Cross posted from Skeptic North
While doing some digging into the quackery of a local acupuncturist, I came across a sentiment that I found more than usually appalling. In her story of why she became an acupuncturist, she tells a melodramatic tale about a positive Pap smear test result that changed her life*. There’s all the usual makings of an natural health anecdote, with convoluted tales about her life being out of balance and her needing to take control of her own health – all pretty par for the course. However, what dropped my jaw was this paragraph:
My research about cervical cancer at the time told me it was very rare and that it occurred most often in women who had multiple sexual partners, who also had multiple sexual partners. In other words, the nurse said, it’s mainly a disease of prostitutes.
Well, I said, “That’s not me!”
Although my gut instinct was horror that she would imply that women with cervical cancer are prostitutes or they deserve their illness, I was willing to give her the benefit of the doubt. Maybe she was simply recounting what this extraordinarily judgmental nurse had told her. Maybe she wasn’t actually implying that only whores** get cervical cancer as some sort of retribution for their immoral behaviour. (Though in my head I couldn’t help wonder if she also feels that AIDS is a “gay disease.”)
Or maybe she totally was. I watched her accompanying video, which basically repeats the information on the website for those of us too lazy to read.
So immediately I fell into research. And what I found out is that there’s a very specific profile of a person with cervical cancer. That person usually has many sexual partners. She’s very promiscuous. And her partners, in turn, also have very many different partners. What is really came down to was a description of a prostitute. And I knew that wasn’t me.
Considering this “advice” is coming from someone who is legally allowed to call themselves a doctor (of acupuncture) in the province of Alberta, I think these claims are worth examining.
- Cervical cancer is rare
- Cervical cancer happens to only very specific types of people.
- Promiscuity or prostitution is necessary to develop cervical cancer.
First though, a few notes on cervical cancer.
What is cervical cancer?
The cervix is the lower part of the uterus that connects the uterus to the vagina. Cervical cancer occurs when some cells become abnormal and start to proliferate. However, not all abnormal cells will become cancer – many will die because they are too abnormal. Others will not be abnormal enough that they grow and divide out of control. The purpose of a Pap smear, where a doctor takes a sampling of cells from the cervix to be examined via microscope, is to detect these early abnormalities. Weird cells can happen for a ton of reasons, but when they do they are called dysplasia. Dysplasia ranges from “a little weird but will likely not cause issues” all the way to “not looking anything like they should and almost certain to become cancerous.” Most positive Pap tests are not actually cancer. The most common result is classified as Atypical Squamous Cells of Undetermined Significance (ASCUS). These cells only might be dysplastic and so they will ask you to come back in a few months for a repeat Pap before they do anything. However, screening for cervical cancer is extremely important, as it has few clear signs or symptoms (heavy periods and back pain could be anything or nothing) and without early detection has high rates of death. In 2004, the five year relative survival rate of Canadian women with cervical cancer as 74% – in other words, a quarter of women will die within 5 years of receiving a diagnosis of cervical cancer. Fortunately, this is a huge drop in mortality since the introduction of the Pap test, and the number continues to fall as provinces aggressively promote screening to groups of women who are less likely to get regular Paps.
Is cervical cancer rare?
There are many way to answer this question, but it’s easiest to just say… no. It’s not. Cervical cancer is the 3rd most common type of cancer worldwide, accounting for 10% of all cancers. In Canada, it is less common, ranking back in 12th, although it is still in the top three cancer diagnoses for women between the ages of 20-49. In 2011, there were approximately 1,300 new cases of cervical cancer in Canada, and 350 deaths. 1 in 150 women is expected to develop cervical cancer over a lifetime. In other words, cervical cancer is about as rare as some estimates of autism spectrum disorders.
In any case, although “rare” in the context of disease prevalence doesn’t have an official definition, Health Canada policy indicates it considers rare to be diseases that affect fewer than 1 in 1000 people. It’s also important to remember that Pap tests allow us to catch things before they become cervical cancer, and approximately 2% of all Pap tests are positive. Cervical cancer, then, is not rare.
Does cervical cancer only happen to certain types of people?
Cervical cancer only affects people who have cervices, so I suppose that’s a type.
What is implied by the “certain type” comment, however, is the association of cervical cancer with infection by sexually transmitted human papilloma virus (HPV). Some types of HPV can infect the cells of the cervix and can cause the cells to behave oddly, which can send them down the path to becoming dysplastic or even cancerous. Of course, only promiscuous women and prostitutes get HPV, right?
