I saw many faces of death in my 37-year career as a physician.
There were very few related to pregnancy and very few related to gynecology, except for one: cervical cancer. I saw hundreds of women die of this terrible cancer while working in South America and South Africa. It is the leading cause of death from cancer among women in developing countries, where it kills roughly 190,000 women each year.
It is estimated that only 380 women died of cervical cancer in 2015 in Canada. I am happy to report this is due to a great preventative program, the not so popular Pap smear screening.
Recently, we’ve added a new vaccine that may eliminate the cancer all together. Let me tell you about my encounters with this cancer and some of the patients I saw over the years and in various continents.
Unbeknown to me, my first encounter with cervical cancer was in high school in Paraguay. I chose to present a project about Juan and Evita Peron in history class. Evita, immortalize by the song “Don’t cry for me Argentina” died in 1952 at age 33 from “hemorrhaging,” according to the official report. Argentines went into a state of shock when she died and an estimated three million mourners filed past her casket to pay their last respect.
The cause of hemorrhage was cervical cancer, and Juan Peron was married before, and his first wife, Aurelia Tizón, also died of cervical cancer at 31.
Cervical cancer is caused by the human papilloma virus (HPV) in 99 per cent of cases.
HPV is widespread and sexually transmitted. Many studies have confirmed that about 75 per cent of the population will acquire the virus at some point in their lives, most likely around age 20; however, our immune system gets rid of HPV in more than 80 per cent of cases within 12 to 24 months. If it doesn’t, it can cause cancer in a small percentage of women. But the boys, like Mr. Peron, may actually pass on the virus, often without getting sick.
In my home country in Paraguay, I saw the first case of cervical cancer when I was a medical student. Soledad was in hre mid-30s, and when she walked into the consulting room, we noticed a nauseating and rotting smell. My professor told me he had learned to diagnose cervical cancer by this smell, caused by an infection when the cancer is advanced. Soledad was a mother of four, and died soon afterward.
She was so nice and so young.
The first major blow against cervical cancer was the discovery by Dr. George Papanicolaou in the 1940s the cancer is preceded by an early lesion called cervical intraepithelial neoplasia (CIN).
His research lead to the developed of the “Pap test,” which is used to discover these lesions before the patient has any symptoms, before they hemorrhage, before they have the bad smell.
Unfortunately for Evita, the test was not available when she died. And, unfortunately, Soledad could not afford to go for the Pap test and the treatment required to get rid of the CIN.
While working in South Africa in the 1980s, I had a Zulu patient called Busisiwe. She also had advanced cervical cancer, and was lodging at the hospital while going for daily radiotherapy treatment. She had a beautiful walking stick next to her bed.
I saw her every day for a month, and every time, I grabbed her stick, and gave it a golf swing, which she enjoyed. One Sunday, I was too busy and didn’t swing the “golf club.”
She cried because she thought I didn’t like her anymore. I had to give it a swing, to the laughter and applause of other patients. That was the closest I ever got to winning the British Open.
One morning, Busisiwe was not there, and her walking stick was next to the bed of another patient. The nurse told me that she bled to death the night before. The nurse was not perturbed at all.
She said in the Zulu culture, death is a more natural part of life itself. As a sign of respect to Busisiwe and all her suffering, I did not give it a swing.
The second mortal blow to cervical cancer came when a German virologist called Harald zur Hausen discovered the role of HPV at the cause in the early 1980s. He received a Nobel prize in medicine in 2008. Once it was confirmed the virus was the cause of the cancer, it was just a matter of time before a vaccine was developed. The vaccine is used extensively now, and it should prevent the acquisition of HPV, and therefore, the development of CIN. It is not 100 per cent effective, but the newer one should prevent 90 per cent of cases.
In Canada in the 1990s, I met Melanie, a beautiful woman in her late 20s. She had three children in primary school.
Melanie had an aggressive type of cervical cancer. She was too busy to have Pap smears, and went without one for five years. Melanie had all these dreams about going back to school, and seeing her children graduate and become professionals. Sadly, and despite all our efforts, she died before she turned 30. Although I knew the end for her was near, I cried when I found out.
Many beautiful, young lives have been truncated by cervical cancer caused and HPV. We now have many tools to fight it at different levels. I am confident that in the 21st century, we will see the elimination of this cancer all together.
We shall then sing “Adios HVP, we won’t cry for you.”
Dr. Roberto Leon is a Kelowna-based gynecologist who has delivered 10,000 babies (at least) over 35 years. Learn more at drleon.ca.