The new mother with the 2-month-old girl told me, very kindly, that she didn’t need to have her postpartum follow-up visit with an obstetrician, because she was fine. I mentioned the value of the visit, including her routine care and her Pap smear. Her response was very quick and clear, “If God wants me to have cervical cancer, I will have it.”
I’ve heard this sort of response before, but usually from older adults who’ve been advised to get colonoscopies and mammograms. I had never heard this from a young woman.
I think this conversation has stayed with me because as Kentuckians, we continue to see rates of cervical cancer and other HPV related cancers that are among the highest in the country. Our residents also tend to develop cervical cancer at a younger age, on average, compared to most other states. For decades we have studied the situation and tried numerous public health interventions at the state and local levels to increase screening rates for cervical cancer and facilitate access to treatment for low income women.
have an opportunity and an obligation as pediatricians to end these grim
statistics in Kentucky and elsewhere. One of the most effective ways we can do
this is by counseling families about the importance of getting the HPV vaccine
at the start of adolescence.”
At the same time, Kentucky has some of the highest rates of low birth-weight babies. Cervical health plays a vital role in carrying a child to term, and cervical biopsies for abnormal Pap smears related to HPV compromise cervical integrity. As community health centers, we closely track our screening rates and invest time and resources in outreach to women, tracking patients in complex registries. This data is followed closely nationally by the U.S. Bureau of Primary Health Care.
We have an opportunity and an obligation as pediatricians to end these grim statistics in Kentucky and elsewhere. One of the most effective ways we can do this today is by counseling families about the importance of getting the Human papillomavirus (HPV) vaccine at the start of adolescence. The vaccine protects against cancers caused by HPV infection, which claim the lives of 33,700 women and men in the United States each year. Our practice makes HPV a routine immunization and describes it as our first cancer prevention vaccine.
I find conversation about the HPV vaccine, which I usually begin when patients turn 9, to be very easy with families in our practice. We’ve been fortunate in being able to achieve an 83 percent HPV vaccine completion rate for our adolescents. The majority of families I see generally welcome the best that American health care has to offer, including all vaccines. It is not unusual for them to have crossed jungles and deserts, lived for decades in refugee camps, been forever separated from cherished family members, and escaped violence and wars just to have the opportunity to live and raise their families in the United States. (Some have taken 3 buses just to get to sit in my exam room that day.)
Now, they are Kentuckians. Overall, our state’s HPV immunization rates are still low, while HPV infection rates remain high. But we’re hopeful that we can change the HPV related cancer statistics for the next generation of Kentuckians.
* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.
Julia E. Richerson, MD, FAAP, serves as chair of the American Academy of Pediatrics national Committee on Practice and Ambulatory Medicine and practices with the Family Health Centers Iroquois office in Louisville. Dr. Richerson was a 2018 HPV Vaccine Is Cancer Prevention Champion Award recipient from the Center for Disease Control and Prevention, Association of American Cancer Institutes, and the American Cancer Society for her outstanding efforts to protect Kentuckians from cancers caused by HPV.