillomavirus is also associated with cancers in other parts of the body.

[00:22:39]So, the same virus is heavily associated with head and neck cancers, especially cancers of the throat.

[00:22:47]But it's also associated with cancer of the penis, cancer of the anus, cancer of the vagina, and cancer of the vulva.

[00:23:02]So, how how does a woman get cervical cancer from HPV?

[00:23:10]So, the first thing that happens is that you get infected with the human papillomavirus.

[00:23:15]And once you're sexually active, there's greater than an 80% chance that you will become infected with HPV.

[00:23:25]The good thing is that after infection, more than 90% just go away by themselves.

[00:23:33]So, the overwhelming amount of human papillomavirus infections will clear within 2 to 3 months.

[00:23:43]For some reason that we don't totally understand just yet, a a small amount actually persists.

[00:23:54]So, the overwhelming majority of times, the body clears it. In a small percentage of cases, it persists. And this is the first critical step to the development of cervical cancer, the persistence of HPV infection.

[00:24:13]Once it persists, it goes through certain pre-cancer changes.

[00:24:20]So, to simplify it, changes lead to CIN1.

[00:24:26]Then, the majority of CIN1 actually go away.

[00:24:32]But some do move on to CIN2, and some amount of the CIN2s will move on to CIN3, and then you move on to cancer.

[00:24:43]So, this is a critical and important part to understand in cervical cancer. It has a fairly long pre-cancer period.

[00:24:56]So, from CIN1, which is not a cancer, to CIN2 to CIN3, then cancer, that takes about 7 to 10 years.

[00:25:10]So, this is where we want to focus.

[00:25:13]We want to catch things from the pre-cancer period.

[00:25:17]And this is one of the reason why I would describe cervical cancer as a good cancer.

[00:25:24]It gives us 7 to 10 years to pick it up and treat it and prevent it.

[00:25:33]So, this is a very very important principle for all of us to understand.

[00:25:38]And when we talk about Pap smear, we're not looking for cancer because the aim is to prevent it. What we really want to do is to pick up the changes that may lead to cancer. We want to pick up CIN1, CIN2, CIN3, and to arrest it at this time before it invades and become a cancer.

[00:26:06]What are some of the risk factors for cervical cancer?

[00:26:13]Early age of intercourse and multiple sex partners.

[00:26:18]And to extend this, having a partner who has multiple sex partners is equivalent in terms of you yourself having multiple partners.

[00:26:30]Multiple multiparities associated with cervical cancer, meaning the more children you have, the more likely you are.

[00:26:42]And there are some reports which the association of low socio socioeconomic standing, but we believe that there can be some amount of confounding factors when it comes to this risk factor.

[00:26:56]Any immunocompromised state will increase your risk of developing cervical cancer.

[00:27:03]By immunocompromised states, we mean any condition that will prevent your body or reduce the chance of clearing it.

[00:27:14]So, the common immunocompromised states that we see are usually like advanced HIV disease, persons who are diabetic, persons who have active cancers, persons who are being treated for cancers, especially when suppressive therapies are being used, people with autoimmune disease such as SLE.

[00:27:43]These all these conditions will increase your chance of of developing cervical cancer.

[00:27:53]Another important association is actually cigarette smoking. Once you're a cigarette smoker, your chance of developing cervical cancer is increased.

[00:28:07]Like I've said, the most important thing is for us to prevent it because this thing gives us 7 to 10 years from the very first change to cancer where we can find it and arrest it.

[00:28:23]So, what are the levels of prevention that we can draw on?

[00:28:27]So, we speak about primary prevention, which is prevention before exposure happens.

[00:28:33]And in the case of cervical cancer, what we'll be talking about is a vaccination and behavioral changes.

[00:28:42]So, we can use vaccination to help to prevent cervical cancer even before you're exposed to the virus that causes it.

[00:28:55]So, essentially, what vaccination does is that it it creates soldiers. It creates a defense system that is there waiting for the HPV whenever you get exposed to it.

[00:29:12]So, persons who are vaccinated against human papillomavirus, they are ahead of the game because they are waiting. Their body has been prepared. There is a defense waiting. So, your chance of clearing that initial infection is significantly improved if you're appropriately vaccinated.

[00:29:36]The next level of prevention is aimed at those persons who are exposed but has no symptoms. So, this is where our screening comes in.

[00:29:48]And the screening methods are our Pap smear and our HPV typing. So, by and large, the most common screening method that is available to us is the Pap smear.

[00:30:01]So, how the Pap smear works, you want to pick up the changes from there at the CIN stage. You want to pick up things from from a pre-cancer stage.

[00:30:18]And this gives you the ability to prevent cancer from happening.

[00:30:22]And the tertiary prevention, now now that we find an abnormality, how are we going to deal with it? And there are a number of ways that we can treat it. And it is usually most of these treatments are usually in-office and extremely extremely short, low-cost, with little to no downtime.

[00:30:45]So, just to go over it again, our first defense to prevent it is by vaccination and behavioral changes.

[00:30:55]When young girls are vaccinated, they they you you you you essentially put a defense in their system for whenever they're exposed to HPV, their body clears it significantly faster and more efficiently. Then the next step is really our screening, which is our Pap smear and HPV typing. And once you screen and find something, we want to treat it and get rid of it before it moves on to something to cancer itself.

[00:31:29]So, just a word on vaccination.

[00:31:33]There are a number of regimens.

[00:31:38]You have the bivalent Cervarix, which is no longer available locally.

[00:31:44]You have the quadrivalent, which is Gardasil, which is the one that is used in in the government program.

[00:31:52]And you have the the nine-valent, which is available available privately.

[00:31:59]So, how does the vaccination work?

[00:32:03]And what these variants are about. So, in the earlier part of the presentation, I mentioned that there are about 12 types of HPV that actually can cause cancer, cause cervical cancer.

