AAP Voices Blog

During a typical day at my practice, a little hectic and very busy, I had an unusual conversation with a new mother of a 2-month-old girl. Our office, part of a multi-site community health center in Louisville, KY, serves the most diverse neighborhoods in our city. Most of our families speak a language other than English at home, and come from homelands across Mexico and Central America, Africa, Asia and Europe.

I love my role as cultural ambassador, telling families how pharmacy refills work, how to help get their child into the "magnet" public school, and where to go to find the best playgrounds. Most of my conversations through the day with families and children are very interesting, but this particular one has stuck with me for years.

During the first few well visits for an infant, I usually focus on the health of the mother. I ask if she has help at home, for example, how breastfeeding is going, and whether she is getting adequate nutrition. I also inquire how her mood is, if she has thought about spacing and birth control, and whether she has her follow-up appointments scheduled with the obstetric provider.

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.

"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 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.