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A shot that could save thousands of lives in the U.S.

By Alice Dreger  Posted by Wallace Stephens (about the submitter)     Permalink
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By Alice Dreger, an associate professor of medical humanities and bioethics at the Feinberg School of Medicine of Northwestern University
Published July 5, 2006

I don't have cervical cancer--yet. What I have are strains of human papillomavirus, or HPV, the virus that causes cervical cancer, and an enormous sense of relief that, in spite of some opposition, a federal panel just voted to recommend that all girls and women ages 11 to 26 routinely receive the new HPV vaccine against cervical cancer.

As a historian of medicine, I look back at the patients' rights movements around HIV/AIDS and breast cancer and see all of those people who stood up to make absolutely sure that the maximum resources of medical science and public health were thrown at these horrific diseases.

So, why have women like me been mostly silent in the public discussions about the cervical cancer vaccine?

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Imagine if there were a vaccine that could prevent HIV or breast cancer. Imagine too--as in the case of the new HPV vaccine--that some people hoped to prevent full implementation of the vaccine because of a naive notion that if we mandate that girls be given this vaccine, maybe they won't abstain from sex. The vaccine is most effective when administered to girls before they become sexually active.

The HIV/AIDS and breast cancer (or prostate cancer or whatever) advocates should be shouting from the highest hills. They should be saying what is absolutely true: Your sexual politics should not determine whether women like me have to live with or die of HPV.

So why are women like me being so quiet?

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I think I know. In fact, I know I know. Because as I thought about writing this, I kept thinking one thing: My parents are going to read this. My neighbors are going to read this. My colleagues are going to read this.

And like a lot of women in this country, I've gotten the clear message that I'm not supposed to be honest about the fact that I've had sex with anyone other than the guy I married.

So let me allow the HPV vaccine to out me, just as HIV/AIDS caused so many gay men to be outed.

I was 17 when I started having sex. My first sexual partner was a trusted high school teacher of mine who took advantage of my emotional vulnerability. I went on the pill, so he didn't use a condom.

I have no idea whether he was the man who passed HPV on to me. It could have been another man I slept with. When I was 23, my annual Pap smear showed up positive. I had cells that were precancerous because by then, somewhere in my sexual chain, I had picked up HPV.

I suppose I counted it as lucky that we caught it early. After the positive Pap, I made an appointment with my gynecologist so he could use a freezing technique to kill and remove a conical section of my cervix, in hope that this would remove my risk for cancer.

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I tried to ask him about what this meant for my future: Was I going to get cancer? Could I have a baby? But he didn't want to talk about all that. He just told me in a rather grandfatherly voice that we'd deal with all that when it was time.

Twelve years ago, when I was 28, I fell in love with the guy I knew I would marry. Before we started having sex without condoms, I was tested for every sexually transmitted disease I could, and came up clean. Every one except HPV, which I knew I probably still had and which maybe he didn't. The guy who became my husband knew this too. He knows that if he goes on to have another sexual partner in his life, he puts her at risk of cancer.

The guy I married happens to be a doctor, an internist. Whether he has HPV, I don't know. Last year I finally got up the nerve to ask him, as we were making breakfast together, what if one of my Paps comes up positive? What if I do get cervical cancer?

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