Dr. Almieda D. Cepedoza, known affectionately as Doc Apple, is an obstetrician-gynecologist based in Bohol. She completed her residency training at the Gov. Celestino Gallares Memorial Medical Center and served as the Training Officer of the Department of Obstetrics and Gynecology from 2019 to 2024. Dr. Cepedoza is an active consultant at several hospitals, including GCGMMC, Ramiro Community Hospital, ACE Medical Center Bohol, HNU Medical Center, MMG Cooperative Hospital, Tagbilaran Community Hospital, and Bohol Doctors Hospital. She also provides her services at lying-in centers in Tagbilaran City and operates her clinic at Ground Floor, Lim Hong Khu Medical Arts and Wellness Building, Celestino Gallares St., Tagbilaran City, Bohol.
Dr. Apple, an esteemed medical professional, holds Fellowships in the Philippine Obstetrical and Gynecological Society, Philippine College of Surgeons, Philippine Society of Climacteric Medicine, Association of Women Surgeons of the Philippines, and Academy of Medicine of the Philippines. She is dedicated to advocating for cervical cancer awareness and specializes in menopausal care. Dr. Apple earned her medical degree from the Cebu Institute of Medicine, where she was classmates with her husband, Dr. Florence Cepedoza, the first surgical oncologist in Bohol.
Cervical Cancer..What We Should Know About
By: Almieda Dueñas-Cepedoza, MD (Doc Apple)
Fellow, Philippine Obstetrical and Gynecological Society
Fellow, Philippine College of Surgeons
Fellow, Philippine Society of Climacteric Medicine (Menopause)
Fellow, Association of Women Surgeons of the Philippines
Fellow, Academy of Medicine of the Philippines
Imagine a vibrant woman whose life is abruptly upended by the silent big C of cervical cancer. She bravely faces not only the physical toll of this disease but also the emotional and psychological challenges it brings.
As a gynecologist, I have seen first hand the profound impact of cervical cancer on women ranging from their early 20s to late 60s, and how it reverberates through their relationships, families, and communities, leaving behind a trail of fear and uncertainty.
In the Philippines, the month of May is dedicated to Cervical Cancer Prevention Awareness.
Cervical cancer develops when cells in the cervix (the lower part of the uterus that connects to the vagina) start to grow abnormally.
I am truly privileged to partake in raising awareness about cervical cancer, with the aim of empowering and supporting these resilient individuals who could be our friends, family members, or colleagues, in their journey towards health and well-being.
What is the scope of the problem?
Cervical cancer is one of the most preventable and, when detected early, treatable cancers. Yet, 12 Filipina women die daily from cervical cancer. It is the second most frequent cancer among women between 15 and 44 years old, second to breast cancer, and it is often diagnosed at the very late stage of the disease.
Unfortunately, it is a grim reality that 3 out of 5 women diagnosed with cervical cancer will die within 5 years of diagnosis.
What causes cervical cancer?
Most cases of cervical cancer are caused by human papilloma virus (HPV), a sexually transmitted virus that is passed on through genital contact (vaginal and anal sex), or skin-to-skin contact.
Both women and men can become infected with HPV.
There are over 100 types of HPV, but there are certain types of high-risk HPV that can cause cervical cancer.
HPV is a lot more common than most people think. At least 50% of sexually active people will get genital HPV and most won’t know they have it. Of the 50-80% of women who will acquire an HPV infection in their lifetime, up to 50% of those infections will be a high-risk type HPV infection, but not everyone will develop abnormal cell changes.
For most people, HPV is cleared by the body’s defense system, however, some people may not clear the virus and the consequences depend on the type of HPV involved.
The most easily recognized sign of genital HPV infection is genital warts which appear within 3 months after infection.
These are seen in the vulva, cervix, vagina and anus of a women and scrotum, penis and anus of men.
Who are at risk?
A woman’s risk of developing cervical cancer increases if she has multiple sexual partners, if her partner has a history of multiple sexual partners, if she experienced early sexual debut, has a history of sexually transmitted infections, engages in smoking or passive smoking, has given birth to five or more children, and if her immune system is compromised.
What are the symptoms of cervical cancer?
Cervical cancer may not exhibit noticeable symptoms in its early stages. This is what makes the disease particularly dangerous, as the woman may be unaware that she is already affected by cervical cancer!
As the disease progresses, women may experience any of the following: (1) abnormal vaginal bleeding like bleeding in between periods or bleeding after sex, (2) abnormal foul smelling vaginal discharge, (3) abdominal or pelvic pain, (4) pain during sex, and (5) frequent or painful urination.
How can it be prevented?
Prevention strategies for cervical cancer can be classified into primary, secondary, and tertiary measures.
Primary Prevention means taking steps to stop cervical cancer from happening in the first place. This includes: getting vaccinated against HPV to prevent infections that can lead to cervical cancer, practicing safe sex to reduce the risk of HPV and other infections, and quitting smoking, as smoking can increase the changes of getting cervical cancer.
Secondary Prevention is about finding and treating cervical cancer early, before it causes serious problems. This involves and I have to emphasize getting regular PAP smear.
Tertiary Prevention focuses on preventing complications and recurrence of cervical cancer. This includes surgery, radiation and chemotherapy as well as providing support and care to improve the well-being and quality of life of individuals who have been diagnosed with cervical cancer.
When should PAP smear be done?
In the Philippines, it’s generally recommended that sexually active women aged 21 and older get a PAP smear every three years.
Some guidelines also suggest starting PAP smears within three years of the onset of sexual activity or at age 21, whichever comes first, and continuing annually until age 30, after which they may be done every 2-3 years if three consecutive normal pap smears are obtained.
Women aged 65 and older who have had adequate prior screening and are not at high risk for cervical cancer may discontinue routine PAP smear testing. However, women with history of cervical cancer, precancerous lesions, or other significant risk factors may need to continue screening beyond the age of 65.
If a woman has had a total abdominal hysterectomy for non-cancerous conditions, during which both the uterus and cervix were removed, PAP smears are generally not required since there is no longer a cervix present for testing. After receiving the HPV vaccine, routine PAP smear screenings are still recommended to detect any abnormal cervical cell changes, as the vaccine does not protect against all HPV types that can cause cervical cancer.
How to Prepare for PAP smear?
You should not schedule your PAP test for a time when you are having your period. If you have a scheduled PAP test within the next two days, it is recommended to avoid douching (rinsing the vagina with water or other fluids), using tampons, engaging in sexual activity, or applying any vaginal medications or creams. Practice relaxation techniques, such as deep breathing, before the test to help reduce anxiety and discomfort during the examination.
Cervical cancer is highly treatable when detected early through routine screening tests. As early stages often have no noticeable symptoms, it is crucial to get screened regularly. This can help identify potential health issues long before symptoms develop, lead to a better prognosis and enable more effective treatment. Routine screenings and HPV vaccination can help prevent cervical cancer. So ladies, lift up your skirts and save your life.