First let me remind you that I’ve written extensively about HPV infection, cervical cancer, and Gardasil, the vaccine to prevent these. The links are at the bottom of the post for your reference.
OK, here’s the deal. A bloggy friend of mine is dealing with some serious health concerns due to HPV infection. I’ve written lots of pieces about the more intimate side of medicine, but no one can tell it like a patient. How someone deals with disease is a personal matter, and she has decided to “come out” and share her story in order to help others. (Digression: a great book called Everything Changes about dealing with cancer as a young adult is out, and it is also a bit harsh on our current health care system. It’s a Studs Terkel type oral history, and a good read.)
I’m sorry to keep getting derailed here, but for some reason, a lot of my friends have cancer, and it’s right in my face these days. I have one friend who’s had ovarian cancer since her baby was born four years ago, another who just had a bilateral mastectomy, another with metastatic melanoma—you get the idea. If there had been some way to prevent these cancers, either by aggressive screening to identify early disease or by primary prevention through, say, vaccination, I’d be a much happier person.
Which brings me back to my friend. The internet is a funny place. Stephanie and I certainly don’t agree about everything, but we do read each other’s stuff fairly regularly and have had the chance to meet in person, albeit far too briefly. I’m hoping she and her hirsute hubby will make it to ScienceOnline this winter. Anyway, like many Americans, Stephanie hasn’t always been able to get regular screening exams, and whether it’s because of insurance, finances, laziness, or aliens, the point is that screening (that is, Pap smears) requires an action on the part of the patient to understand risk and to present themselves to a doctor for an invasive and expensive exam at least once a year.
Like many American women, Stephanie harbors the human papillomavirus, and apparently her guest is one of the cancer-causing strains. This virus lives in her cervix and messes with the genes of cervical cells, causing them to reproduce uncontrollably. In her case, the malignant cells haven’t yet figured out how to invade very deeply, but they are spread out rather diffusely, making cure certain, but not easy. Stephanie has a good picture up at her place, but let me give you a little more detail. I find that people who don’t actually dig into other people regularly don’t always have a good feel for more hidden anatomy. You can check out the linked picture, but more helpful (at least for women) would be to ask for a mirror at your next gynecology appointment.
When a woman lays back on the exam table at her yearly exam, the doctor or nurse first looks at the outside of the vagina for any abnormalities such as external yeast infections or genital warts. They then open up the vagina with a speculum and can see the vaginal walls, and eventually the cervix, which at this angle looks a bit like a think donut. Depending on technique, a small, cylindrical brush is inserted into the cervix and rolled around to collect cells, and a wooden spatula is scraped around the outside of the cervix. Then the speculum is removed, and fingers are inserted internally and a hand is pressed against the pelvis to feel for any other abnormalities. Usually a finger is also inserted into the rectum to feel the tissue between the rectum and vagina.
If all this sounds rather invasive, it is. Some women have very little sensation in their cervix, but many women have a very sensitive cervix and yearly pelvic exams can be very, very unpleasant. For women with a history of physical/sexual abuse, the discomfort can be magnified a thousand-fold. So if you’re wondering how a woman could possibly fail to get a regular Pap smear, try a little empathy. In medicine, we find it tempting but ultimately not useful to blame people for their diseases.
So Stephanie is going to be fine. If left untreated, she’d have about a 50/50 chance of developing invasive cancer. If treated aggressively, some nasty cells can still come back, so she will need close monitoring. In this case, “aggressive treatment” means chopping or lasing out a large hunk of cervix, or maybe even a hysterectomy. Stephanie shared publicly that she is not interested in birthing babies at this point, but many women in her position are.
So there you have it. Stephanie is one of tens of thousands. Yes, Pap smears work and she is not going to die of cervical cancer. But wouldn’t it have been better for her to have been able to prevent this altogether? My daughter will likely never suffer what Stephanie is going through, because in a couple of years, she will be able to get the HPV vaccine. This vaccine is not free—like any intervention it has a cost associated with it. But if some day, my daughter forgets her Pap smear, she will be very, very unlikely to be stuck with cervical cancer, and her yearly Paps will be much less likely to detect abnormalities that will force her to undergo very unpleasant interventions. By the time she is old enough, boys will probably be getting the vaccine as well, reducing her risk even further (with certain assumptions made, of course).
The outcry against the HPV vaccine is coming from two places: the Religious Right, which should be immediately discounted as misogynist bullshit, and the antivaccination crowd, whose propaganda should be countered point-by-point. That has been done effectively at several other blogs, but in sum, there has been, despite millions of vaccines, no evidence of harm. None.
We can’t let superstition stand in the way of our the health of our daughters. It’s time to stand up to loud-mouthed, hate-filled demagogues and let everyone know that preventing the suffering of women is a good thing.
A few bloggy references