I met “Samantha” during my first rotation as an intern. She was a strong-willed and optimistic lady who weighed about 100 pounds. She was dependent on a tube in her stomach for nutrition, and she appeared 10 or 15 years older than her age of 44 years. Pictures of her children were next to her bed. I asked her how we could help her. She cried.
Her husband of 20 years was by her side and answered for her. “She wants to eat again,” he stated. Her tears worsened.
The problem is that Samantha would probably not tolerate normal food again because her digestive organs were permanently damaged from radiation to her abdomen and pelvis. Jennifer was a survivor of cervical cancer, a disease that claimed the lives of over 4,000 women in the United States in 2013. She was now in the hospital for the effects of the therapeutic radiation, an unavoidable consequence of her life-saving treatment.
We now know that cervical cancer is almost universally associated with various strains of human papillomavirus (HPV). During my college days in the late 1990s, I was part of a group that lectured to various living organizations on and around campus about sexually transmitted diseases (STD’s). The teaching at the time was that HPV was the most common STD on college campuses.
Many years later, I am far more enlightened. Today, I wouldn’t even classify HPV as an STD because, in most of us, it doesn’t result in a “disease.” The fact is that almost all of us have encountered one or more strains of this little pest and eliminated it without even knowing it was there. HPV had already come, gone, and would come again without sign or symptom for most or all of the people I lectured to. Only in very rare cases does it progress to cervical cancer. It is also responsible for cancers of the penis, anus, throat, and vulva, again, typically long after initial exposure and only among random unlucky victims.
I had the occasion of working as a medical technologist for a laboratory testing company after graduate school, and I briefly worked with a specimen processor named “Jenny.” Jenny was from a home of lesser means and had two small children as well as an abusive husband. She needed the job more for the health insurance than the money. Jenny had a heart of gold and a passion for her children, but her husband forced her to quit her job when he heard that there were other men working with her. Many years later, I thought I had recognized her in a store, so I tried to look her up on the internet before risking the embarrassment of approaching a stranger in public. It wasn’t Jenny in the store that day. A search of her name revealed an obituary. Cervical cancer had claimed another victim. Jenny was only 36 when she died.
Modern science brought us the HPV vaccine more than a decade ago, but some opponents have argued that providing the vaccine serves as a de facto promiscuity license. This is literally a vaccine that prevents cancer, and I will never understand why there persists such controversy, even today.
As a current physician, former microbiologist and card-carrying native of a poor conservative town where amorous activity with college locals unbeknownst to parents was often the only cure for boredom, allow me to explain how cervical cancer can materialize. Assume you have raised your morally straight and chaste daughter to abstain from sex until marriage at age 24. Her new caring and faithful husband had only one previous girlfriend who was unfaithful to him on one occasion which he never found out about. It turns out that the disloyal stranger had previously dated someone who was trying to break Wilt Chamberlain’s record for conquests. If this scenario is confusing, it should be, because now I am three or four completely asymptomatic outsiders removed from the happily married, spiritual couple. If the new wife is considerably unlucky, a cell containing DNA from the virus can cause the cell to lose its ability to stop replicating even though none of the other people in the scenario showed any sign of infection. While she never did anything wrong, the vaccine probably would have prevented the malignancy because her trained and prepared immune system would have blocked the virus from setting up shop.
The message I seem to get from those opposing the HPV vaccine for moral reasons is that their daughters ought to be subject to an unnecessarily slow and painful death because their parents believe that they have a handle on their child’s future sexual health, a complex future that will probably be dependent on tens or hundreds of strangers (if you keep working out that “past partners tree above”). I can’t help to think how exploitive and cunning viruses are to prey on this ignorance.
To reiterate, HPV is something that just about all of us have had. It doesn’t make you a tramp or a slut. It just makes you human.
Jenny and Samantha both grew up before the age of the HPV vaccine. While both women in my scenario are Caucasian, it should be noted that this disease affects African American and Latino women at a greater rate. Jenny’s children will never see their mother again, and Samantha’s suffering probably persists today if she has remained cancer-free. This doesn’t have to happen anymore.
Cory Michael is a radiologist.
Image credit: Shutterstock.com
