One of my patients and her husband were about to begin infertility treatments when a routine Pap test brought their plans to a halt. The screening detected an aggressive form of pre-cancer. After several months of consideration, the couple decided to forego trying to become pregnant so she could have a lifesaving hysterectomy.
This patient's surgery was one of three hysterectomies I performed recently for women in their thirties. Each developed a severe pre-cancer related to the human papilloma virus (HPV) that could not be treated with a less invasive procedure.
I have been in practice for 10 years, and currently see patients in a community gynecology practice. Approximately one out of every five women I see comes to me for a problem related to HPV. New data show, and my practice confirms, that many HPV infections do not "clear" but rather go dormant and reactivate later in life. Most of my patients are in their thirties and forties. Almost all are married. One had been abstinent for 26 years before her first positive HPV test.
"New data show, and my practice confirms, that many HPV infections do not 'clear' but rather go dormant and reactivate later in life."
If a woman's Pap or HPV test comes back with abnormal results, it often triggers years of follow-up. To catch pre-cancerous changes before they can develop into cancer, I remove a piece of the patient's cervical skin for biopsy. Some women will show severe pre-cancerous changes on their biopsies and require a minor surgical procedure to remove the diseased portion of their cervix to prevent the development of invasive cancer. I have to monitor the others for years with cervical biopsies to make sure they are not developing cancer.
In the United States, at least 8,000 men and women will die from an HPV-related cancer this year—a death toll similar to measles in the pre-vaccine era. As a gynecologist, I see HPV vaccination as an incredible advance, and a way to vastly improve the lives of women and men by protecting them during adolescence. Gynecologists already have made a difference among women coming into our offices for cervical cancer screening—if they've been vaccinated, their chances of having pre-cancer are dramatically lower. I encourage healthcare providers and physicians treating adolescents to strongly recommend this life-saving vaccination for all their patients.
Rebecca Perkins, MD, MSc, serves on the Project Advisory Team for the American Academy of Pediatrics cooperative agreement on improving HPV vaccination rates, which is funded by the Centers for Disease Control and Prevention. An associate Professor of Obstetrics and Gynecology at Boston University School of Medicine/ Boston Medical Center, she has been actively involved in cervical cancer prevention research since 2003. Her work focuses on attitudes toward HPV vaccination in parents of low-income, minority adolescents in the United States and the providers who serve them. She is also studying interventions to improve HPV vaccination rates in low-income, minority adolescents.
Photo courtesy of the Massachusetts Medical Society