Well, barring the outrageous slut shaming which I cannot even begin to discuss here, it’s important to note that 70% of all sexually active Canadians will exposed to HPV over a lifetime. 70%! Even condoms are not fully protective since HPV can spread via any skin-to-skin contact. Plus, HPV infection is almost entirely asymptomatic, and there is no general screening test to look for it. In other words, for most people, until you are diagnosed with cervical cancer, you have absolutely no way of knowing if you or your partner are positive for HPV. Only in a world of strict, puritanical monogamy is this a disease for prostitutes and the promiscuous, and given that 70% of women are exposed, I think it’s fair to say that such an expectation is profoundly unrealistic. Either that, or 70% of Canadian women are whores! What a charming sentiment.
Realistically, if you want to prevent cervical cancer, then you should be advocating for the use of the HPV vaccines, which protect against many types of aggressive HPV infection and is now approved for males, as well as females. Maybe, if there is enough uptake in the community, we can dramatically reduce the rates of cervical cancer so that it is a rare thing.
Do only promiscuous women develop cervical cancer?
The ridiculous assertion that cervical cancer only happens to “promiscuous” women works on the assumption that HPV is the only cause of cervical cancer. This is also not entirely true. Smoking, for example, doubles your risk of cervical cancer. Other things that put you at risk for cervical cancer include taking immunosuppressants (people with organ transplants or auto-immune diseases), the use of oral contraceptives, giving birth to many children, or having taken a synthetic estrogen called diethylstilbestrol to prevent miscarriage, or being the daughter of a woman who had taken diethylstilbestrol. There also may be a genetic component. And, of course, even if all of these happen through an HPV-mediated mechanism, you cannot control whether your partner has ever had other partners in the past (or may have them in the future).
On another level, this sort of attitude is profoundly damaging since it blames the individual with the disease. Women will have portions of their cervix removed, and may even be going through chemotherapy and radiation. They are facing the possibility of infertility. They are dealing with a potentially life threatening illness that they in no way invited into their body, particularly since there was no way for them to know the HPV status of their sexual partner(s), and furthermore, HPV is not necessarily the cause. To call them prostitutes simply for being sexually active is degrading, insulting, and incredibly cruel, to say nothing of being profoundly hypocritical.So, I guess we can say there is a type of person who doesn’t get cervical cancer: the type that never has sexual contact of any kind, never smokes, never requires an immunosuppressive drug, and isn’t born predisposed to it.
Even if we can blame HPV solely for the development of cervical cancer, to place blame squarely on the women who have it is to point a finger at just one piece in a larger puzzle. For the purposes of sexually transmitted infections, you are having sexual contact with every sexual partner your partner has ever had. A woman could be as chaste as they come until her traditional one-man-one-woman marriage and only have sex for procreation, and still contract HPV because her husband had sexual contact (with or without penetration, with or without protection!) with someone who was infected in the past.
Oh, that whore, having sex with her husband and having multiple children. When will she ever learn?
What’s her professional recommendation?
I continued my annual PAP tests for a few years after that. But since I no longer have a conventional medical doctor for many years now, I can say that I don’t need one. I don’t do PAP smears anymore. I don’t do anything that conjures up unnecessary fear. Instead I rely on what I know today, real preventive measures.
Yes, you eschew actual knowledge about your body because it’s scary. You hide from reality because it might hurt your feelings. I mean, you will almost certainly die if you do actually have untreated cervical cancer, but hey, at least you’ll die happy. Sorry, that’s not the word I was looking for. I believe what I was looking for was “in agony and far too soon.”
I sincerely hope nobody with cervical cancer ever has the misfortune of entering this woman’s office. Nobody deserves to die of cancer. If you can look into the eyes of a woman dying of cancer and tell her that she deserved it, well, let’s face it. You have bigger problems than false positive Pap smears.
Does not deserve this.
*I’ve had an abnormal pap test, and unlike Freak-out McMelodrama, I talked to my doctor about what it meant and why it wasn’t particularly concerning, but worth monitoring. It wasn’t a cancer scare, it was a “huh, that’s weird.” Maybe I’m just used to my body doing strange things, but I really can’t fathom using it as the impetus to quit my job and go to an unaccredited college to get a unrecognized 4 year TCMD (Traditional Chinese Medicine Doctorate) diploma for $40,000. If you’re worried about an abnormal Pap test, or just the potential to exposure to HPV and the risks of cervical cancer, talk to your family physician. And if they tell you that only prostitutes get HPV, find a new physician, and then talk to them.
**In case this is not perfectly clear, throughout the article, my use of the word “whore” is satirical and in no way passes judgement on the sexual activity of women. If you don’t know why you shouldn’t be calling women whores/prostitutes/sluts/tramps etc, check out this awesome video by a 13 year old girl who is better spoken and more informed than most 30 year olds.
Images from euthman and Offbeat Photography on flickr.