[00:32:17]So, although we know that there's about 200 150 to 200 and to 200 subtypes, of these, only about 12 can cause cancer. Of these 12, about about 70 to 80% of cervical cancers are caused by two subtypes, type 16 and 18. So, that was the idea behind the the the bivalent vaccine. It gives you immunity against type 16 and type 18, which is the most common type.

[00:32:55]The quadrivalent, which is the one that is available through the government program and called Gardasil, it has it protects against four subtypes, 6, 11, 16, and 18.

[00:33:10]Type 6 and 11 are usually not cancer-causing, but more like genital warts.

[00:33:17]So, once you're vaccinated with the quadrivalent, it actually reduces the risk of developing genital warts. So, genital warts is another pathology that is caused by human papillomavirus.

[00:33:32]And you have the nine-valent, which actually covers 6 and 11 and the seven other more common strains that is associated with cancer that are cancer-causing.

[00:33:48]So, the national HPV vaccination program, it was rolled out in 2017.

[00:33:54]And there was generally poor uptake.

[00:33:58]Because one of the thing is it is most effective if it is administered before before persons are exposed to sexual intercourse.

[00:34:15]Because if you should follow the reasoning, this thing is caused by a sexually transmitted virus.

[00:34:23]So, you would want to prepare the girl before her first sexual encounter. And importantly also, before the immune system is fully developed.

[00:34:36]So, that is the rationale for administering it in in between age 9 and age 40. And as I've said before, the uptake has been generally not as good as we would have hoped. And especially in developing countries, they do not rely as much on the Pap smears to prevent cervical cancer. The bulk of their prevention is actually primary through vaccination.

[00:35:06]One of the thing with vaccination, it takes some time before you really see the the the the benefits.

[00:35:12]And a number of first-world countries have been able to bring down cervical cancer incidence less almost to zero simply through a robust vaccination program 25 to 30 years ago.

[00:35:33]So, most people would be familiar with what we would refer to as secondary prevention, the screening.

[00:35:40]And the bulk of the screening that we do is through the Pap smear.

[00:35:45]So, what the Pap smear does is that we take some cells from the cervix, the neck of the womb that we described earlier, and we really look under the microscope for the changes that we described earlier that may progress to cervical cancer.

[00:36:04]So, an important concept to understand is that when you do a Pap smear, we're not looking for cervical cancer.

[00:36:15]We're looking for changes that may lead to cervical cancer.

[00:36:20]So, even when you do a Pap smear and I should call you and tell you to say, "Guess what? Your Pap smear shows something and we usually and we need to discuss it."

[00:36:30]There's no need to be afraid. We're not It's unlikely that we're going to tell you that you have cancer.

[00:36:37]We're the most likely scenario is that we're going to tell you that there are changes that over another 7 to 10 years may lead to cancer and we can avert it now.

[00:36:55]Another thing that we we use for screening is a high-risk subtypes.

[00:37:00]So, just like how we do the Pap smear, we actually can take a sample and send it to the lab and the lab will tell us that, "Guess what? We're seeing HPV, but the type that we're seeing is not the type that is that usually causes cancer." And that gives us some reassurance. Or they can tell us that, "Guess what? We're seeing HPV and it is the type that that is associated with cancer. So, we need to be a little bit tighter."

[00:37:30]So, we can screen with the Pap smear itself or we can use the Pap smear and the HPV typing. And this is called a co-testing.

[00:37:41]How often and how long should we screen for?

[00:37:45]So, most programs usually recommend 1 to 3 years.

[00:37:49]I mean, the bulk of the recommendations now are closer to having screening every 3 years, especially if you're able to have a good recall system, wherein your the overwhelming majority of patients will come back when they're told to do so.

[00:38:07]But one of the challenge with with in our setting is that we we have a lot of what we call opportunistic screening, meaning a patient just comes in for something else and you just seize the opportunity and screen them. As opposed to places like in England, once you miss a Pap smear, they're going to call you. You don't get that call, they're going to come to your house. So, they have a very very good screening program, finding you and ensuring that you're screened.

[00:38:37]And when they do that, you know, they not necessarily just care about you, but when they do the math, they realize that, "Guess what? It is much much much cheaper to find you and to do your Pap smear than to treat you for cancer 15 years down the line." Or reduce your tax-paying years by 15 15 years.

[00:39:00]So, just the economics of it makes screening the better thing to prevent cervical cancer.

[00:39:10]We usually say you can discontinue at age 65 if you have three consecutive negative Pap smears. Or if you're doing the co-testing, if you have two consecutive negative negative ones. And these are just general guidelines, cuz for example, a diabetic, you know, you might want to go longer. And you have to tailor these guidelines to our realities.

[00:39:37]I've seen patients who have been screening all their lives and they stop at 65 and they come back to Jamaica and they turn up at 72 with cervical cancer.

[00:39:52]So, I personally usually go beyond 65.

[00:40:00]So, now that we screen and we pick up something, how do we manage it?

[00:40:06]So, like I said in the earlier slides, what I've described is that we the Pap smear is meant to look for pre-cancer lesions, not cancer.

[00:40:17]The Pap smear is meant to pick up these changes and present them in such a way that you can prevent cancer.

[00:40:27]So, most CIN1, which are which is really the first set of pre-cancer change, usually go away by themselves. So, sometimes we just need to repeat it.

[00:40:40]In 6 months' time and the overwhelming majority tend to go away.

[00:40:45]If you go up the ladder a little more though, your CIN2 and CIN3, which are which are still pre-cancer lesions, these usually require treatment. And again, not to go into details as to what these treatments are, but they usually take less than 15 minutes. They're usually in-office.

[00:41:07]So, even if you have an abnormal Pap smear, the treatment is usually curative. You get rid of it completely.

[00:41:16]It's usually not painful. It's usually low cost.

[00:41:22]Very, very low downtime.

[00:41:24]You come in the office, it is sorted out or you go to the hospital as a day case and it is sorted out and you go back home.

[00:41:32]This is not the case if we should miss the boat and we end up with cervical cancer.

