My college girlfriend Nichelle was the first person I ever knew who had a problem with her pap test. This was in the late 70's before AIDS announced itself. Doctors weren't 100% sure what caused cervical cancer, and thus, no vaccine was available.
Sit back, relax, and I'll tell you more about her, others, a murder, and mix it with information that you might find highly useful, even if you're a man or a parent.
The history of scientists trying to figure out the cause of cervical cancer is fascinating. To summarize part of the 8-29-2006 New York Times article, How a Vaccine Search Ended in Triumph:
In the 1930’s, Dr. Richard Shope of the Rockefeller University, was on a hunting trip and heard a friend describe seeing rabbits with “horns,”. He asked his friend to send some of the horns. He then ground them up, filtered them through porcelain that let only tiny virus-size particles through, and injected the filtrate into other rabbits, which grew horns in turn.
This is why some jack rabbits have antelope-looking horns. These 'jackalopes' are infected with their own version of the papilloma virus. In humans it's called HPV.
"It took decades for scientists to even figure out the cause: the papillomavirus, named for the papilla, or bud, that the tumor creates. Species as different as birds and whales have their own papillomas. There are more than 100 human strains. Many are harmless. Some cause warts on hands, noses or genitals, and some cause cancer. As a result, blame has been laid on origins like toads, witchcraft and God’s anger at promiscuous women."
I don't remember exactly how Nichelle told me, only that she looked worried when she did.
"What does it mean?", I asked.
"The doctor found weird cells on my cervix," she answered. "He said I need a surgical procedure to scrape them off."
"Ewwwl. Scrape? That sounds painful. What happens if you leave them alone?"
"They might turn to cancer. Then I would have to have a hysterectomy."
Cancer?, I thought. At her age? I was stupefied.
"Does it run in your family?"
"Well, how did you get it?"
She shrugged evasively. "The doctor isn't sure," she said.
My parents were fruitcakes when it came to sexual diseases. They came of age in an era when there was no treatment for gonorrhea or syphilis until after WWII. My mother caught staphylococcus while in the hospital in the early 60s. This was a not uncommon bacterial skin infection.
It must have been close to her private area, because my father initially assumed this was a sexually transmitted disease, thinking it was related to what he called gonococcus, the bacteria responsible for gonorrhea.
Knowing them so well, I can just imagine their argument, or maybe I actually heard it and it's buried in the recess of my mind:
Him: You've been cheating and now you have disease! Coccus! I know what that is! I better not have it!
Her: If I ever catch a disease, it would be from you, you bald-headed bastard!
Thankfully, a doctor enlightened him. Didn't matter. Their marriage had been doomed long before this.
Now, as I looked at my friend, I made a similar assumption my father did and wondered if her problem came from sexual activity, although she previously said she was a virgin.
I asked, "Did you have sex?"
She looked embarrassed. Nichelle was an only child of successful, upper middle black parents. Her neighborhood and schools were predominantly white, and she didn't speak ebonics or use slang.
A clear, crisp yes rolled off her tongue.
She looked away, then I did too.
I thought of her boyfriend, angrily thinking that if she caught it, he gave it to her. I didn't like him the first time I laid eyes on him but don't remember why. He was neither ugly - a huge turnoff when you're young - nor stupid.
"Will you still be able to have kids after this?"
"I don't know," she replied sadly.
Her procedure went well. She would need follow up paps each year, and didn't want to talk about anymore.
Two years later, Nichelle graduated and met a new guy. I was shocked when she announced she was getting married; none of my other friends had. A year after that she mailed me a photo of her new baby girl. I wondered then if she rushed into starting a family, worried that her problem might come back.
Around 2002, America was online, and I did an Internet search for her. I should have found her, because like me, she had been a journalism undergraduate student, but unlike me, she lucked up and got a job with a small newspaper as a reporter in the 80s.
Nada, zip, zilch. Nothing.
I wondered about the worse, but then thought, well, maybe she chose to go by her married name, or like me, couldn't get a good career break in the racist 80s and switched careers. I did a search this morning still no luck. To this day, I hope she wasn't a casualty to cervical cancer.
This dreaded disease is caused by the human papillomavirus (HPV).
"The American Cancer Society assumes a patient was infected with HPV to develop cervical cancer, and it is hence viewed as a sexually transmitted disease. However, most women infected will not develop cervical cancer."
The catch is getting females vaccinated before they get exposed to it, preferably before they become sexually active. Currently, girls between 11 and 17 are the target population.
I thought of my own young daughter and decided to take a wait 'n see approach since it was so new. I recall wishing it was available for boys, since at the time, my son was 16 or 17 and fairly green, having been with only one girl who had also been a virgin.
