Fall from Grace
Years go by, memories fade, and doctors forget things. Then tragedy strikes, like it did to a friend of mine, and sounds a call to arms that comes far too late and at too high a price. I had forgotten just how devastating cervical cancer could be, and I was pushed to revisit its dire consequences when a young friend of mine was stricken. Cancer of the cervix was once the most common cause of cancer death in women in the U.S., but heightened awareness and widespread screening with Pap smear have done much to stem the flow of its onslaught. In 2004, about 10,500 new cases of invasive cervical cancer were discovered, and more than 50,000 noninvasive forms were also detected, leading to a death toll of 3,900.1 What had these women done to deserve such a fate? Why had they been condemned to this “fall from grace?”
Young and old, rich and poor, no one is immune. Underdeveloped countries, with their utter lack of adequate medical services, stagnant economies, and nonexistent patient education have borne the brunt of the attack. This becomes even more obvious when we consider that 85% of the deaths related to this malady in 2004 occurred in women who had never been screened via Pap smear. When an ounce of prevention is truly a matter of life and death, and when cures can be instituted only at the sound of early alarms, every effort must be made to follow the recommendations of the American Cancer Society and the American College of Obstetrics and Gynecology. While the former strongly suggests two consecutive yearly Pap smears in women after onset of sexual activity, or older than age 20, with repeat every 3 years, the latter recommends yearly Pap smears with routine annual pelvic and breast examination.1 Life is oftentimes unfair, and, while the U.S.-based protocols are fine and dandy for our own citizens, what about those less fortunate?
Cervical cancer is the major gynecologic cancer in the Third World, where poverty, early initial sexual activity, multiple partners, and smoking contribute to its prevalence. In both the U.S. and internationally, its cause has been linked to sexual transmission of the human papilloma virus (HPV). Currently, promising studies are underway to create a low-cost vaccination to HPV and subsequent solution to the problem of provision of affordable preventive measures to underdeveloped areas of the world. Screening via repeat Pap smears (90-95% accurate in detecting early lesions of cervical cancer) and follow-up are simply not feasible in those regions. Screening strategies involving a two-visit, visual inspection of the cervix by a healthcare professional and viral DNA testing are being examined as possible, cost-effective alternatives to traditional, three-visit screening programs employing Pap smear in this country.2 After all, right to life is God-given, and must not be subservient to national origin, race, or simply luck of the draw.
Regardless of which side of the tracks, fence, or border a woman is born on, the signs of cervical cancer are unmistakable, and should at the least incite “healthy suspicion” and immediate visit to a qualified healthcare professional. While procrastination is human and no one likes to be pinched and prodded, failure to recognize the signs of abnormal bleeding and postcoital spotting, intermenstrual or prominent menstrual bleeding, yellowish vaginal discharge, low back pain, and urinary symptoms can be downright fatal in the long run. Immediate action is called for in those cases. It goes without saying that the earlier the diagnosis and treatment of cervical cancer, the greater the chances of success and the longer the survival rate.
Depending on the stage of the disease, treatment modalities run the gamut from biopsy and abdominal hysterectomy to radiation therapy and chemotherapy. Combinations of these elements are no more effective than the single regimens themselves, and advanced stage cervical cancer has a five-year survival rate of only 7%. Why, oh why, did those women (and their partners) not take prevention more seriously?
While it was too late for my friend, if this short piece in an obscure quotidian crosses the desk and catalyzes preventive gynecologic examination of just one reader, then her “fall from grace” will serve as a fitting epitaph and message of salvation.
Young and old, rich and poor, no one is immune. Underdeveloped countries, with their utter lack of adequate medical services, stagnant economies, and nonexistent patient education have borne the brunt of the attack. This becomes even more obvious when we consider that 85% of the deaths related to this malady in 2004 occurred in women who had never been screened via Pap smear. When an ounce of prevention is truly a matter of life and death, and when cures can be instituted only at the sound of early alarms, every effort must be made to follow the recommendations of the American Cancer Society and the American College of Obstetrics and Gynecology. While the former strongly suggests two consecutive yearly Pap smears in women after onset of sexual activity, or older than age 20, with repeat every 3 years, the latter recommends yearly Pap smears with routine annual pelvic and breast examination.1 Life is oftentimes unfair, and, while the U.S.-based protocols are fine and dandy for our own citizens, what about those less fortunate?
