Happy screening, happy life (saving)

“Our flight time from San Francisco to South America today will be 14 hours,” the pilot said by intercom. His sing-song accent seemed oddly happy about the long flight. He repeated his greeting in Portuguese and would go on to give bilingual announcements more than a dozen times before we landed. It was a marathon. Yet hours later, his voice remained cheerful-to-a-fault as we deplaned, “Thanks for flying with us, folks. Happy travels. Happy life.”

Airport lines winded on for over an hour. As I snaked around, one customs agent caught my view - also oddly happy – processing travelers with a consistent smile that would have hurt my cheek muscles. Her voice had the same rhythmic inflection once I fell into her line and approached with my documents. “Bem-vindo ao nosso lindo país,” she said and then translated, “Welcome to our beautiful country.” There’s no reason to be that happy in customs, I thought.

The turbulent, hour-long, connecting flight in a small propeller plane gave me instant regret - but also a low-altitude, birds-eye view of the terracotta-clay interior region of the state of Sao Paulo. Swaths of red soil were cut by green patchworked rows of banana trees. The final drive that followed – to Barretos, a small city known for its rodeo, cowboy boots, and Sertanejo country music – was a humbling close-up introduction to this landscape and its rural poverty. At a roadside fruit stand baking in heat, a caged oscillating fan blew flies cyclically upwards, into acrobatic hovers, then back down onto small bananas, star-shaped Carambola, cans of Guaraná, and sliced Maracujá passion fruit seeds - with each rotational sweep. A worker came in from the fields, greeted me on dirt floors with a wide toothless smile and an oddly happy voice, “Obrigado, você!” – “No, thank you,” he said in departure. It became a theme of my visit – people all around happier than expected. Perhaps they knew things could be worse and were grateful they weren’t.

I had been awarded a global health research grant by the American Society of Radiation Oncology to modernize radiation treatments for women with cervical cancer in rural Brazil. Barretos, I learned, had remarkably transformed itself into a destination for cancer care. By sheer willpower, hospital pioneers had projected a reputation of excellence and unprecedented compassion that brought thousands seeking treatments from cities and remote villages alike. Many braved days of travel on steep dirt roads by the busload. Known as the Hospital of Love (Hospital do Amor), the enigma facility operated like St. Jude Children’s Research Hospital in Memphis – entirely on donations. It competed with larger profitable private hospitals, frugally served me and its employees a simple daily breakfast of buttered bread with water, and impressively offered free cancer care to thousands, including women with cervical cancer.

Cervical cancer is caused by the human papillomavirus (HPV) - a common sexually transmitted disease present in most Americans. HPV microscopically burrows inside cells and hijacks DNA replication machinery to make copies of its own genetic material. Once detected, the body usually eradicates HPV infections without later problems. However, certain strands of the virus leave the DNA copying machinery permanently damaged and prone to future mistakes once work resumes replicating human DNA. Over years to decades, this propensity for copy mistakes increases the odds of unintended DNA mutations that later change cell instructions and result in atypical cell behavior and appearance. Cells can turn into fully-rouge cervical cancer in about 2% of infected women, growing into colonies large enough to bleed.

Stage describes how far a cancer has spread when discovered – typically assigned a number 1 through 4. If cells have burrowed upwards into the uterus (stage 2) or outward into neighboring lymph nodes (stage 3), cure is possible but difficult. If cells have already invaded the blood and circulated around the body (stage 4), cure is impossible. Many young women have died, first not noticing anything wrong, then bleeding for months, then finding cancers too late.

Cervical cancer is more deadly in Brazil than the US for one primary reason: Pap smears. “Pap smear” is the nickname of a test invented in the 1940s by Cornell University physician, Dr. Georgios Papanikolaou. His research into scraping and then “smearing” cells of the cervix to look for abnormalities and signs of HPV was a breakthrough in early cancer detection that dramatically reduced mortality. His surname shortened, “Pap” smears (and now HPV vaccines) are more readily available and widely utilized in the US than Brazil. The chance of surviving cervical cancer for 5 years is 92% if found early and only 58% if more advanced. America’s most lethal threat is lung cancer, where the chance of surviving for 5 years is 60% if found early and only 22% if more advanced (American Cancer Society. Cancer Facts & Figures. 2022).

Screening is key to curing cancers in Nevada County and is available locally for cancers of the cervix, breast, colon/rectum, lung, prostate, and skin. Depending on your age and risk factors, a Pap smear, mammogram, colonoscopy, lung CT scan, PSA blood test, or skin check screening can ensure early staging - and early staging is lifesaving. Discovering cancer early is oddly happy – like I learned in Brazil, you’ll realize things could be far worse, and you’ll be grateful they aren’t.

Contact your doctor, visit www.cancer.gov/about-cancer/screening, or contact the SNMH Cancer Center at 530-274-6600 for more information about cancer screenings. Cancer in Your Corner aims to advance public health, bolster community trust, and enhance readership understanding through medical storytelling. Dr. Hess is the Director of Radiation Oncology at Sierra Nevada Memorial Hospital. His views do not reflect official positions of CommonSpirit Health, Dignity Health, or Sierra Nevada Memorial Hospital. Some aspects of this article are fictionalized history but are based on a true story. Names are fictitious to protect confidentiality.