By Josh Fischman
Evita's Cancer
The silence surrounding cervical cancer a generation ago is giving way to an era of increased communication—and optimism
By Josh Fischman
A missed Pap test was behind Paige Anderson’s cancer, too. “I’d been having them every year since about, oh, 1985,” says Anderson. “When I was in high school, I didn’t know anything about cervical cancer. But that summer, which was just before I left for college, my mom set up an exam for me. She never said the word ‘cancer.’ I think she told me it was something I needed to do each year for good health.” So Anderson did, faithfully, until she got married in 1997. “My doctor told me I didn’t need to do them [as often], since I was married and healthy and had no risk factors for disease.”
Several years went by. “I could kick myself,” she says now. “I have a master’s degree. I’m not ignorant. I should have known better.” American Cancer Society guidelines do say that women older than 30, with three negative test results in a row, can skip the Pap smear for two or three years—but not longer.
Early in 2004, Anderson and her husband, Mark, decided they wanted kids, and that sent her back to a doctor. “He tried to do a Pap smear, but it hurt me too much,” Anderson says. “I actually started bleeding.” To do an exam, the doctor had to anesthetize her. He did a biopsy. When Anderson woke up, he told her that he’d call her with the results on Monday, after the weekend.
“So on Monday, he came at me with the C word,” Anderson remembers. “The whole world kind of tilted on me. He was talking to me, but I heard most of it like the teacher in Peanuts: ‘Waaa waa waaa. Waaa waa.’ ”
Unlike Eva Perón, Anderson had options. Her stage IB2 cancer—an advanced stage I tumor—was too big for surgery, her doctors told her. But she could have a series of radiation treatments, plus a course of chemotherapy. Radiation would destroy her ovaries, Anderson learned, but at least there was hope for life.
Her husband, who had been looking up cancer treatments on the internet, and other family members pushed for a second opinion. So Anderson flew to California—where she grew up—and met with Karlan, the director of the Women’s Cancer Research Institute at the Cedars-Sinai Medical Center in Los Angeles. After examining some imaging scans, Karlan told Anderson the tumor wasn’t quite as big as her other doctors believed. It could be removed surgically. That would allow Anderson to keep her ovaries, the natural estrogen they produce, and her quality of life. “To me, it’s very important to coordinate care for the whole patient,” Karlan says. “You’re not just an ovary or a cervix. You’re a wife, a mother, a daughter.”
Anderson—wife, daughter, cancer patient—decided that surgery was the right step. Even if it didn’t work, she could fall back on radiation later. A week after her hysterectomy, Karlan gave her good news: It looked like the surgery removed all the cancer. And CT scans every year since have found no evidence of the disease. Neither have Pap smears, which she initially got every three months after surgery and now is getting every four to six.
The biggest shock for Anderson, after hearing her diagnosis, was learning about HPV. “I didn’t know the virus caused cancer. I didn’t know how the heck I got it.”
She got it because almost everyone does. The virus is ubiquitous. It lives in skin cells, and particularly in those that line body cavities. That means it can be passed from person to person through sexual contact—not just intercourse, but skin rubbing against skin. Luckily, the body gets rid of most HPV infections all by itself. The virus that lives in the skin leaves by way of the skin: We’re constantly shedding skin cells, and we usually dump the virus with them. At any given time, for instance, about 25 percent of teenage women are infected with HPV, but only a tiny fraction develop an ongoing infection. The virus usually just goes away.