[00:41:39]So, like I said, the bulk of the presentation is meant on prevention because we know that this thing can be prevented.

[00:41:49]Can be prevented through vaccination, through screening, and appropriate interventions if an abnormal Pap smear presents itself.

[00:42:00]But, just a word on cervical cancer, very, very, very rarely it is picked up on Pap smears.

[00:42:08]Our patients usually present by and large in my practice and in the literature, the overwhelming majority of patients that we see with cervical cancer, the common thread is that they have not been screened usually in the last 10 years. They have not had a recent Pap smear.

[00:42:32]So, how patients usually present with cervical cancer, usually an abnormal bleeding pattern.

[00:42:40]So, you may be bleeding between the periods. You may be bleeding after intercourse.

[00:42:46]In a lot of cases, there's this persistent abnormal vaginal discharge which I've seen on numerous occasions, patients being treated multiple times for a malodorous discharge without being examined and it turns out that there is a fungi there is a lesion on the cervix which is which is which is causing it.

[00:43:10]So, an important point to note is that the pre-cancer lesions that we're looking for, these cause no symptoms at all.

[00:43:20]So, a Pap smear is really for somebody who is healthy and for somebody who was not suspecting that they have cancer.

[00:43:30]So, if we were examine you and we believe that there may be cancer, then a Pap smear wouldn't be the appropriate thing. What you really, really need, once we're able to see that something is off, it's no longer a Pap smear. What you will require now is a biopsy.

[00:43:49]So, though we want to bring this thing down close to zero, we know that we still like I said, in 2023, we had in excess of 300 women being diagnosed with cervical cancer.

[00:44:05]So, even if we should miss the pre-cancer lesion, we still prefer to catch to catch the disease itself at an early stage.

[00:44:16]In terms of treatment, early stage disease can be treated effectively with surgery.

[00:44:22]Usually just taking out the womb and the cervix for very early disease is usually adequate.

[00:44:29]For more advanced diseases, we may need chemotherapy, generally medications, and radiotherapy as part of the treatment regimen.

[00:44:40]And I've had a number of cases and I might have a patient diagnosed with cervical cancer and they will say, "But, just take out the womb." No. Usually in locally advanced disease, surgery is usually radiotherapy that gives you the best outcome and not necessarily surgery.

[00:45:03]But, by and large, we would prefer to prevent it and to catch it long before we have to think to be thinking about chemotherapy and and radiotherapy.

[00:45:15]So, in summary, what are the selling points that I would want you to take away?

[00:45:21]That cervical cancer remain a major public health burden, albeit that the majority can be prevented.

[00:45:29]Cervical cancer continue to disrupt homes, continue to disrupt marriages, continue to disrupt families, continue to disrupt the potential of our women, the potential of our children, the potential of our community and the potential of our nation.

[00:45:49]Vaccination and Pap smears are vital for prevention.

[00:45:54]And the vaccination has been proven to be quite safe and effective in preventing not only cervical cancer, but other HPV-associated cancers such as cancers of the throat, cancers of the penis, cancers of the anus, and cancers of the vagina.

[00:46:20]So, >> [clears throat] >> another important point to remember is that once you start having symptoms, once you start having these abnormal bleeding, then a Pap smear would not be the the appropriate test.

[00:46:38]You need to be examined and if there's something there, then a biopsy should be taken.

[00:46:47]Thank you.

[00:46:56]Thank you very much, Dr. Miller.

[00:47:00]That was a real comprehensive report on cervical cancer.

[00:47:08]You went through a lot.

[00:47:11]A whole lot.

[00:47:13]And I hope that I'm hope I'm hoping and I'm sure that there will be many questions.

[00:47:20]You went through the development of cervical cancer, how it's caused through the HPV, human papillomavirus, and that it's sexually transmitted, and can be prevented.

[00:47:35]You told us about how how um we can get the virus, what the cervix is, a lot of information, which we are very grateful for.

[00:47:48]I am sure that particularly the younger ladies who are on tonight, this information will be very beneficial to them.

[00:48:02]Uh they were told about uh we were all told about the risk factors and how early sexual being sexually active at an early age and having multiple sex partners are high risk. You told us about the prevention, primary, secondary, tertiary.

[00:48:27]The the how the vaccination is a blocker. It's something that's recommended that young ladies take at an early age. It's a way of preventing them from getting the virus.

[00:48:43]You told us about screening and eventually at the end, you told us that the disease can be successfully treated if by chance someone should get it, mainly through surgery.

[00:49:00]And that vaccination and Pap smear are vital for prevention.

[00:49:08]Lot of information, Dr. Miller. Thank you very much.

[00:49:13]Thank you.

[00:49:17]Sister Turner, I'm sure Sister Turner is going to direct the question and answer period for me.

[00:49:27]Sister Turner?

[00:49:35]Sister Turner.

[00:49:47]While I wait on Sister Turner, are there any questions? I think we could start with the questions until I have a question.

[00:49:59]Go ahead, man. Go ahead, Dr. Robinson.

[00:50:02]>> [laughter] >> Oh, yes. I want to thank you, Dr. Miller, for a very interesting and um impactful presentation, as expected.

[00:50:13]We're happy. Thank you so much again. Um question. Since Since you see the the vaccine is the most important in preventing cervical cancer, why is the uptake so so low?

[00:50:29]Um do you have any insight on that? Um my two cents on it is uh people don't know about it. So, when they come to to my office for like medicals and so, cuz usually that's you know, that's when we want to offer the vaccine, and they don't know that it is offered free of cost in the schools and and so forth.

[00:50:53]And that's one aspect my my understanding.

[00:50:56]The other understanding is some persons are so naive they say, "Me no ex once me give me pickney vaccine it will give her the permission for go start have sex."

[00:51:06]Can you How do you speak to those persons?

[00:51:09]Yeah.

[00:51:11]Very very good point, Lincoln. And a number of studies were actually done, not only locally, but in other developing countries and other first world countries, as to the barriers to to to the uptake of of the HPV vaccine.

