Stigma of Cervical Cancer Puts Ethnic Women at Risk

Viji Sundaram, New America Media

 SACRAMENTO— Susan Carrillo of Redlands, Calif., remembers how her husband reacted when he found out she had cervical cancer soon after their second child was born. She was 23 at the time. 

“He just flipped out when my doctor told him it was a sexually transmitted disease,” recalls Carrillo, who is now 32 and divorced. “Then he began abusing me. After I was cured, he once said, ‘I wish the cancer had killed you.’”

The shame and stigma associated with cervical cancer is what makes this disease, usually caused by the human papillomavirus (HPV), so difficult to eradicate despite the development of vaccines that are effective and widely available. That was the takeaway message at a conference on the disease organized by the California Medical Association (CMA) Foundation in Sacramento earlier this month. 

“There’s a certain stigma about cervical cancer that doesn’t exist with other cancers,” says Marlene von Friederichs-Fitzwater, director of the UC Davis Cancer Outreach Research and Education Program. 

Friederichs-Fitzwater was diagnosed with cervical cancer at age 38, when she was a journalist at the Los Angeles Times. After she was cured, she changed careers and began educating medical students about cancer prevention.

Speakers agreed that more parents would be willing to get their daughters vaccinated if the embarrassment surrounding the cause of cervical cancer were reduced.

“Let’s make the cervix equal partners with the breast,” urged Jennifer S. Smith, director of the Cervical Cancer-Free Initiative at the University of North Carolina. She said cervical cancer should not be characterized as a sexually transmitted disease.

The CMA Foundation has launched a cervical cancer education and prevention campaign targeted at women who are at greatest risk, including those with low rates of screening and prevention.
Cervical cancer is the tenth-most common form of cancer among California women, according to figures from 2008, the first year statewide data was available. Each year, about 400 women in California die from the disease, says Dr. Eileen Yamada, a public health officer at the California Department of Public Health.

In the United States, about 30 percent of sexually active 14- to 19-year-olds are infected with HPV at any given time. In some girls and women, persistent HPV can eventually lead to cervical cancer. If diagnosed early—for example, with a Pap smear—cervical cancer is almost completely curable, but if caught at the most advanced stage the five-year survival rate plunges to as low as 15 to 20 percent.

Hispanic women in Los Angeles, Riverside and Fresno counties have the highest rates of cervical cancer in the state, says Sara N. Cook, CMA Foundation’s Cervical Cancer and HPV project director. 
In Los Angeles County, older Korean women also have a high incidence of the disease, consistent with rates in South Korea, says Victoria Cortessis, assistant professor of preventive medicine at the University of Southern California’s Keck School of Medicine.

The HPV virus is highly infectious, experts say. Vaccines marketed in the United States protect against four strains of the virus, only two of which are associated with cervical cancer.

The L.A. County Public Health Department’s cervical cancer prevention initiative, launched in 2000, has proved highly successful, notes Dr. Rita Singhal, medical director of the department’s Office of Women’s Health. The initiative’s toll-free number, with a multilingual staff, has fielded around 25,600 calls so far. 

Such public health programs have reduced the incidence and mortality rates of cervical cancer in the state. But cancer rates remain higher in black and Hispanic women, says Dr. Gary A. Richwald, a clinical virologist and communicable disease expert in Los Angeles.

The U.S. Centers for Disease Control and Prevention recommends that 11- and 12-year-old girls be targeted for the vaccine, before most are sexually active and, therefore, before they have been exposed to HPV.

“Incidence is highest in women in their 20s,” Richwald, says adding: “No one knows why there is a solid decrease of the disease after age 30. Our guess is women have fewer sex partners after that age.”

Although studies have shown that the HPV vaccine is safe and effective, just one-third of teenagers and young women who start the vaccine process receive all three doses, and almost three-quarters don’t bother to get vaccinated at all, according to data recently presented at the American Association of Cancer Research.

Yet despite the vaccine’s effectiveness, experts warn that patients and health professionals should not place too much confidence it. Pap screening is just as important, they note. 

Detection remains a challenge, as most HPV infections have no obvious symptoms, Richwald notes.
That was the case for Carrillo. 

She learned she was infected with HPV at age 19, during a routine examination by her ob-gyn to find out if she was pregnant. Because the doctor told her the virus would go away, “I didn’t think it was a big deal and didn’t do anything about it,” she says.

She had no clue that the cancer was growing in her cervix, until she had a Pap screening four years later.

Now cured and healthy, she has joined the National Cervical Cancer Coalition in Los Angeles. She is determined to educate young women, especially immigrants, about how they can protect themselves.
“‘Go and get your Pap,’ I tell them. Cervical cancer is preventable.”

“I also tell women: ‘Just because you got it, doesn’t mean you’re a piece of s - - t.’”

“About 40 percent of women said they heard about our campaign through TV,” Dr. Rita Singhal, medical director, Los Angeles County Dept. of Pub. H, office of women’s health. “For Latinas, TV is the main news source.