When I was in first grade my parents took us to visit their friends and my brother, sister, and I played with their children. While we were there the mother’s doctor gave her a pain shot. We knew she was sick, but people usually got better. A few months later she died. The children and father were crying. I later learned from my mother that she died from cervical cancer (female cancer of the opening to the womb). This used to be the leading cause of cancer death in young women. Most cancers attack seniors. The older you get the higher your risk of cancer (1). This cancer devastated young families because children were without their mothers and husbands were without their wives.
Since the 1950’s cervical cancer has been reduced by 70% in rich countries like the US but remains a devastating killer in underdeveloped countries. It accounts for one out of every 10 cancer deaths in women worldwide (2). The breakthrough was from a Greek doctor and scientist, George Papanicolaou (3). In 1913 he emigrated to the US to work at the Department of Pathology at New York Hospital. Testing the vaginal fluid of female guinea pigs, he discovered malignant and premalignant cells that could easily be seen. He published his research in 1928. This was the birth of the Pap smear. He then applied this knowledge to humans, but it did not become widely accepted until the 60’s (4).
The key to the reduction in deaths was being able to detect and eliminate precancerous cells (dysplasia). The detection and elimination of dysplasia allowed us to prevent the development of cervical cancer and its deadly consequences. By getting a yearly Pap smear, women were able to prevent this cancer (and the need for radiation, radical surgery, and chemotherapy). Many women think that they have and are being treated for cervical cancer when they have an abnormal Pap smear and dysplasia. Dysplasia is easily treatable and can prevent the development of cancer. Dysplasia is a disease of the surface layer of the cervix and can only be seen looking at cells under the microscope. No one has ever died from dysplasia, but left untreated or undetected it can progress into deadly cancer. Cancer is when these cells start invading down into the tissue beneath the surface layer. The process from dysplasia to cancer usually takes several years so there is ample time to catch and treat this abnormal change before it becomes the deadly cancer. Dysplastic cells can be easily frozen, cauterized, or surgically removed (simple outpatient procedure). Freezing or cautery will not cure cancer. Radical surgery and/or radiation is necessary to cure cervical cancer if it is detected early enough. Early cervical cancer can now be cured 90+% of the time. It is always best to detect and eliminate dysplasia before it has a chance to progress into cancer.
Dr. Papanicolaou’s discovery of the Pap smear was even more incredible when you understand we were able to detect, treat, and eliminate dysplastic cells before they had a chance to progress into cancer, without even knowing the cause. In the late 1990’s we received scientific proof that cervical cancer was caused by the human papillomavirus (HPV) (5,6). About 15 different types account for most of the cases of cervical cancer worldwide. Type 16 alone is responsible for 50% of cervical cancer cases and deaths. Type 18 is responsible for another 20%. The new HPV vaccine, GARDASIL®9 (Human Papillomavirus 9-valent Vaccine, Recombinant) prevents 90% of the worldwide cases of cervical and penile cancer and 90% of genital condyloma (warts)(7). Eighty percent (80%) of men and women will get an HPV infection during their lifetime. The vaccine only works if given before exposure to these viruses. It does not do any good to give the polio or smallpox vaccine to someone that already has polio or smallpox. A two-shot series 6-12 month apart is recommended between ages 9-14. Just as our parents and grandparents prevented us from getting smallpox and polio by getting us vaccinated as children, we need to protect our children from cervical and penile cancer when they are older. Only 60% of teens received this vaccine in 2016 (8). This means that 40% of parents have left their children at risk of dying from these cancers that are preventable (cervical and penile cancer). A vaccine is a small price to pay for not dying from smallpox, polio, and preventable cancer. Only two cancers are currently preventable using vaccines. We will discuss prevention of liver cancer in another story about the Hepatitis B vaccine.
Reference
1.) National Institutes of Health. Cervical Cancer. NIH Consensus Statement. 1996;14(1):1–38.
2.) Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74– 108. [PubMed: 15761078]
3.) https://en.wikipedia.org/wiki/Georgios_Papanikolaou
4.) Papanicolaou GN, Traut HF. "The diagnostic value of vaginal smears in carcinoma of the uterus". American Journal of Obstetrics and Gynecology. 1941;42:193.
5.) Bosch FX, Manos MM, Munoz N, et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995;87:796–802. [PubMed]
6.) Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12–19. [PubMed]
7.) https://www.cdc.gov/hpv/parents/vaccine.html
8.) https://www.cdc.gov/hpv/hcp/vacc-coverage/index.html