THE MOST IMPORTANT SOMEONE

The large pharmaceutical company Merck, perhaps still reeling from the troublesome recall of their immensely popular anti-inflammatory, Vioxx, has launched a public awareness campaign for cervical cancer. It’s called “tell someone,” and is penetrating the print and television media with splashy ads, including tear out colorful postcards in Spanish and English and 60+ second television commercials outlining the importance of screening examinations (Pap smears) that can detect cervical cancer at very early, and precancerous stages.

Cervical cancer is the third leading cause of cancer-related mortality in women worldwide. This year an estimated 10,370 women will be diagnosed with cervical cancer in the United States and approximately 3,710 women will die from this disease. Ninety-nine percent of cervical cancers are caused by a virus called the human papillomavirus (HPV). This virus is sexually transmitted and rampant. It is suspected that more than 80% of sexually active adults are infected with or carriers of this virus. Recently published studies demonstrate the effectiveness of an HPV vaccine which Merck will introduce to the market amidst this public service media blitz. Speaking of media, in the time since I was diagnosed, I have seen TV news coverage, news magazine coverage, and even blogs about cervical cancer and HPV, and the controversy surrounding the new vaccine. Glaxo-Smith-Kline, another pharmaceutical giant is working on a vaccine of their own.

In the 15 years since I have graduated from medical school, there have been few medical developments of such magnitude. In surgery, the pendulum has swung from radical mastectomy past lumpectomy and axillary dissection to lumpectomy with sentinel lymph node excision in the treatment of breast cancer. The introduction of laparoscopic surgery continues to influence surgical practice, with more and more minimally invasive procedures developed and perfected each day. But a vaccine to prevent cancer? That is big. Really big.

But while I'm "telling someone," who is the most important "someone" to tell? Obviously too late for me, and for anyone like me, already diagnosed, in fact already treated for cervical cancer. Who will a vaccine that can decrease the risk of this cancer help the most? Editors of The Lancet medical journal wrote a piece this past January exploring this question. The studies on the drug included young women in their teens and twenties. The studies have shown maximal effectiveness in the young women who were not sexually active and who tested negative for HPV. Effectiveness has not yet been proven in men nor in children, although studies are ongoing.

It has been more than 30 years since the model of a cancer causing virus was first proposed. It has taken that long for a vaccine to fight that virus to be developed, and may take a few more years to understand the epidemiology behind eradicating it or at least protecting people from its worst consequences. In the meanwhile, my philosophy will be "Tell Everyone," and the most important "someone" that I need to tell is outside swimming in our pool. She's only eight, and just got home from school, so I have some time to let the FDA and the political pundits work on some of the controversies. It won't be long, though. Indeed, she has already been subject to more than her share of "serious conversations" in the past few weeks. That's how I know that my daughter (and I) will be able to handle this one, too.