In March 2007, Merck, the makers of the vaccine Gardasil, along with a bunch of experts recommended that teenage girls get vaccinated. The speed of acceptance has been breath-taking. News this weekend:
"This protects against some of the HPV viruses that cause cervical cancer. By the last few months of last year, 25% of teenage girls had received at least one dose of the vaccine, which is given in a three-dose series."
That doesn't include all populations of girls. Only 1% of Latina girls have a shot, and I wonder about the black female population in various areas.
A study of 290 men from southern Arizona between 18-44 years old show these HPV infection rates.
"Over the entire study period, roughly half of men were infected with HPV and nearly a third of the HPV types found are known to cause cancer. About 75 percent of the infections cleared within a year of detection... The HPV vaccine is currently being tested on men."
Half of men? Jeez!. What the hell are they doing in southern Arizona? Sounds like a modern day Sodom or Gomorrah, or like they have too much free time on their hands. I shudder to think what stats from NYC and other sprawling urban areas would look like.
For now, this vaccine sounds heaven sent for women. It offers protection for 70% of the strains that cause HPV as well as genital warts.
Keep in mind that all vaccines have side effects, and Gardasil is said to be one of the most painful childhood shots. Read up on it and talk with your doctor about it first.
Years ago, I worked with a lovely, expressive, 14 year girl who was sent to me for therapy. She came from deep poverty. Both parents had serious drug problems; they weren't bad people, but they were bad parents. Chronic neglect was a major issue because of their addictions.
Kianna and her and her four siblings had been in and out of foster care, and her older brother, 17, was living in a group home for juveniles. I knew him too, because I had done three therapy sessions with him a year earlier, before this angry kid was moved into a new group home that had their own therapist.
As though her life wasn't bad enough, one evening she was raped by a slimeball in her neighborhood who dragged her into the woods. Kianna cried and cried telling me about it, but wouldn't tell the police, her social worker, or me, the name of the guy who did it, fearing retribution. She was too scared to snitch.
Then she discovered she had been infected with genital warts. She needed surgery to remove them and was told she might need another surgery if they returned.
That's when she told her brother. He was the kind of brotha who don't play that shit. He administered street justice and murdered her assailant.
Kianna told me about this months after it happened. Truth be told, I wasn't even mad.
He got away with it too. No names given, no witnesses, too many murders in whatever area the homicide took place to link him to one particular murder, and no date of the killing. Thus, no case.
Five years later I ran into her. She looked terrible. Both earlobes were split from being assaulted in a homeless shelter. Her life hadn't gone well, but she had one thing she was proud of:
"I have a son," she said. She showed me his picture.
"He's beautiful!", I gushed.
"He's not with me, though," she said sadly. "He's in foster care until get my life together."
"I'm so sorry," I said.
I meant it. Some people are born in terrible circumstances and life goes down from there. She was a classic example of this.
"How's your brother?" I asked.
"He's locked up. Gonna be there a long time."
"He ever kill again?"
"No, that was the only time. I named my son after him."
I nodded with understanding, for I generally believe that there before the grace of God go I. Under her circumstances, I might have done the same thing, given that he was the only person she felt who protected her.
As I sit here now, I wonder how the awful lives of those two lost siblings would have turned out if she had the simple vaccine that prevents most HPV strains and genital warts. It wasn't available then.
Xenophobia, racism, and greed never ends:
"An expensive cervical cancer vaccine is now needed by young female immigrants before they can become legal U.S. residents, a requirement that immigration advocates say is unfair. Federal officials recently added the Gardasil vaccine to a list of vaccinations that immigrants must have before they can obtain green cards. The cervical cancer vaccine is required of females ages 9 to 26."
This immediately struck me as strong-arm lobbying by the pharmaceutical company combined with racism and classism to keep out less well-to-do immigrants. The reason is the prolonged age requirement. To age 26? That ain't what the CDC recommended.
"This is a huge economic, social and cultural barrier to immigrants," said Tuyet Duong, and attorney at the Asian American Justice Center in Washington.
Gardasil, given in three shots over a six-month period, costs about $400. That puts an added burden on green card applicants already paying more than $1,000 in fees and hundreds of dollars for mandatory medical exams, advocates say.
That's expensive as hell for a lot of Americans, especially in these dire economic times when the uninsured working class falls through the cracks. They earn too much for free medical assistance, and too little to afford health care. Often their part time or commission jobs offer no insurance. It's no accident that their sales were down 34% in July and August of this year.
Except for my son, who gets free health insurance until he's 21 because this came with his adoption, my daughter and I are one of the families who have fallen through the no insurance cracks.
The funny thing is, we've been healthier than when I was earning a ton of money working full-time and had great coverage. It's like we made a conscious decision to not get sick, dammit.
