October 07, 2019
Thirty-year-old women with babies in diapers, toddlers in daycare and children in grade school should not be fighting cervical cancer. Sadly, I have seen 2 of these young mothers in the last week.
Several months after giving birth to twins, Kelly* was having irregular bleeding. She saw her gynecologist, who noted mild changes on Kelly’s Pap smear. But the bleeding wouldn’t stop. Within 6 months, Kelly was in my office with advanced cervical cancer.
Kelly, who recently completed chemotherapy and radiation therapy, brought her 3-year-old daughter to our last visit. The adorable little blonde with big rosy cheeks was worried because her mommy was spending so much time at the doctor’s and needed to have another exam. I had good news for her mom. She had responded well to treatment and was in remission.
My second patient is not as fortunate. She came to me with progressive cervical cancer, which did not respond to chemotherapy or radiation therapy. Dana* lit up as she told me about a recent visit with her boys, ages 8 and 10. She showed me pictures of their adventures at the library and their paintings of the fall leaves.
Dana no longer has the strength to care for them and relies on her family for assistance. At 32, Dana is facing an incurable cervical cancer. When we meet, we work together to optimize her quality of life, address her pain and symptoms, discuss her future wishes and plans for herself and the boys. I address her palliative care needs to improve the quality of her life in the time she has remaining.
Cervical cancer is predominantly caused by the human papillomavirus (HPV), and today this is a preventable illness. Pap testing has reduced cervical cancer rates significantly in industrialized countries, but it hasn’t yet brought the number of cases to zero. Both of my patients had regular screening exams and yet their HPV-related cervical cancers were not caught in time.
We can, and must, do better.
A vaccine that targets cancer-causing HPV has been available since 2006. In October, an improved, 2-dose version of the HPV vaccine, which targets 9 different types of the virus, was approved by the Food and Drug Administration. For 10 years, we’ve had a vaccine that can prevent cervical cancer and multiple other HPV-related cancers. And yet, millions of adolescent girls and boys are not being vaccinated. Kansas and Missouri have 2 of the lowest rates of HPV vaccination in the country.
My hope for the future, and my challenge to the community during Cervical Health Awareness Month each January, is to support the vaccination of girls and boys against HPV. We must do this so we do not have another 30-year-old mother facing an incurable cervical cancer diagnosis. We cannot allow our women and girls to slip through the cracks when we have a safe and proven method of preventing this horrible disease.
*Names are changed to protect patient confidentiality.
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