Abstract:

Cervical cancer is a serious health threat for Indigenous women in Guyana's remote Region 9 (Upper Takutu-Upper Essequibo). To understand why, we spoke with 101 Amerindian women (Makushi and Wapishana), ages 21 to 65, at health centers and community events across the region between November and December 2025. We asked them about their knowledge, attitudes, and practices around cervical cancer screening, HPV, and the use of traditional medicine.  Our survey found that the average age of participants was 32.6. While over 60% had an HPV test (with 27.7% testing positive), less than half (44.6%) had ever had a Pap smear. At the same time, traditional medicine plays a major role in their lives. Over 40% of the women consult traditional healers, mostly for women's health issues, and many use both traditional and modern treatments. The biggest hurdles to getting medical care were distance (67.3%), cost (47.5%), and long waits at clinics (41.6%). Our findings point to a critical gap in cervical cancer screening and highlight how central traditional medicine is to healthcare for these communities. This shows an urgent need for health programs that are culturally aware and blend modern and traditional approaches to improve women's health in Region 9.

References:

[1].   Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., Bray, F., 2021, Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA A Cancer Journal for Clinicians, 71(3), 209–249, https://doi.org/10.3322/caac.21660

[2].   Arbyn, M., Weiderpass, E., Bruni, L., de Sanjosé, S., Saraiya, M., Ferlay, J., Bray, F., 2020, Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. The Lancet Global Health, 8(2), e191–e203, https://doi.org/10.1016/S2214-109X(19)30482-6

[3].   Cohen, P. A., Jhingran, A., Oaknin, A., Denny, L., 2019, Cervical Cancer. The Lancet, 393(10167), 169–182, https://doi.org/10.1016/S0140-6736(18)32470-X

[4].   Bruni, L., Albero, G., Serrano, B., Mena, M., Gómez, D., Muñoz, J., Bosch, F.X., de Sanjosé, S., 2019, ICO/IARC Information Centre on HPV and Cancer. Human Papillomavirus and Related Diseases in the World. Summary Report. https://www.hpvcentre.net/statistics/reports/XWX.pdf

[5].   GLOBOCAN, 2020, Cancer Today: Guyana. International Agency for Research on Cancer. https://gco.iarc.fr/today/home

[6].   Forte, J., Melbye, M., Guevara, A., 2018, Health disparities in Indigenous Communities of Guyana. Journal of Rural Health, 34(2), 145–153, https://doi.org/10.1111/jrh.12272

[7].   UNDP Guyana, 2020, Sustainable Development Report: Hinterland Communities of Guyana. United Nations Development Programme. https://www.gy.undp.org/

[8].   World Bank, 2019, Guyana Health Sector Assessment. World Bank Group. https://www.worldbank.org/en/country/guyana

[9].   Robinson, M. M., Zhang, X., 2011, The world medicines situation 2011: Traditional medicines: global situation, issues and challenges. World Health Organization. https://apps.who.int/medicinedocs/documents/s18063en/s18063en.pdf

[10].  WHO, 2019, WHO Global Report on Traditional and Complementary Medicine 2019. World Health Organization, Geneva. https://www.who.int/publications/i/item/978924151536

[11].  Vandebroek, I., Thomas, E., Sanca, S., Van Damme, P., Van Puyvelde, L., De Kimpe, N., 2004, Comparison of Health Conditions Treated with Traditional and Biomedical Health Care in a Quechua Community in Rural Bolivia. Journal of Ethnobiology and Ethnomedicine, 4, 1, https://doi.org/10.1186/1746-4269-4-1

[12].  Picking, D., Younger, N., Mitchell, S., Delgoda, R., 2011, The prevalence of herbal medicine home use and concomitant use with pharmaceutical medicines in Jamaica. Journal of Ethnopharmacology, 137(1), 305–311, https://doi.org/10.1016/j.jep.2011.05.025

[13].  Launiala, A., 2009, How much can a KAP survey tell us about people's knowledge, attitudes and practices? Some observations from medical anthropology research on malaria in pregnancy in Malawi. Anthropology Matters, 11(1), 1–13, https://doi.org/10.22582/am.v11i1.31

[14].  De Sanjosé, S., Diaz, M., Castellsagué, X., Clifford, G., Bruni, L., Muñoz, N., Bosch, F. X., 2007, Worldwide prevalence and genotype distribution of cervical human papillomavirus dna in women with normal cytology: A meta-analysis. The Lancet Infectious Diseases, 7(7), 453–459, https://doi.org/10.1016/S1473-3099(07)70158-5

[15].  Torres-Cintrón, C. R., Ortiz, A. P., Tortolero-Luna, G., Pérez-Irizarry, J., Zavala, D., 2020, Disparities in cervical cancer incidence and mortality by race/ethnicity and rurality in Puerto Rico. Cancer epidemiology, biomarkers and prevention, 29(10), 2072–2079, https://doi.org/10.1158/1055-9965.EPI-19-1454

[16].  Ginsburg, O., Bray, F., Coleman, M. P., Vanderpuye, V., Eniu, A., Kotha, S. R., 2017, The global burden of women's cancers: A grand challenge in global health. The Lancet, 389(10071), 847–860, https://doi.org/10.1016/S0140-6736(16)31392-7

[17].  Heinrich, M., Mah, J., Amirkia, V., 2020, Alkaloids used as medicines: Structural phytochemistry meets biodiversity—An update and forward look. Molecules, 26(7), 1836, https://doi.org/10.3390/molecules26071836

[18].  Atanasov, A. G., Zotchev, S. B., Dirsch, V. M., Supuran, C. T., 2021, Natural products in drug discovery: Advances and opportunities. Nature Reviews Drug Discovery, 20(3), 200–216, https://doi.org/10.1038/s41573-020-00114-z

[19].  Cumberbatch, M., Goulbourne, C., Rampersaud, J., 2019, Barriers to cervical cancer screening in the caribbean: A systematic review. West Indian Medical Journal, 68(3), 267–273.

[20].  Islami, F., Goding Sauer, A., Miller, K. D., Siegel, R. L., Fedewa, S. A., Jacobs, E. J., 2018, Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA: A Cancer Journal for Clinicians, 68(1), 31–54, https://doi.org/10.3322/caac.21440

[21].  Ministry of Health Guyana, 2020, National Cancer Control Plan 2020–2025. Ministry of Health, Georgetown, Guyana.

[22].  Bosch, F. X., Lorincz, A., Muñoz, N., Meijer, C. J. L. M., Shah, K. V., 2002, The causal relation between human papillomavirus and cervical cancer. Journal of Clinical Pathology, 55(4), 244–265, https://doi.org/10.1136/jcp.55.4.244

[23].  Lewis-Bell, K., Subhan, F., Mungrue, K., 2013, Cervical cancer in trinidad and tobago. West Indian Medical Journal, 62(3), 237–241.

[24].  Van Andel, T., Myren, B., van Onselen, S., 2012, Ghana's herbal market. Journal of Ethnopharmacology, 140(2), 368–378, https://doi.org/10.1016/j.jep.2012.01.032

[25].  Newman, D. J., Cragg, G. M., 2020, natural products as sources of new drugs over the nearly four decades from 01/1981 to 09/2019. Journal of Natural Products, 83(3), 770–803, https://doi.org/10.1021/acs.jnatprod.9b01285