By: Rebecca Perkins MD, MSc, FACOG
I have been in practice for more than 10 years, and I currently see patients in a community gynecology practice.
Approximately one out of every five women I see presents for a problem related to the human papillomavirus (HPV).
New data show, and my practice confirms, that some HPV infections do not "clear" but rather go dormant and reactivate later in life. Most of my patients are in their thirties and forties. Almost all are married. One had been abstinent for 26 years before her first positive HPV test.
To prevent cervical cancer, I evaluate my patients with abnormal Pap or HPV testing with biopsies of their cervix. Some of these women develop severe pre-cancerous changes and require a minor surgical procedure to remove the diseased portion of their cervix before they develop invasive cancer. I have to monitor the others for years with painful cervical biopsies to make sure they are not developing cancer.
Almost every year, I perform a hysterectomy on a woman in their thirties who developed a severe pre-cancer that could not be treated with a less invasive procedure. At the time that one of these patient's pre-cancers was discovered on a routine screening Pap test. She and her husband were beginning infertility treatments. Because of the aggressive nature of her pre-cancer, a hysterectomy was recommended following her initial procedure. After several months of consideration, she and her husband decided to forego having children together so that she could have a lifesaving hysterectomy.
I am not an oncologist.
In the United States, at least 8,000 men and women will die from an HPV-related cancer this year—a mortality burden similar to measles in the pre-vaccine era. As a gynecologist, I see HPV vaccination as an incredible advance, and a way to vastly improve the lives of women and men by protecting them in adolescence.
About Dr. Perkins:
Rebecca Perkins, MD, MSc Associate Professor of Obstetrics and Gynecology at Boston University School of Medicine/ Boston Medical Center, has been actively involved in cervical cancer prevention research since 2003. Her work focuses on attitudes toward HPV vaccination in parents of low-income, minority adolescents in the United States and the providers who serve them. She is also studying interventions to improve HPV vaccination rates in low-income, minority adolescents. She is currently working with the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Cancer Society, and CDC on national HPV vaccination work.
Medicine Before Vaccines
This article is part of a series of first-person accounts published in recognition of National Immunization Awareness Month, which is held in August every year.