[00:51:27]And like you rightly say, our local studies one is a lack of knowledge. They don't know that it exist. But that has not been the main reason we have found.

[00:51:40]The top top top reason is really out of fear.

[00:51:45]Exactly what this fear is.

[00:51:47]Like you rightly say, some parents believe that guess what, this thing may hurt their daughter.

[00:51:52]This thing will encourage them to have to to to to to start having having sexual intercourse. So, these are the two the top two reasons that that contribute to the the poor uptake.

[00:52:07]But by and large is really a lack of knowledge and a lack of appreciation of uh of the benefits and a lack of appreciation of the low risk that it it has it it is posing.

[00:52:23]And it's important to know that even though we started this thing in Jamaica in 2017, there's other countries that have been doing this for the past 30 35 years. So, there is a lot of experience and a and a lot of information regarding the safety.

[00:52:41]So, there's no evidence to suggest that girls who are vaccinated are more likely to engage in sexual activity.

[00:52:51]There's no evidence to suggest that girls who are vaccinated will have fertility issues in the future. And these are the what our studies show.

[00:53:04]For for the parents who are reluctant, who know that it exist, the the the the the over the two overriding reasons are usually fear of impairment of future fertility and fear that it will open a pathway for for sexual intercourse.

[00:53:26]The second part of your question, Lincoln, as to how do we address this, is information gen- what I refer to as gentle information. So, every opportunity you get, you pass on what the facts are, you know, and you empower people to choose. Cuz at the end of the day you can't be forceful.

[00:53:46]You can't is they're really their children and their bodies, you know? So, the more you can build the trust and the more you can provide accurate information, then that is our best bet.

[00:53:59]Not only as health care providers, but as individuals who empower others, that is our best approach to break down these barriers and these but these almost stigma associated with it.

[00:54:16]Thank you. Thank you very much. Thank you, sir.

[00:54:25]Any other question?

[00:54:33]I think Miss Esther has raised her Good night, everyone. Um Good evening, Dr. >> Good night, everyone. Good night. Good night. And might I say very excellent presentation, Dr. Miller.

[00:54:45]Could you be kind to to stop sharing, please? Okay. So, we could >> [laughter] >> um All right. Hold on.

[00:54:56]I stop sharing.

[00:54:59]Okay, my question and observation is that since 2020, what's the 2020 COVID?

[00:55:08]Um well, that's a statement, but the program that used to be in school with the girls, especially the all girls schools, where they offer the vaccination or is it vaccination for the H? Whatever else, whatever the letter.

[00:55:28]Um vaccination, is that still has that been revamped or because I know before COVID it was usually like every year at the start of the year or somewhere there, but I have not seen it happening. Um am I correct or you could advise us there cuz I'm not >> Yes, you are correct. So, in the school it has been significantly scaled down. I know that it is still available at some of the health centers, but not all.

[00:56:04]But the funding for the program has waned and the uptake was just not good.

[00:56:10]So, I'm not >> That means you're talking about going into the schools was not good? Overall.

[00:56:16]So, when they went in the schools cuz they have to get permission from the parents, the overwhelming majority of students were not Or the parents?

[00:56:26]>> Yeah, were not giving permission to to take them.

[00:56:33]Okay, thank you.

[00:56:35]Yes.

[00:56:37]Dr. Miller, you said that roughly 386 cases were detected in a particular year, and that there were 247 deaths, which is very very high, the death rate.

[00:56:58]Were the cases detected in any particular age group?

[00:57:03]Yes, the majority of cases are usually in the 40 to 49 age group.

[00:57:11]And I think you touched on an important point that we have to I have to highlight.

[00:57:20]>> [snorts] >> So, it's When it comes to cervical cancer, two things are going against us.

[00:57:26]One, we are not preventing it as much as we should.

[00:57:34]But it is much much less costly to prevent.

[00:57:39]The other important thing is that our ability to treat it it's far far far far far far far far far below what the standard of care should be.

[00:57:56]So, even the the kind of mortality that we see, if you should end up with cervical cancer in Jamaica or cervical cancer in the US, your chance of surviving is about 7 to 8 folds.

[00:58:13]>> [snorts] >> Simply because of the availability of resources for appropriate treatment.

[00:58:20]And and that is why I believe that for us as a country, the emphasis should be on prevention.

[00:58:29]It is much much much more costly to try to treat.

[00:58:34]And we have not been We have not done very well at treatment, unfortunately.

[00:58:46]So, the kind of what we refer to as mortality rate, it is significantly higher in in developing countries.

[00:58:57]Okay.

[00:58:59]The prevention prevention prevention.

[00:59:02]That's where we have to put the bulk of the resources and the bulk of the effort. Were the cases in any particular group demography?

[00:59:12]Say that again?

[00:59:13]Were the cases that were detected in any particular group, any particular demography?

[00:59:21]>> You mean age group?

[00:59:24]No, no. Uh profession? Any Yes. No, I I think it was No, I don't think it was further. Stratified, we didn't have that breakdown as to if there are any other defining social factors. Mhm. No, no, no, we're not able to pinpoint that. Okay.

[00:59:46]Yeah, but one of the the recurring thing with these 386 patients is a lack of screening.

[00:59:57]So, out of these 386 patients, more than likely probably about 370 of them did not have a Pap smear in the last 5 years.

[01:00:08]That is the overwhelming that is the recurring thing.

[01:00:16]Poor screening.

[01:00:19]Okay.

[01:00:20]Um Sister Valerie, Yes.

[01:00:23]>> There's a question on the chat. Would you like me to read it?

[01:00:29]Shh.

[01:00:30]Uh uh how many doses of the HPV vaccine is required?

[01:00:35]Yes. Two Okay. Okay. All right. How many doses of the HPV vaccine is required to be fully vaccinated?

[01:00:45]Does one dose of the vaccine provide any coverage or protection? It does provide some amount of coverage, but not satisfactory.

