With the concerning 1 in 8 women who will be diagnosed with it – both normal folk and celebrities alike, friends and family who solicit for donations for charity walks, pink this and pink that, it is no wonder that it is on the minds of many women.
Built into the annual visit to the gynecologist is a breast exam, during which the doctor reminds us to perform a self breast exam every time we are in the shower. Should anything not feel right, we are encouraged to make an appointment for a follow up, which could lead to anything from a mammogram and ultrasound to, if warranted, a biopsy. Add to this that we are expected to get annual routine mammograms, starting in our mid-40s, we have become a society that is all too aware of breast health.
Aged 16 to 95, one thing we women are really good at is discussing our boobies.
See how natural that was to slip that word in? Did you even bat an eyelash reading it? Or did you see it, pause for a second, maybe let out a little chuckle but you weren’t offended, I hope. We all know someone who is affected by breast cancer. How many women can you name who have had it or who are currently being treated for it? Without really thinking about it, I can think of 10. I am sure if I thought a little harder, I could come up with a few more. 8 survived, thankfully. Two of them had double mastectomy (with immediate reconstruction, so nobody is the wiser). One died before she saw her 30th birthday and a dear friend of mine who is fighting it for the third time in five years must endure a year’s worth of chemo. Her prognosis is excellent, surprisingly.
Just to Prove a Point About How Comfortable we are Talking About Breast Cancer
I once accompanied a friend to an appointment with the plastic surgeon who was to perform her reconstruction following her double mastectomy. Diagnosed with aggressive cancer, surely the disease weighed more heavily on Denise’s mind than the eventual outcome of having two new breasts that would be formed using fat from her abdomen.
As we rode the elevator in silence, a woman asked if this was her first visit. Maybe the fear on Denise’s face was recognizable to this woman, but I did wonder how she knew which one of us had the appointment. Without batting an eyelash, the stranger lifts her blouse, loosens her brassiere and shows us the perkiest breasts I have ever seen in my life. “I promise you, when he’s done with you, your girls will look better than they do now!” And she was right. Less than a year after Denise had her surgery, long after the drains were removed, memory of her stay in the ICU had worn off and she was back to work, this introverted scientist giggled each time she lifted her blouse to show off her cancer-free girls to anyone who asked about her ordeal.
What is it that drives women to be so open and honest without a shred of modesty about the topic of breast cancer? Is it that our breasts are so visible, whether they are covered in a sweater, a blouse, even a winter coat or exposed in an elevator for complete strangers to oooh and ahhh over? Is it that they are revered and discussed ad nauseam by men and do as much to define femininity as do long locks of thick and luscious hair? And the bigger question, why aren’t we as talkative about cervical cancer, a disease that strikes approximately 13,000 women annually and that at one time was the leading cause of death caused by cancer in women?
My best guess is that the reason is two-fold. One is because of where the cervix is located, which is at the bottommost part of the uterus that connects to the vagina. For many women, discussing the health of the vagina is difficult. Whether with their doctors or with girlfriends, it is not uncommon for grown women to refer to their own vaginas as “their private parts,” “their unmentionables,” or simply “down there.” And for those who can speak freely about their vaginas, they find themselves chastised for doing so. A part of the body that became the center of a debate in June 2012 when addressing the House, State Representative Lisa Brown spoke of the threat of women’s reproductive rights and found herself silenced when she referred to her own vagina at the end of her speech. If it isn’t proper decorum for a woman to discuss women’s vaginas in “mixed company” when talking about reproduction, it is certainly understandable why a woman might be shy to discuss it with her doctor when she is concerned that something just doesn’t seem right with her vagina.
The other piggy backs off the first one. With vagina being such a taboo word, it is no surprise that a disease that is most often the result of having contracted a sexually transmitted disease, who in her right mind is going to feel anything but shame admitting she has cervical cancer? Add to this the fact that in many cases, she may not have been aware she had the STD until she received a diagnosis of cervical cancer.