Now, however, I wonder what Casie will be like after she turns 13 the end of this year. She began high school in September. She's younger than all her friends and not very interested in boys yet, but she notices they notice her. It's cute. She laughs that a nerdy boy asked her if they could go together. In her social circle, this means they would talk in school and on the phone.
"Whatchu say?", I asked her.
"No," she replied snottily. "I don't wanna go with no dumb boy."
"See any yet that you like?"
She rolled her eyes. "Nuh-uh."
I have to chuckle at this, and boy am I glad.
Her lil' friends, already 13, come across as virgins too. They're sweet and more innocent than they think.
I'd love to freeze this moment in time, but the calendar pages have been turning for years. The clock ticks and the seasons pass. As it is supposed to be, she has been moving along nature's invisible path where she will gradually claim her sexuality and womanhood.
I'm struggling over whether to bite the bullet and cough up $400 bucks for her to get this vaccination now, or wait until she's 14 or 15... but that may be too late. My baby doll can already pass for 16.
As a mother and one with a natural tendency of thinking of the worst case scenario under any circumstances, other kinds of thoughts go through my mind. What if I wait too long? What if she gets a boyfriend before late next year or actually has one now, and I don't know about him?
I seriously, seriously doubt it, but kids can be unexpectedly sneaky.
The world is not especially safe either for the feminine sex. I read that one out four or five American women get raped at some point in their lives. I myself was nearly date raped in early 20s - by a gawd damned drunk attorney, who of all people, should have known better - on our first and last date. What if my daughter got raped and she got infected with HPV - or worse - like my former client?
I think of my own son's thuggish tendencies and easy anger. He's extremely protective of her and has that you bettah not look at my sister mindset. He'd snap if anyone seriously harmed her, and I can easily picture him doing what Kianna's brother did.
Yep, time to bite that bullet and not delay. That's gonna be one of Casie's Christmas presents. It might be one of the best gifts she ever receives.
Important Addendum, Sunday 10/12/2008 @ 10 AM EST
I would like to thank Cheri T. who left the first comment below, and a couple others who emailed me after posting this about concerns with Gardasil vaccine.
In this post there is mention of the need to be aware of side effects, to read up on them and to speak with your doctor before determining if this vaccine is right for the pre-teen or teen girl in your family.
After reading suggested links and watching the YouTube videos, I concluded a casual mention of side effects wasn't enough. I had so much doubt that I considered yanking this post. Instead, I decided to keep it here and add the word 'Maybe' to the title.
Also, here are two videos that might scare the shit out of you:
Is HPV Safe? CBS News, July 2008
Gardasil Warning - CNN Report 8-11-2008
It is clear that Merck has been very aggressive in promoting this vaccine and that Big Pharmaceuticals have their bottom-line as being profit-oriented. This in and of itself is not necessarily a bad thing, but after further consideration, it bothers me that this vaccine hasn't been on the market that long - or long enough to know:
1) how many years will the vaccine provide immunity before it wears off, and
2) the side effects on girls who had all three shots. This is important, because reportedly, 25% of US girls have had at least one vaccination. What's the percentage of girls who had all three? And why didn't Merck ask or include this data in their report? Is it lower because they haven't gotten around to it yet or lack the money for it, or because these girls had side effects but never reported them?
It's weird that this past weekend, the news has been so rosy about the vaccination. Were these media plants or moles by Merck to push these news stories to push up their lagging sales?
The other piece that bothers me is that in Canada, all 6th grade girls will soon be required to have this. As I said in the post, the Gardasil vaccine sounds heaven sent, but isn't it a bit new for this to be a proven fact? Or more disturbingly, for Big Brother to take over a parent's decision?
The HPV Vaccine & The Canadian Government
I'm not saying we should reject it since there are always a small number of people who have adverse reactions to vaccinations, but this morning I am having some serious doubts.
Since my daughter doesn't appear to be close to becoming sexually active, for now I'll put a lid on my worries and hold off a bit on making a decision. By then I'll know more about this and whether or not the HPV vaccination is truly a gift that can prevent the kind of misery from cervical cancer and genital warts as described in this post.
Otherwise, please feel free to get a conversation going on your thoughts about the pros and cons of this, and any experience you may have with this issue, or as hinted by Cheri, any ties to eugenics, etc. Thanks.
Important Update, Nov 3, 2008:
The shocking news today is the HPV virus causes 25,000 cancers each year. Make no mistake - this is an epidemic and makes a bout of herpes pale in comparison.
From US News: "The U.S. Centers for Disease Control and Prevention found that the most common sites for HPV-associated cancers were the cervix, head and neck, anus, vulva, penis and vagina."
Read it, consult with your doctor or your daughter's pediatrician if the vaccination is right for you. Hopefully there will one available for teen and young adult males next year.