[01:00:55]So, usually you need three doses.

[01:00:58]And even though we think the benefits are greatest for the below 15 age group, there are still significant benefits for adults, especially up to age 26.

[01:01:13]So, we know for the Gardasil that's the the the one being offered in the the the public health system, the one that covers against four strains, if it is that it is administered below the age of 15, sometimes we can give two doses.

[01:01:32]But generally, it's usually a three-dose regimen.

[01:01:39]Okay.

[01:01:41]Okay.

[01:01:42]Any other question?

[01:01:44]Good night, everyone.

[01:01:47]Good night.

[01:01:48]Dr. Foreman, Sister Wendy.

[01:01:51]Um my question, what barriers, since there are so much poor screening and persons, you know, not coming forward to want to do a Pap smear or take the vaccine?

[01:02:09]What are some of the barriers you you would have seen that are preventing women from getting screened?

[01:02:17]Yeah. So, one, it's limited information, meaning persons just don't know the importance of being screened.

[01:02:35]Two, there's a lot of fear.

[01:02:39]Fear for the pain of a Pap smear, fear for the pain of being examined.

[01:02:48]The third, which usually doesn't feature significantly, is the the the cost.

[01:02:57]So, we know that cost can be prohibitive.

[01:03:00]But in my experience and what the studies would have shown is that a lack of knowledge and fear are usually the top two the top two reasons why people don't do their Pap smears and seek appropriate screening care.

[01:03:23]All right. Thank you so much.

[01:03:25]Um there's just one follow-up question, too. I think um there are some myths going around as well in terms of, say for example, older persons and, you know, who'd have gone into menopausal states and all of that.

[01:03:43]Say an abnormal bleeding comes on, you know, persons would say, "Why bother? You know, that normally happens." And persons might go away thinking, "Okay, I don't need to get checked." Also, and um I don't know if if you've heard it, but it is also said that it is a silent um disease because, you know, you would go unnoticed for a number of symptoms until it's too late. Is that Is that true? It is.

[01:04:18]It is. It is. And I've said it in the presentation that if we should describe a good cancer, I would say cervical cancer is a good one simply because it gives us such a long pre-cancer period.

[01:04:33]Imagine 10 years. So, if you if you miss if you do the Pap smear and you miss it and you do it again and you're not going to miss it on four consecutive Pap smears. Cuz you have a period you have a a span. So, we do know that the Pap smear has certain amount of false negative, meaning something might be there and the Pap smear comes back as being okay, what we call a false negative. But if you're if you're if you're following a a a a a a frequent screening program, it is unlikely that these pre-cancer lesions would would would would have been missed.

[01:05:15]And abnormal bleeding patterns, it's important for us to know abnormal bleeding patterns because a lot of gynecological problems do present with abnormal bleeding patterns.

[01:05:33]So, you shouldn't be bleeding after intercourse.

[01:05:36]And again, I usually tell patients that guess what?

[01:05:40]It's most likely not serious, but it needs to be checked out. If you're bleeding after intercourse, probably it's a cervicitis, probably it's a polyp on the cervix, but there is always the possibility that a cancer is there.

[01:05:57]So, the majority of times, it is not serious, but it needs to be checked out.

[01:06:02]So, if you're bleeding after intercourse, it needs to be checked out.

[01:06:04]If you're bleeding between the periods, that needs to be checked out.

[01:06:11]If you're having progressively heavier menstrual bleeding, meaning last year you were using five pads and this year you're using seven.

[01:06:23]Last you've never had overflow and you were using the same brand of pads and now the pads are overflowing.

[01:06:30]It needs to be checked out.

[01:06:32]If you're at age 45 and more and you start having any form of bleeding pattern, abnormal bleeding pattern, it needs to be checked out.

[01:06:42]If you have stopped seeing a period for more than a year and you start to bleed again, that needs to be checked out. It is considered an abnormal bleeding pattern.

[01:06:53]And we know that there's a lot of fear out there and a lot of people would say, "Guess what? They prefer not to know cuz as they know this thing going to kill them."

[01:07:01]The fact of the matter is, a lot of these pathologies, even when they're cancers, if they're picked up early, the treat treatment is usually fairly simple and it is usually curative.

[01:07:16]When it is picked up late, the treatment is usually quite complex, quite expensive, and the majority of times, the intent is is what we call palliative and not necessarily We just want to improve your quality of life.

[01:07:34]But our chance of getting rid of the disease completely would now have significantly diminished.

[01:07:42]So, it's important that as women, as husbands, as members of the family, that we we recognize these abnormal bleeding patterns.

[01:07:53]And to help to allay the fear, the overwhelming majority of times, it is not serious, but it needs to be checked out.

[01:08:09]Thank you.

[01:08:10]Welcome.

[01:08:14]Any other question?

[01:08:17]Good night, everyone.

[01:08:19]Not a question, but but an observation here. I'm Roslyn McLean.

[01:08:25]Go ahead, Sister Roslyn.

[01:08:26]Sister Sister Roberts asked about the revamping of the HPV vaccine in schools.

[01:08:36]It is still going It's still ongoing.

[01:08:40]However, a few years ago, um we have very very very um very much resistant from some of the school the school principals.

[01:08:57]I don't know what the problem was, if it was bad, they did not know much about it, but we got a lot of resistance when we went into school because I was one of those who had been going to schools to offer it, to talk to the principals, the teachers, but then you realize they were not buying into it.

[01:09:25]But now we, I think government had made some effort to start sensitizing, re-sensitizing people again or the public again. And so, I realized that coming into the public health system, there are more people, there are more young there are more young ladies, more females coming in for asking for the HPV vaccines.

[01:09:54]And we also make it a part of their school medical whenever they are they have to go into a new school, we make it a part of it so that they get it before when they whenever they're doing their medical.

[01:10:14]So, it is being revived now, but I don't think enough public education campaign is being done.

[01:10:23]Okay. Tha- thanks very much for that clarification because I I was under the impression that it actually no longer in existence.