Cervical cancer is the major gynecologic cancer in the Third World, where poverty, early initial sexual activity, multiple partners, and smoking contribute to its prevalence. In both the U.S. and internationally, its cause has been linked to sexual transmission of the human papilloma virus (HPV). Currently, promising studies are underway to create a low-cost vaccination to HPV and subsequent solution to the problem of provision of affordable preventive measures to underdeveloped areas of the world. Screening via repeat Pap smears (90-95% accurate in detecting early lesions of cervical cancer) and follow-up are simply not feasible in those regions. Screening strategies involving a two-visit, visual inspection of the cervix by a healthcare professional and viral DNA testing are being examined as possible, cost-effective alternatives to traditional, three-visit screening programs employing Pap smear in this country.2 After all, right to life is God-given, and must not be subservient to national origin, race, or simply luck of the draw.
Regardless of which side of the tracks, fence, or border a woman is born on, the signs of cervical cancer are unmistakable, and should at the least incite “healthy suspicion” and immediate visit to a qualified healthcare professional. While procrastination is human and no one likes to be pinched and prodded, failure to recognize the signs of abnormal bleeding and postcoital spotting, intermenstrual or prominent menstrual bleeding, yellowish vaginal discharge, low back pain, and urinary symptoms can be downright fatal in the long run. Immediate action is called for in those cases. It goes without saying that the earlier the diagnosis and treatment of cervical cancer, the greater the chances of success and the longer the survival rate.
Depending on the stage of the disease, treatment modalities run the gamut from biopsy and abdominal hysterectomy to radiation therapy and chemotherapy. Combinations of these elements are no more effective than the single regimens themselves, and advanced stage cervical cancer has a five-year survival rate of only 7%. Why, oh why, did those women (and their partners) not take prevention more seriously?
While it was too late for my friend, if this short piece in an obscure quotidian crosses the desk and catalyzes preventive gynecologic examination of just one reader, then her “fall from grace” will serve as a fitting epitaph and message of salvation.
Years go by, memories fade, and doctors forget things. Then tragedy strikes, like it did to a friend of mine, and sounds a call to arms that comes far too late and at too high a price. I had forgotten just how devastating cervical cancer could be, and I was pushed to revisit its dire consequences when a young friend of mine was stricken. Cancer of the cervix was once the most common cause of cancer death in women in the U.S., but heightened awareness and widespread screening with Pap smear have done much to stem the flow of its onslaught. In 2004, about 10,500 new cases of invasive cervical cancer were discovered, and more than 50,000 noninvasive forms were also detected, leading to a death toll of 3,900.1 What had these women done to deserve such a fate? Why had they been condemned to this “fall from grace?”
Young and old, rich and poor, no one is immune. Underdeveloped countries, with their utter lack of adequate medical services, stagnant economies, and nonexistent patient education have borne the brunt of the attack. This becomes even more obvious when we consider that 85% of the deaths related to this malady in 2004 occurred in women who had never been screened via Pap smear. When an ounce of prevention is truly a matter of life and death, and when cures can be instituted only at the sound of early alarms, every effort must be made to follow the recommendations of the American Cancer Society and the American College of Obstetrics and Gynecology. While the former strongly suggests two consecutive yearly Pap smears in women after onset of sexual activity, or older than age 20, with repeat every 3 years, the latter recommends yearly Pap smears with routine annual pelvic and breast examination.1 Life is oftentimes unfair, and, while the U.S.-based protocols are fine and dandy for our own citizens, what about those less fortunate?
Cervical cancer is the major gynecologic cancer in the Third World, where poverty, early initial sexual activity, multiple partners, and smoking contribute to its prevalence. In both the U.S. and internationally, its cause has been linked to sexual transmission of the human papilloma virus (HPV). Currently, promising studies are underway to create a low-cost vaccination to HPV and subsequent solution to the problem of provision of affordable preventive measures to underdeveloped areas of the world. Screening via repeat Pap smears (90-95% accurate in detecting early lesions of cervical cancer) and follow-up are simply not feasible in those regions. Screening strategies involving a two-visit, visual inspection of the cervix by a healthcare professional and viral DNA testing are being examined as possible, cost-effective alternatives to traditional, three-visit screening programs employing Pap smear in this country.2 After all, right to life is God-given, and must not be subservient to national origin, race, or simply luck of the draw.
