Does anyone know that January happens to be cervical cancer awareness month? Or that teal is the ribbon color commemorating thousands of innocent lives every year? More importantly, does anyone care? Why is it that every October we are inundated with pink—brawny NFL players showcasing pink cleats, both huge department stores and small mom and pop shops promoting pink drives, pink mascara bottles, pink flash lights? Undoubtedly breast cancer is a horrendous disease which directly or indirectly affects millions. But does that mean that the cervix must be demoted to evil stepsister status? Are the lives lost to this disease in any less of vain? And why is it that we hear breast cancer survivors and advocates clamoring from rooftops, while their cervical cancer counterparts are all too often afraid to even speak?
As an oncologist, this deadly female malignancy has always intrigued me for a multitude of reasons. For starters, its grossly neglected standing in society belies how common it really is. Worldwide statistics show that cervical cancer snatches one life every 2 minutes, while in the United States it kills roughly 4,000 women annually. What makes these numbers especially hard to swallow is that this is the one cancer in which death is almost completely avoidable. Unlike most tumors, it is exceedingly unique in that we have both primary and secondary preventative measures available to us. The latter refers to the pap smear, the highly effective early detection method which allows identification of most cancers at curable stages. This public health godsend has singlehandedly decreased cervical cancer death in America by approximately 70%.
Primary prevention comes in the form of the HPV vaccine, which is targeted against the microbe responsible for the majority of cervical cancer cases. In the world of medicine, the vaccine is nothing short of earth shattering, a true milestone. For the community at large, however, it remains a mystery mired in undue controversy. What is boggling is that while the lay public implores for a cure to cancer, the vaccine is as close to that ideal as we have ever been. In simple terms, we have available to us a vaccine against cancer, preventing upwards of 70% of all cervical cases. Unfortunate in that watershed realization is its gross underuse in this country. While other Western nations including Australia and England enforce school based mandates and are vaccinating their children at a rate of approximately 90%, America’s numbers remain abysmal at close to 40%.
This stark reality prompts a discussion of the most provocative aspect of cervical cancer—its intersection with much larger, more profound social issues. Part of our apathy lies in the assumption that it is a disease relegated to the developing world. While it is true that the global burden is heaviest in regions such as South-Central Asia and Eastern Africa, the reality check is that cervical cancer was once the leading cause of cancer death for American women as well. We remain relatively immune today only because of the widespread implementation of successful screening programs.
From a domestic perspective, this cancer has historically been known as a disease of the poor minority. It is a fact that Hispanic and African American women are not only at an increased risk of contracting the disease but also of dying from it. This is where the erroneous stigma of it all comes into play. Because of HPV’s strong sexual association, we assume that the women who are hit with this terror must have behaved in a promiscuous manner worthy of the diagnosis. But here is the zinger: about 80% of the US population has been affected with HPV at some point in their lives. So it follows that the real issue at hand is not loose morals, but rather the disparity in availability and accessibility of health care for our most destitute.
Our job is clear. We must de-stigmatize HPV and cervical cancer screening. We must encourage vaccination and demystify its implications. To allay the fear of many, a recent study found that administration of the vaccine does not alter the sexual behaviors or choices of our youth. And finally, we must educate not only our legislators, but more importantly parents and teachers. My earnest hope is that cervical cancer is no longer a compelling talking point but rather the first cancer to ever be eradicated. As a brave and beautiful survivor recently told me, “No one claimed it was an easy cause to care about, but we owe it to our fallen sisters to give them the voice they needlessly lost.” We have the tools, all we need now is a voice.
Mamta Singhvi, M.D.
UCLA Department of Radiation Oncology