To think about, even if not infected

“Until I had an abnormal smear test I never thought much about the screening programme.”

So far I have received many emails from readers of this project. Experts have shared their knowledge and research, whilst patients have shared their experience.

All patients who have contacted me have had some kind of personal experience related to cervical cancer, most being women with a history of abnormal smear tests. This shows, just like with other diseases, that unless it affects us or our beloved ones we are rather unlikely to engage in the debate. However, most of what these patients have told me should be of interest to the general public, especially young women. Here are some of those thoughts.

(Note: In order to protect the identity of the sources, I was asked to keep them anonymous.)

“Associating infection with sexual behaviour is unhelpful and stigmatising”, a woman told me. She had treatment for high grade cervical pre-cancer at the age of 33 and claims to have had two sexual partners with whom she has always used condoms. Her abnormal smear test came when she had been married for many years.

Do condoms protect against HPV? Credit: Wikicommons

Indeed, I wrote about the links between HPV infections and sexual behaviour, but it should be emphasised there is not one single way to prevent cervical cancer. Vaccines, smear tests, few sexual partners or use of condoms do not necessarily prevent the disease. To what extent would better health education and communication help tackle this problem?

In fact, “safe sex” is not enough, as many factors are associated with an HPV infection. Sexual intercourse is not the only way to transmit the virus; some of its strains can be transmitted through kissing. Most people will be infected in their lives, but in many cases our body’s immune system will be able to clear the virus without it causing problems.

Ironically, when it comes to vaccination this infection seems to be persistent, as most experts claim that a HPV vaccine doesn’t clear the virus if it has already been contracted. Again, HPV may not be as alarming as HIV, but shouldn’t there be more information about this virus?

Concerning HPV related cancers other than the cervix, let me share with you what a 31-year old Mexican man wrote me: “If I had taken the vaccine, I might have had my complete tongue by now”. He was 27 when diagnosed with tongue cancer. “In the biopsy we found HPV. The doctor asked me if I had had any homosexual intercourse, and the answer is no. I just have had one sexual partner, and that is my wife.”

His words reflect the need to clarify how HPV affects men. The fact that his doctor asked him about his sexuality may show that gay men are at increased risk of HPV-related cancers, however heterosexual men can develop these too. The number of sexual partners one has also does not necessarily determine how likely he or she will be infected with the virus. Many people become infected having had only one sexual partner – this partner might have had others though. But is it fair, or even useful, to let the rule of probabilities ruin the confidence between a married couple?

Prevention of cervical cancer in private healthcare can reach high costs. Credit: Grant Cochrane

A young woman from Portugal mentioned the financial costs associated with a HPV infection. In this project I’ve tried to discuss policies from different countries, therefore we should balance the weight of private healthcare services and insurance companies in other nations.

Upon being diagnosed with a HPV infection in her cervix, this 27-year-old Portuguese patient has paid more than €600 in the private sector for HPV testing, smear tests, other exams and dermatological treatment to her genital warts. She wonders whether the SNS (Portugal’s public healthcare system) would have prescribed her the same exams, how much of these costs would have been taken by the state, and how quickly she would have been treated otherwise. What is the situation like in your country?

When seeing these realities, one shouldn’t forget the UK has a National Health Service and an effective, public cancer screening programme. A British woman wrote me about her disappointment towards this programme, but she admitted not having had contact with health services of any other country.

The progress of science has allowed us to prevent and treat many diseases that people would have easily died of some years ago. It seems that the more we have, the more we expect; should we, journalists, make citizens wonder whether they are in the right to complain?


The key cervical cancer questions

These are some of the main questions I aim to investigate:

  • What is the incidence of false positives and unnecessary treatment for cervical cancer?
  • What is the difference between the Gardasil and the Cervarix vaccines?
  • Should men be vaccinated?
  • Are there any cervical screening programmes running in Africa?
  • Is it cost effective to run screening and vaccination programmes in tandem?
  • What is the scientific evidence that governments are based on to implement cancer prevention programmes?
  • What is the link between HPV and other types of cancer?

Feel free to add any questions.

Picture courtesy: Jan Christian, Creative Commons

Opening the discussion

The Cancer-Screening project is now open to your thoughts. Whether you want to comment on my interviews with experts, to ask questions about the presented data or to share your own experiences, make sure you write it down.

If you would rather not write your comments in English, you can do it either in Portuguese, German, French or Spanish, and I will make sure they are accurately translated.