HPV and Cervical Cancer
Ever since the vaccine for cervical cancer was approved in 2006, I’ve been fantasizing about what I would say to anyone who asked me about it. Yes, actual fantasizing, to the point of having pretend talk show interviews in the shower. ("Ellen, I’m glad you asked me here today.") My opinion? You don’t want to have cervical cancer. You don’t want your daughter to have it. If your daughter were to get cervical cancer, it probably wouldn’t kill her, though it might. But it could make it hard, or even impossible, for her to have children.
I understand fears about new drugs. My life was altered by my mother’s decision to take a seemingly benign medication, DES. That’s why I think it makes sense that the FDA decided to recommend the HPV vaccine for girls and young women but not require it. I’m sharing my story in the hope it will help women make the vaccine decision for themselves and for their daughters.
More than 30 years ago, when I was 26, I had an emergency hysterectomy as a result of early-stage cervical cancer. I’d known since I was a teenager that it was important for me to get regular Pap smears. My mother’s obstetrician had put her on DES, a synthetic hormone, to help get her through her high-risk pregnancy with me. Eighteen years later, he called to tell her that my DES exposure put me at risk for a particularly aggressive kind of cervical cancer called clear-cell adenocarcinoma.
Almost from my first Pap smear, I had abnormal results, specifically, dysplasia. Doctors have wildly differing opinions about dysplasia. My layperson’s understanding is that it’s a kind of mild confusion among cells that can mean nothing more than that the body is trying to fight off infection. If you get a Pap smear and the doctor tells you it shows mild dysplasia, it’s probably no big deal. But because of my medical history, my doctors always assumed the worst, attempting at different times to freeze, burn, and cut out the abnormal cells.
What none of us realized was that the culprit was not DES but HPV, the virus that causes cervical cancer. Looking back, I must have been exposed to HPV in the early 1970s, while I was a student at the University of Texas in Austin. The sexual revolution was in full tilt and seemed to have the same weight and importance as protests against the Vietnam War. I wasn’t aware of HPV back then, and neither was anyone I knew.
Who Should Get the HPV Vaccine?
Because HPV is sexually transmitted, one of the things that makes it difficult to talk about is the assumption that "only sluts get it." I am overstating this, but perhaps only slightly. A friend’s pediatrician just told her that her daughter wouldn’t need the vaccine because she "wasn’t that kind of girl."
Was I that kind of girl? I did spend a couple of years behaving as if it were possible to separate sex and love, so I guess some people would say I was. Others would say that because I was a virgin until I was 18 and had pretty limited experience after that, I’ve got full "good-girl" credentials. Either way, it makes no difference. HPV is the most common sexually transmitted infection in the U.S. Women who are virgins when they marry and live monogamously can get the virus if their husband has had even one sexual partner before or outside the marriage.
There are many strains of HPV, and most don’t create problems. Some cause genital warts, which aren’t exactly a fashion accessory but aren’t the worst thing in the world. Some, like strains 16 and 18, which I have, can cause cervical cancer. It takes only one moment of intimate contact to get infected, and a condom won’t necessarily protect you (the virus can be found on areas condoms don’t cover). I shudder when I think of all the beautiful young girls out there giving oral sex and thinking they’re safe because they won’t get pregnant.
By the time I was 23, I had married, moved to Washington, D.C., and started working to put my husband through law school. My Pap smear results got a little worse. My new doctor told me that if I wanted to have children, I should go ahead and get pregnant. I remember hearing it as a casual comment: Of course I would have children some day. I was young and didn’t understand that my life could include absolute loss.