Regardless of which side of the tracks, fence, or border a woman is born on, the signs of cervical cancer are unmistakable, and should at the least incite “healthy suspicion” and immediate visit to a qualified healthcare professional. While procrastination is human and no one likes to be pinched and prodded, failure to recognize the signs of abnormal bleeding and postcoital spotting, intermenstrual or prominent menstrual bleeding, yellowish vaginal discharge, low back pain, and urinary symptoms can be downright fatal in the long run. Immediate action is called for in those cases. It goes without saying that the earlier the diagnosis and treatment of cervical cancer, the greater the chances of success and the longer the survival rate.
Depending on the stage of the disease, treatment modalities run the gamut from biopsy and abdominal hysterectomy to radiation therapy and chemotherapy. Combinations of these elements are no more effective than the single regimens themselves, and advanced stage cervical cancer has a five-year survival rate of only 7%. Why, oh why, did those women (and their partners) not take prevention more seriously?
While it was too late for my friend, if this short piece in an obscure quotidian crosses the desk and catalyzes preventive gynecologic examination of just one reader, then her “fall from grace” will serve as a fitting epitaph and message of salvation.
Young and old, rich and poor, no one is immune. Underdeveloped countries, with their utter lack of adequate medical services, stagnant economies, and nonexistent patient education have borne the brunt of the attack. This becomes even more obvious when we consider that 85% of the deaths related to this malady in 2004 occurred in women who had never been screened via Pap smear. When an ounce of prevention is truly a matter of life and death, and when cures can be instituted only at the sound of early alarms, every effort must be made to follow the recommendations of the American Cancer Society and the American College of Obstetrics and Gynecology. While the former strongly suggests two consecutive yearly Pap smears in women after onset of sexual activity, or older than age 20, with repeat every 3 years, the latter recommends yearly Pap smears with routine annual pelvic and breast examination.1 Life is oftentimes unfair, and, while the U.S.-based protocols are fine and dandy for our own citizens, what about those less fortunate?
Cervical cancer is the major gynecologic cancer in the Third World, where poverty, early initial sexual activity, multiple partners, and smoking contribute to its prevalence. In both the U.S. and internationally, its cause has been linked to sexual transmission of the human papilloma virus (HPV). Currently, promising studies are underway to create a low-cost vaccination to HPV and subsequent solution to the problem of provision of affordable preventive measures to underdeveloped areas of the world. Screening via repeat Pap smears (90-95% accurate in detecting early lesions of cervical cancer) and follow-up are simply not feasible in those regions. Screening strategies involving a two-visit, visual inspection of the cervix by a healthcare professional and viral DNA testing are being examined as possible, cost-effective alternatives to traditional, three-visit screening programs employing Pap smear in this country.2 After all, right to life is God-given, and must not be subservient to national origin, race, or simply luck of the draw.
Regardless of which side of the tracks, fence, or border a woman is born on, the signs of cervical cancer are unmistakable, and should at the least incite “healthy suspicion” and immediate visit to a qualified healthcare professional. While procrastination is human and no one likes to be pinched and prodded, failure to recognize the signs of abnormal bleeding and postcoital spotting, intermenstrual or prominent menstrual bleeding, yellowish vaginal discharge, low back pain, and urinary symptoms can be downright fatal in the long run. Immediate action is called for in those cases. It goes without saying that the earlier the diagnosis and treatment of cervical cancer, the greater the chances of success and the longer the survival rate.
Depending on the stage of the disease, treatment modalities run the gamut from biopsy and abdominal hysterectomy to radiation therapy and chemotherapy. Combinations of these elements are no more effective than the single regimens themselves, and advanced stage cervical cancer has a five-year survival rate of only 7%. Why, oh why, did those women (and their partners) not take prevention more seriously?
While it was too late for my friend, if this short piece in an obscure quotidian crosses the desk and catalyzes preventive gynecologic examination of just one reader, then her “fall from grace” will serve as a fitting epitaph and message of salvation.
Copyright 2006, Albert M. Balesh, M.D. All rights reserved.
In memoriam, Grace
posted by Dr. Al at
7/08/2006 07:34:00 PM
2 Comments:
Looks nice! Awesome content. Good job guys.
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