Although I could write a dissertation on why there is something innately wrong with the fact that our society labels women who have slept with more than one man anything from promiscuous to a slut, but reveres men for their virility and sexual prowess who are equally or even more active, the fact is, all of this plays a part in why women have difficulty discussing cervical cancer. Interestingly, given the fact that cervical cancer is usually the result of having contracted the human papillomavirus (HPV), it might serve all of society some good to realize that both men and women contract HPV at similar rates and that in men, HPV can cause cancer in the anus and penis.
Indeed, it is estimated that half of all sexually active people – be they married, single, and whether they have had sex with one partner, numerous partners or anything in between, will contract HPV. The unfortunate thing is that it is not uncommon for people to live unaware of this until they discover genital warts or in the case of women, until they receive a diagnosis of cervical cancer. Compounding the issue, not all forms of HPV will present with genital warts and so the only obvious telltale sign may elude someone for years. In these cases, without knowledge means that something that could have been treated very easily when it was first caught can linger in in the body and eventually form into cancerous cells. It may alleviate some of your fears to know that of the 100 types of human papillomavirus, types 16 and 18 cause approximately 70 percent of all cervical cancers.
Cervical Cancer: Risk Factors
Fortunately for all women, regardless of age and how often and with whom she enjoys sex, cervical cancer has seen a significant decline over the last 40 years. We have the Pap smear, which is part of the routine pelvic exam, to thank for this. A Pap smear detects precancerous cells, known as dysplasia, which have formed along the cervix’s surface. At this stage, this precancerous condition is 100% curable.
Some risk factors for cervical cancer:
- Not being vaccinated against HPV
- Socioeconomic status
- Compromised immune system
- Being born to a mother who took diethylstilbestrol (DES) during the 60s to prevent miscarriage
There is a window in which both men and women can receive the HPV vaccine to prevent genital warts in men and cervical cancer and genital warts in women. This is between the ages of 9 and 26. It wasn’t available when we were between 9 and 26.
It isn’t uncommon for men and women not to follow up on a test that comes back abnormal, such as a Pap smear, because money is tight and/or she doesn’t have health insurance. If you are on Medicare, I cannot urge you enough to follow up on an abnormal Pap smear. Again, dysplasia is 100% treatable.
If your immune system is weakened or compromised for whatever reason, be it the result of former drug use, HIV status, a previous cancer or overall poor health, your risk for cervical cancer (or any cancer for that matter) increases.
You cannot do anything about it if your mother took DES, unfortunately.
Symptoms that you could have cervical cancer and that should bring you to the doctor immediately:
- If you are still menstruating, heavier than normal periods or bleeding between periods
- Vaginal bleeding during sexual intercourse or when you are already in menopause or are post menopausal
- Vaginal discharge that is brown, pink, bloody and/or smells foul
Metastatic cervical cancer, meaning cancer that has spread to other parts of the body may present with any of the following symptoms:
- Decreased appetite
- Bone pain
- Unexplained bone fractures
- Chronic, but unexplained back pain and leg pain
- Incontinence (either urine or feces)
- Unexplained weight loss
- Pelvic pain
Diagnosis of cervical cancer is a multipart process. After the abnormal Pap smear, the doctor will do what is known as colposcopy, which allows her to look at your cervix under extreme magnification. If the results warrant it, something known as a cone biopsy will be performed.
There are many treatments for cervical cancer, which will depend on the patient’s age and her overall health, the size of the tumor, whether it has metastasized, and what stage the cancer is. If you have been diagnosed with cervical cancer, your doctor may elect to freeze the abnormal cells, use electricity to remove them, laser to burn them or perform a hysterectomy.
If you still have a uterus, whether you are still menstruating, pre-menopausal, in menopause or are passed all of that, and regardless whether you are sexually active or not, I cannot urge you enough to continue getting your pelvic exams and Pap smears. Whether you are comfortable using the word vagina or still after all these years call it “down there,” “your unmentionables,” or your “private parts,” please take care of it as you would any other part of your body. And if you have cervical cancer, please do not suffer in silence. By googling “cervical cancer support groups,” you can be instantly connected with hundreds of online and in-person support groups. By talking about it, we gain power over it. It doesn’t matter where cancer starts, it sucks and you should never, ever be ashamed to admit you have it. You might be surprised to know how many women out there need someone like you to break the ice.
January is cervical cancer awareness month. Part of being aware is starting the conversation. I started it; please continue it.