Many of my patients are scared of having abnormal Pap Smear. The idea strikes terror in their hearts as they think they may have cancer of the cervix. I recently had to do a hysterectomy on a 34 year old patient because her mother died from cervical cancer and her cervical cells on biopsy showed severe dysplasia. Even after removal of the diseased area on the cervix she still was scared and wanted hysterectomy because she saw how her mother suffered. I am therefore thrilled that finally there is a vaccine that will prevent this horrible disease.
My second patient had no insurance and hence had been using the emergency room(ER) for her healthcare. She went to the ER whenever she had any medical problems. I was called to the hospital to see her after she had been admitted with vaginal bleeding and abdominal pains. Pelvic examination showed a hard tumor in the vagina involving the right side of the pelvis. Further tests showed her right ureter, the tube that drains her right kidney to the bladder was blocked and the disease had spread beyond the pelvis. She died 2 months later.
Cancer of the cervix and genital warts are caused by the Human Papilloma Virus (HPV). The HPV affects the anus , vulva, vagina and penis and are transmitted by sex. There are many different types of HPV. If left untreated the disease can cause precancerous changes on the cervix that, if also untreated, can lead to cancer of the cervix. Other risk factors for cervical cancer include:
- Having sex at an early age
- Multiple sexual partners
- Sexual partners who have multiple partners or who participate in high-risk sexual activities
- Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1970s to prevent miscarriage
- Long-term use of birth control pills (more than 5 years)
- Weakened immune system
- Infections with genital herpes or chronic chlamydia infections
- Poor economic status (may not be able to afford regular Pap smears)
The vaccine, preferably, should be given to girls before they become sexually active. However it is recommended for the age group 9-26 years. It is assumed that even if sexually active women are infected they may not be infected with all the 4 types of HPV. Research on the safety and effectiveness of the vaccine in women over 26 years has not been completed, though some physicians have suggested that the vaccine be given to women over 26 years old. Three injections are given over 6 months. The second and third doses should be given at two and six months after the first dose.
The vaccine would be a boon to the third world where no or minimal screening for cervical cancer is done. Many patients go to the hospital when they start bleeding at which time the cancer is at an advanced stage. It is in this light that the Brazil government should be commended for considering giving the vaccine free of charge to its qualified citizens. Even in the US, the cost may prevent some people from getting the vaccine. That is why we should applaud the announcement by the government of New Hampshire that it is going to offer the vaccine free to its qualified citizens - ( about 17,000 girls and women).
The 2 patients above show how important this discovery is. People are still dying in this country from this disease which is preventable. It is my hope that the insurance companies will pay for the vaccination to wipe out this scourge form this country.