[01:10:31]It has waned so much.

[01:10:33]But definitely that is useful.

[01:10:36]Okay. Mhm. And it is it's I know it's still available at the health centers. Yes, we do give it at the health centers. Yes, I know it's still there, but I thought the school program had come to a halt completely.

[01:10:49]>> No, no, no.

[01:10:51]We have we have been going in, but as I said before, we used to get some resistance, but now it is it is on the immunization schedule.

[01:11:02]Okay. It is now on the immunization schedule, so people are coming in to ask for it. You have one and two who are resisting, but there are people who are they they they the uptake is more is is more better, right? Okay, very good.

[01:11:22]There's a question. Somebody's asking if over 20 if they're over 26 can get the vaccine.

[01:11:29]You you can get the vaccine over 26.

[01:11:33]There are still benefits.

[01:11:35]But the maximal benefits are are before.

[01:11:38]But there are still significant benefits to get it over 26. So, that is usually a discussion, you know, you look at the potential benefits, what the risk may be, what the cost, and so on. And then that is a decision between yourself and your caregiver. By and large, that is usually the approach for over 26.

[01:12:00]Okay, thank you.

[01:12:07]Any more questions?

[01:12:10]Let's see. Let me look on YouTube. Hold on, let me look on YouTube if there's any. Okay.

[01:12:20]Ooh, coming in from the YouTubers.

[01:12:25]Ooh.

[01:12:31]Ooh.

[01:12:33]Okay, so while she's looking >> Okay, um Oh, did you find one? Yes, um there are some sorry, sorry, Sister Valerie. There are some questions on YouTube. Is there a test for men for the HPV?

[01:12:51]Oh, yeah, they're saying on the YouTube platform.

[01:12:56]Um I'll just put them together. Are you hearing me?

[01:13:00]Yes, I'm here. They're like, could you personally recommend the vaccine for boys?

[01:13:07]Information, that's what they're men can the HPV, so protection is key. Is there a test for men for the HPV?

[01:13:17]Um Okay.

[01:13:21]That's what I'm seeing on YouTube. Yes.

[01:13:26]And the presentation and so on. Yes, so typically there's not a test for men for the HPV screening.

[01:13:36]But importantly, there are benefits to immunize it to to providing immunization for boy.

[01:13:46]So, one once the boys are protected, they automatically protect the girls because the boys will be the ones who will be transmitting it.

[01:13:58]So, the principle of what we call herd immunity. So, if you can get a significant amount of the population immunized including boys you would automatically reduce the potential source from which it can be transmitted. So, if you protect the boys, you by extension protect the girls.

[01:14:19]Secondly the other benefits from immunizing from providing immunization for the boys we know that cervical cancer is one of the more common cancers associated with HPV. However there are cancers in the males that it actually protects against.

[01:14:43]So, penile cancers are not as common as cervical cancer, but males do get penile cancers that are associated with HPV and the vaccine will provide some protection against it. Yeah, anal cancers the vaccine will provide some some protection against it. And your head and neck cancers the vaccine in boys will provide protection against against that.

[01:15:11]So, there are in fact benefits, well-established benefits from providing the vaccination for boys.

[01:15:22]And just to add to what Dr. Miller says we are also giving males the vaccine between the ages of 9 to 14.

[01:15:33]Yeah.

[01:15:42]The I see a statement here on YouTube, too. I'm going to read it. I don't know Dr. Miller if you would be in a position to respond.

[01:15:52]It says that the issue at the time with those vaccines is that our ministry didn't test them to be sure what was in it. And they were pushing it onto the populace without the necessary safety checks.

[01:16:14]Y- yeah.

[01:16:16]Yeah, I can't speak specifically to the safety and so on.

[01:16:21]But I I I personally one of my personal views at the time was that there wasn't adequate stakeholder engagement, you know. You the population wasn't adequately prepared for this thing.

[01:16:36]It was almost foreign. There was the information was wasn't properly disseminated.

[01:16:43]And you don't you it >> [clears throat] >> For you to have a successful campaign you need it to be safe.

[01:16:55]Where you need your stakeholders to know that it is also safe. You can't establish that it is safe and keep it to yourself.

[01:17:04]You have to have adequate stakeholder engagement and eventually with the aim of getting good stakeholder buying. And I think the program fell down significantly at at at that critical buying stage.

[01:17:28]Okay, okay. And Nurse McLean, you can probably comment on that also.

[01:17:40]She's she's about she's on it. Anyway, there's another Sorry, I I don't know of that because um I think what we have is some Caribbean countries, we have Caribbean countries who have almost eliminated cervical cancer.

[01:18:06]And it is through the uptake, too, of the HPV vaccines.

[01:18:11]We have smaller Caribbean countries than ourselves. So, I guess um as Dr. Miller says, I don't know if it wasn't um it wasn't publicly um sold to the public it wasn't sold to the public as it should. And so, the buying in was not good.

[01:18:38]Okay, thank you.

[01:18:40]There's another question, Doc. I think you spoke to it, but um I'll read it nonetheless. It said, should women over 60 continue doing Pap smear?

[01:18:57]Yeah, the the the simple answer to that is yes.

[01:19:01]But we know that you're going to see recommendations that says, boy, once you have three you have three Yeah, you have three negatives, you can stop. But we believe that one one cervical cancer in a fit healthy woman is too that is too is unacceptable.

[01:19:21]And in my personal experience, I have seen patients who were screening screening screening. They were in the US and they opt to screen and they came back home at age 65 and you see them at age 72.

[01:19:35]You see them 8 years later with a with a with with with with cervical cancer.

[01:19:41]So, my usual guidance, it's it the screening is fairly simple.

[01:19:49]So, it's not like a colonoscopy that we have to put you to sleep and it is expensive and so on. So, it is okay to miss one or two.

[01:19:59]And I'm not being biased because this is my area. I don't think given the simplicity of a Pap smear and the ease that we can treat a pre-cancer lesion, I think we should screen as far as the woman is healthy.

