First Fridays in First Person. In the following excerpt from a New York

electron micrograph image of HPV

Times article, Dr. Ben Daitz gives a personal account of treating patients with cervical cancer and the changing technologies available for prevention and earlier diagnosis.

” ‘Someone please help me with my daughter!’ the middle-aged woman announced in the waiting room of our clinic. ‘She’s in the back of the car and I can’t carry her.’

I followed the woman to her car. Her daughter, in her late 20’s, lay huddled under a blanket in the back seat. Her face was ashen and her body cadaveric, and when I picked her up, she stared at me with hollow, dull eyes as her bones rubbed against my arms. Her mother told me that she’d brought her daughter back on a plane from New York City, where she’d been a ballerina. I had never seen an adult patient so thin, so emaciated. My patient said she had pain in her abdomen and pelvis, and when I did a pelvic exam, I did not know what I was
feeling. I only knew it was very bad.

That was almost 30 years ago, and I was feeling the contours of a cauliflowerlike mass, a so-called fungating carcinoma of the cervix, a cancer every bit as bad as it sounds. It caused my young patient’s death several weeks later.”

In this commentary, Vaccine Prevents Cervical Cancer. So, What’s the Down Side?, Dr. Daitz conveys the devastating cost of cervical cancer and then proceeds to discuss the cost and benefits of a newly developed vaccine.

In the decades since, routine Pap test screening has been established to identify and diagnose changes in cervical tissue before it actually progresses to cancer. Moreover, nearly two decades of biomedical research has taught us that these changes and specifically cancerous tumors are caused by the Human Papilloma Virus (HPV). This is a sexually-transmitted virus without symptoms infecting upwards of 6 million men and women yearly. In 2006, the Food and Drug Administration (FDA) approved a vaccine that prevents two types of HPV (HPV 16 and 18 ) that cause 70% of all cervical cancers. The vaccine also prevents two types of HPV (HPV 6 and 11) that cause 90% of all genital warts. The prospect of protecting future generations of young men and women from HPV and young women from cervical cancer is truly exciting. But I agree with Dr. Daitz as he cautions against compulsory immunization. The existence of highly accurate Pap tests, condoms, and treatments for infections means that HPV infection does not guarantee certain death or disability as is the case with current infectious disease against which we currently require immunization by law. Society cannot allow technology to out pace its ethics. Mandatory HPV vaccination is an unnecessary violation of a patient’s right to autonomy—his or her right to refuse treatment. With appropriate education, we could significantly decrease the prevalence of HPV, if not eradicate the virus altogether. At this stage, however, it is inappropriate and unethical to sacrifice individual rights through compulsory immunization to accomplish this goal.

Source: statistics regarding HPV and cancer from the American Cancer Society website

Learn more: the National Library of Medicine Online Exhibit highlights HPV Vaccine development in Against the Odds: The Role of Science

Featured Health Observance. The US Congress has designated January as Cervical Health Awareness Month to increase public health education around cervical cancer and the importance of prevention and early detection. According to the American Cancer Society, approximately 11,000 cases of invasive cervical cancer were diagnosed in the United States during 2008. Moreover, researchers estimate that non-invasive cervical cancer (also called carcinoma in situ) is about 4 times more common than invasive cervical cancer. Unfortunately, nearly 4,000 women died from cervical cancer in the United States during the same period.

Once one of the most common causes of cancer death for American women, the increased use of the Pap test (the screening procedure that identifies changes in the cervix before cancer develops) provides doctors the best chances to cure the disease. While the death rate from cervical cancer continues to decline yearly, disparities exist in the survival rates among women of different ethnicities. Cervical cancer occurs most often in Hispanic women with a prevalence rate over twice that in non-Hispanic white women. This is followed by African-American women who develop this cancer about 50% more often than non-Hispanic white women. So we take the month of January to highlight the importance of Recommended Preventive Health Screenings for Women, specifically the Pap test, for preventing cancer and maintaining health.

Learn more: Can Cervical Cancer Be Prevented, Frequently Asked Questions about the HPV Vaccine, National Cervical Cancer Coalition website