Cervical Cancer Awareness

Cervical cancer is the second biggest cancer killer of women worldwide.  We know that nearly all cases of cervical cancer is caused by the human papillomavirus (HPV).  There are many types of HPV but we know that HPV types 16 and 18 are the most cancer causing.  That’s why there is a vaccine targeted to those two types.  There are many ways we can prevent cervical cancer.  For younger girls who have not yet had sex, the vaccine provides good protection against the cancer causing viruses.  For other women, regular screening at their doctor is important.  Screening means your health professional will take a Pap smear.  To do this, a cotton swab is used to gently take some cells from your cervix, no scraping is involved and it should not hurt. For other women, though more rare, they might have an HPV infection but it can just clear up on its own.  But all women should get a regular screening to make sure they are healthy.

Yet given all the things we can do to prevent cervical cancer, why do so many women die of cervical cancer? The answer is, it depends on where you live. In developed countries, which includes North America, Europe, and Australia, the risk of you getting of cervical cancer is only about 5%.  This is because there is regular screening to catch women who are at risk of developing it.  When they are screened, if there are any abnormalities the health professional will treat to prevent progression to cervical cancer.  In low income countries like Kenya, this does not happen as there are not enough resources to screen women. Therefore, over 80% of new cases and deaths due to cervical cancer are in low income counties like Kenya.

Women in Kenya suffer because there is no infrastructure in place to implement regular Pap screening.  However, many health professionals have looked at cheaper and more feasible alternatives to Pap screening. In Kenya, Dr. Megan Huchko from UCSF has helped to implement a cheap diagnostic called visual inspection with acetic acid. At HIV treatment clinics such FACES, where Dr. Huchko works, women can be seen for reproductive health services. As part of a routine check-up, women who attend the clinic have their cervix ‘painted’ with acetic acid, or plain table vinegar. Any abnormal cells turn white. These abnormal cells mean that there is an increased risk of cervical cancer, so it is important that they are removed. Women are offered removal, either through “shaving off” or freezing of abnormal cells in the clinic. A few studies have shown that this is a feasible and cost-effective method of cervical screening for women in low-resource settings.

Cervical cancer is a major risk to a woman’s health. High-income countries have procedures in place to screen women for this risk. Yet most women who live in low-income countries do not have these screenings, which leaves them more likely to die of cervical cancer.  Overall, it is important that we think about feasible solutions that can be used in low-income settings.

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HPV Stigma in Women of Color

When the English celebrity Jade Goody found out she had cervical cancer at age 27, there was an outcry of sympathy in the UK, as well as a stampede of young women rushing to the clinics. Most didn't know why they were heading to the clinic, but they knew they needed a pap smear, and they hoped that if they got this procedure done, it would mean they wouldn't die of cancer.

Goody, a darling of reality TV, found out about her cancer diagnosis on Bigg Boss, the Indian equivalent of the show Big Brother. She was on the show to try to make amends for previous crass and racist statements she made about the Indian actress Shilpa Shetty. (Goody herself was mixed race--half white and half West Indian.) Once diagnosed with cervical cancer, Goody immediately flew back to London where the general public worried, empathized and supported her in her journey.

The reaction in India was completely different. Members of the public went so far as to burn effigies of Goody. Many thought that she deserved to die for insulting Shetty, and she was being punished karmically by this devastating disease. Those who knew about the link between HPV (a sexually transmitted infection) and cervical cancer suggested that she had brought the disease upon herself.


But the attitudes of Indian men and women toward Goody's disease raises questions about the kind of support available to Indian women who have HPV. Because most forms of cervical cancer are linked to HPV (which is sexually transmitted), there are moral and ethical implications for women diagnosed with cervical cancer, especially in countries or cultures where monogamy and virginity-until-marriage is the norm. A study by Cancer Research UK looked at attitudes of HPV testing among Indian, Pakistani, Afro-Caribbean and White British women, and found that all of the women were confused about whether or not cervical cancer was linked to a sexually transmitted infection (in most cases it is). While all the women surveyed said that if they were diagnosed with HPV they would suspect their husbands of infidelity, only Indian and Pakistani women surveyed expressed fears that they would be blamed for contracting the virus from a man other than their husband.