[01:20:18]Okay. Thank you.

[01:20:21]Any other any other questions?

[01:20:35]I'm sorry. I came on a bit late, so I might have missed it. Um in terms of a woman having maybe another kind type of cancer, for example, breast cancer, um should that woman be overly concerned about um screening for cervical cancer?

[01:21:01]So, the the Yeah, so the answer to that is that it should be no.

[01:21:07]It should be no. So, we know we know that there are certain cancer syndromes and there are certain associations, meaning having breast cancer, you know, especially what we call the familial types and so on, it can be associated with ovarian cancer, it can be associated with colorectal cancer.

[01:21:32]But by and large, we believe that there is not a significant genetic predisposition to a significant genetic association with cervical cancer and other types of cancer.

[01:21:46]Because, for example, breast cancer, uh uh there's a big genetic component to breast cancer.

[01:21:55]To ovarian cancer, there's a significant genetic component. To colorectal, there's a significant genetic component.

[01:22:03]The greatest association with cervical cancer is the the the the human papillomavirus.

[01:22:17]So, if to simplify it, you're extremely unlikely that you will ever find cervical cancer in a virgin.

[01:22:27]But if a virgin's sister had breast cancer, especially when at a young age, then that person has a significantly increased chance of develop developing it.

[01:22:41]So, the simple answer is that there's no there's no strong association.

[01:22:47]So, there's you don't necessarily need to adjust your screening simply because somebody had another cancer such as breast cancer.

[01:22:59]We know that HPV the other the presence of one HPV associated cancer, it increases the chance of developing another one.

[01:23:11]So, for example, somebody who has cancer of the vagina or cancer of the anus and if it's HPV associated, then your chance of developing cervical cancer, which again is HPV associated, is increased.

[01:23:37]Got you. Thank you. Okay.

[01:23:42]Doc, I don't remember if you answered this question. I don't remember if Sister Esther asked you. There's a question asking, is there a test for the HPV for men?

[01:23:57]And what are some of the symptoms that men may have?

[01:24:03]Yeah, so there's no >> ask that question?

[01:24:06]>> [clears throat] >> Yeah, so there's no standardized test for men generally.

[01:24:13]You know, so we know that anal swabs and penile swabs actually can pick it up.

[01:24:17]But it is that kind of screening is not as robust as the Pap smear.

[01:24:23]Okay.

[01:24:25]So, for men, and I'll say generally, we don't usually need to screen men in the general population.

[01:24:35]So, we do know that there's some high-risk group of men that you may need added screening and you may need added to to to to pay closer attention.

[01:24:53]But generally for male, that is not required. In terms of the symptoms, it would be because one of the important thing is that pre-cancer lesions don't usually cause symptoms.

[01:25:07]It's really cancer causes symptoms.

[01:25:11]So, you you you can get in terms of the HPV that causes cancer, you're not going to get any symptoms until cancer develops. So, you can get like a fungating mass on the penis, that kind of thing.

[01:25:28]However, there are other HPV subtypes that causes warts.

[01:25:35]These are not cancer-causing, but they are significant.

[01:25:41]And males and females can get these genital warts.

[01:25:54]Thank you, Doc.

[01:25:55]Any more questions? Going going.

[01:26:05]Is this Sister Turner on?

[01:26:08]Yes, I am on.

[01:26:10]>> [laughter] >> Yes.

[01:26:13]Would you like to comment, Sister Turner?

[01:26:17]I just to say it's a very interesting um topic. Um a topic that I am that is I really like.

[01:26:28]And um Dr. Miller did justice to the topic. He leave no stones unturned.

[01:26:34]Very knowledgeable young man.

[01:26:38]>> [laughter] >> And um I am really glad that the the the the team the ministry team really, you know, facilitated this presentation because I can see that persons learned and um you are now empowered now to to pass on your knowledge and the information to others.

[01:27:00]Thank you so much for those kind words, especially the young part.

[01:27:06]>> [laughter] >> I said to you why you are associated with Dr. Robbins.

[01:27:12]>> [laughter] >> I also wanted to Go ahead, Sis.

[01:27:23]Um Sister Turner >> wanted to Yes.

[01:27:27]I also wanted to take the opportunity to encourage persons on the platform and to spread the word that comes the 28th of April, we will be having um a Pap smear day at Mandeville New Testament Church of God. It's free, of course. You don't have to pay for it.

[01:27:44]You just come in and you get your have your Pap smear test done. And this are the information that Dr. Miller just gave, then persons should um now, you know, make use of this opportunity. So, I just want to encourage the women. You can always um call the office and leave your your your name with Sister Sister Western or Sunday coming, you can also write down your name at the usher's table on a a form that is there.

[01:28:17]Excuse me, could you repeat the date, Sister Turner?

[01:28:20]The 28th of April.

[01:28:24]Okay.

[01:28:26]It's next week.

[01:28:28]Tuesday?

[01:28:28]>> Tuesday. Yes. Yes.

[01:28:33]Just to add to what Sister Turner is saying. Sorry.

[01:28:37]Just to add to what Sister Turner is saying.

[01:28:40]On the day of the health fair at Gray Ground New Testament Church of God, HPV vaccines will also be available.

[01:28:50]Amen. Good.

[01:28:53]All right. Sister Tomlinson, through you, may I ask one last question? Sure, Sis. Go ahead. All right. Um I can see how having multiple sex partners and other things um increase the risk of having cervical cancer. But how does smoking increase the risk?

[01:29:18]Yeah, so Yeah, so the the the the thought is the the local immune response.

[01:29:27]So how cervical cancer happens is infection with HPV.

[01:29:36]Which it needs to persist to become to move on to to to to to cancer.

[01:29:43]So what comes from the male.

[01:29:46]Yeah, so the thought is on a local level at the level of the cervix your immunity there is impaired. So your ability to clear the virus in the first place is affected.

