cervical cancer, about 5,000 women a year still die of the disease. “From a mortality standpoint, the problem in this country is largely contained, but worldwide it’s a huge problem,” says Lockwood. “From a financial standpoint it remains a major problem in this country. The cost of surveillance and preventive treatments is astronomical ($200 million a year just for screening), and a woman who has multiple surgical treatments for precancerous conditions of the cervix, such as
1/28/2018 The virus behind the cancer > Features > Spring 2006 | Yale Medicine 7/10 cone biopsies or loop electrocautery excision procedures, is at a higher risk of giving birth to a preterm baby.” Even though cervical cancer in this country is largely under control, women still get it, and when they do, it can be devastating. Thomas J. Rutherford, Ph.D., M.D., FW ’94, associate professor of obstetrics, gynecology and reproductive sciences and director of gynecological oncology, recalls a patient in her mid-30s who was pregnant. The results of a routine Pap smear were abnormal. A colposcopy revealed a very high-grade squamous cell lesion. To save his patient’s life, Rutherford recommended an immediate radical hysterectomy, but that would have meant losing the baby. “The patient finally agreed,” Rutherford says, “but after the surgery she said to me, ‘I can’t believe I gave up one of my children.’ It was a difficult choice she made, but she probably would have died if she hadn’t.” Another patient was a 20-year-old college student who had adenocarcinoma of the cervix, which is also caused by HPV. She underwent a cone biopsy, but the Pap smear still revealed abnormalities in her cervical cells, “We couldn’t repeat the procedure, because she wanted to have children,” Rutherford recalls. “We put everything on the table: This is the situation. Your best option is to have a child now.” The patient took Rutherford’s advice and had a baby, after which Rutherford performed a radical hysterectomy. “There she was, getting married, having a baby and then having a hysterectomy, all before she turned 21,” he says. “I assure you that wasn’t what she foresaw for herself.” Even when a patient isn’t diagnosed with a precancerous lesion, the ordeal of getting a positive test result, going back for more tests and possibly having to have a colposcopy or a biopsy before finally getting a clean bill of health is stressful. “It’s also a very expensive way to prevent cervical cancer,” Brandsma says. “It’s a lot of money and anxiety.” A far better approach, she and other HPV experts say, would be to vaccinate people against the disease. Researchers at Yale and elsewhere have been working on two types of vaccines with promising results. A prophylactic vaccine being
1/28/2018 The virus behind the cancer > Features > Spring 2006 | Yale Medicine 8/10 developed at the National Cancer Institute and the University
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