By Josh Fischman
The silence surrounding cervical cancer a generation ago is giving way to an era of increased communication—and optimism
By Josh Fischman
Eva Perón—Evita, the powerful first lady of Argentina in the late 1940s and early 1950s, the subject of many myths and a Broadway musical—was never told by her husband or doctors about the cervical cancer that killed her when she was 33. She never even saw the surgeon who operated on her, in secret, to try to save her life.
Paige Anderson also had to face this cancer, but at a different time and in a very different way. In early 2004, the congressional staffer was told she had cervical cancer three days after her doctor first suspected it, as soon as lab tests confirmed the diagnosis. Anderson, who lives in Alexandria, Va., developed a close rapport with her surgeon, gynecologic oncologist Beth Karlan. “I am so grateful to her,” says Anderson, now 39. “She gave me options when I thought I didn’t have any. I think I’m here today and healthy because of her.”
A lot has changed in the world of cervical cancer diagnosis and treatment in the last half century. Secrecy, for one thing. “It was pretty common to conceal a cancer diagnosis in the 1950s. Doctors usually did it in cahoots with a patient’s family,” says Barron Lerner, an internist and historian at Columbia University who has studied Perón’s medical care and death. Doctors, he says, thought the word “cancer” would lead a patient to give up all hope.
But today, secrets have been pushed aside by optimism. The Pap test, now in widespread use in developed countries, has made early detection possible and dramatically raised survival rates. Doctors also understand now that almost all cases of the disease are caused by the human papillomavirus, or HPV. That’s led to one big breakthrough earlier this year: the U.S. approval of a simple vaccine against the virus for girls and women between the ages of 9 and 26. Three shots in the arm, like flu shots, should provide 100 percent protection from the types of HPV that cause most cancers, according to clinical trial results. “For young women and girls who get the vaccine, it’s going to be a whole new world,” says Diane Harper, a physician and cervical cancer specialist at Dartmouth Medical School.
One thing that hasn’t changed about cervical cancer: It continues to be a major problem worldwide. Nearly half a million women are diagnosed with it every year, according to recent estimates, and more than 288,000 die. It’s the most common cancer diagnosis after breast cancer among women in the developing world. And the less developed a country, the more severe the problem. In the U.S., there are about eight cases per 100,000 women. In Argentina, more than 50 years after Perón’s death, the rate is nearly double that. In the world’s poorest countries, cervical cancer skyrockets to 30, 60 or even 90 cases per 100,000 women.
The reason for the differences: a lack of good screening programs, including annual Pap smears. For the test, a doctor uses a swab to take a sample of cells from the cervix—the area where the uterus opens into the vagina—and has the cells examined to detect abnormalities. The results come in three general categories: negative (which is good); cell abnormalities (which could be precancerous or actual cancer); and other neoplasms (uncommon types of gynecologic cancers such as melanoma). The test was invented in the 1920s. By the 1940s, the American Cancer Society was campaigning hard for yearly testing. “In the U.S., the Pap test was the first great success of cancer prevention,” Lerner says.