[01:30:08]So if you can't clear the virus effectively, your chance of ending up with cancer is higher.

[01:30:14]And cigarettes it has been found that people who smoke their immune system is not as robust in clearing the virus.

[01:30:32]I hope that answers the question.

[01:30:33]>> Thank you. Um sister Valerie Yes sister Esther.

[01:30:39]I am not going to say I'm confused, but I just state make my statement. The fact is the origin is from the male.

[01:30:51]So shouldn't be that target group be the ones to have all of these preventative thing? Is it something that they were born with? Is it in their blood or what what is it? Where the men? Because if it is transferred from them shouldn't should we [clears throat] call them the vector? Is Is it Is that a correct medical term?

[01:31:23]The carrier?

[01:31:27]Um Doctor, are [laughter] you getting my concern or my lack of knowledge, my ignorance?

[01:31:36]>> I'm getting the concern. [laughter] Please enlighten.

[01:31:44]All right, so I'm [gasps] not going to say [laughter] they are going to say we.

[01:31:48]Yeah, so it's with the it's it's HPV is is it's universal, it's everywhere.

[01:31:59]So it's kind of hard to establish what was the egg and what was the chicken, you know?

[01:32:04]Did it start with a male a million years ago or did it start with a female a thousand years ago? We really don't know. We really don't know.

[01:32:14]So we believe the the the the rationale instance is that guess what? It starts with both men and women. And if you're going to believe the term vector that somebody carries it, then I believe that equally you know both the male and the female are carriers and the transmitters.

[01:32:36]The why the So in terms of vaccination I think it's it's equally important Thank you.

[01:32:45]Yes, and especially from a public health point of view.

[01:32:49]And for you to achieve what we call herd immunity and so on, it's equally important. The male and female. And male and female. But other part of it of it now is that it affects females disproportionately.

[01:33:04]So the the the the the it's more urgent for female because of the disproportionate way that it affects it affects females.

[01:33:14]I mean most doctors will go through their entire career and don't see a penile cancer.

[01:33:21]But you you you're going to see a a cervical cancer or a pre-cancer lesion fairly often for females. So it disproportionately affects females.

[01:33:37]I am not so much talking about the disease affecting the male, it's for them having the the the the thing that causes it.

[01:33:48]Yeah.

[01:33:50]So it is from them to the female.

[01:33:55]Which which I'm thinking they are the carriers. Yeah, but it can be equally argued that that female we hope that that male hopefully had gotten it from a female. [laughter] Okay.

[01:34:09]We just don't know where it started, you know?

[01:34:18]Any other question?

[01:34:28]Going once.

[01:34:29]All right.

[01:34:32]Going twice.

[01:34:34]>> [laughter] >> Gone.

[01:34:37]I'm going to conclude that there are no other questions.

[01:34:42]And so I'm to formally thank Dr. Miller for his very comprehensive and informative presentation.

[01:34:56]I'm going to ask sister nurse Anne-Marie Blair to do the honors for us.

[01:35:06]Good evening everyone.

[01:35:08]Good evening.

[01:35:10]>> sister Blair.

[01:35:11]It is a privilege to propose the vote of thanks for this incredible insightful session on behalf of the Mandeville New Testament Church of God Medical Ministry I would like to express our deepest gratitude to Dr. Miller for taking time out of his demanding schedule to educate us on this this evening.

[01:35:39]Your presentation sir was very timely.

[01:35:43]And you open our our our world of wisdom to us on facts that not only reassured us, but it it is able to help us to navigate the whole aspect of cervical cancer.

[01:36:08]We are sensitized more sensitized now especially when you we notice how you emphasize the PPV virus vaccine and also mentioning the screening which uh the screening which is so vital to detect to detect this this this cancer.

[01:36:33]I I take note of the pre-cancerous stage.

[01:36:38]This it's 7 to 10 years, which is a quite a a big gap time gap to for women to be able to to get help.

[01:36:56]The the preventative measures are in place.

[01:37:00]And you were very transparent when you said that you there were limitations.

[01:37:07]We appreciate that.

[01:37:09]You know, and we want to tell you a very big thank you for for how you have opened our eyes, our understanding.

[01:37:19]And with this information we are more equipped to tackle this whole subject of cervical cancer. Yes, and We thank you, sir. Thank you. Thank you.

[01:37:31]Yes, sir. You're giving us tools now to work with. And we are very appreciative of the effort. Once again, I say thanks.

[01:37:42]>> And thank you for having me. And as I saw your name nurse Blair, but I didn't even realize [laughter] that it was my Blair.

[01:37:50]Yes, it is. It is my Blair. Yes, doctor, it is. I'm grateful for the opportunity.

[01:37:57]Yes, sir.

[01:37:59]Okay.

[01:38:00]Welcome, sir.

[01:38:02]Yes, thank you. All right.

[01:38:05]Sister Sister Sharon Sister Sharon Sister Sharon is apparently half probably [laughter] half asleep.

[01:38:22]I'm right here. Oh, you're you're not half asleep. Okay. Do you Would you like to say anything else before we close?

[01:38:32]Um sister nurse Turner Yes, yes. You have a part You have a a item on the program, don't you? You still going to do it?

[01:38:45]No, I I based on the time, I won't. I will do it at another time. All right.

[01:38:51]Okay. Okay. Um Okay, that would be it for the night then sister Valerie.

[01:38:58]So we Okay, so I'll just take the opportunity to thank everybody again for coming on and I'm sure that we all have benefited immensely And thanks again, Dr. Miller. We can't thank you enough.

[01:39:21]And I'm just I just want to wish everybody now a good night and a good day tomorrow.

[01:39:27]Yes, and thank you, sister Valerie, and thank everyone for coming on the platform to be informed. God bless you.

[01:39:34]You're welcome. Bless you.

[01:39:36]>> Blessings. Good night.

[01:39:38]Thank you. Good night. Blessings. Have a good night.

[01:39:43]Good night, everyone.

[01:39:44]Good night, everyone.