Preventing cervical cancer through HPV vaccination is a personal and professional cause for Brandman faculty member
It wasn’t until I started working with cervical cancer survivors that I saw myself as a survivor. I was one of the lucky ones. It was caught early. I had health insurance and prompt treatment. In 1982, when I was diagnosed, the relationship between human papillomavirus (HPV) and cervical cancer was not known, and we had little understanding of the cause. I had a full recovery and terrific follow-up care.
That doesn’t mean it didn’t change my life.
I remember the day I learned the news very clearly. It was a Friday night, and my mom was over for dinner. I was 27 with two kids, a 2-year-old and a 4-year-old, and had gone in for a routine Pap smear. The kitchen wall phone rang, and it was my doctor.
He said, “I don’t want you to start crying, but we found cancer cells in your cervix and you need to have surgery next week.”
The next week I went in for surgery and had a cone biopsy, which was the first step for a more thorough diagnosis. The surgeon takes a cone shaped piece of your cervix out, which can impact your ability to carry a pregnancy full term. That wasn’t a concern for me, but it’s a concern for many.
A week later I got a call that I had clean margins, that the cancer cells were confined to the surface of my cervix (Stage 0), so all good news. However, I had to visit routinely every six months for colposcopy and biopsy. Basically, they chip away at your cervix, without any anesthesia, and send any tissue that looks unusual to pathology. That continued through my 40s. Once in my late 30s and again in my early 40s, precancerous cells showed up. I had treatment with trichloroacetic acid (TCA) to slough off the diseased cells. Not a pleasant experience.
A cancer diagnosis is challenging for any relationship, especially a when we cloak a cancer in silence. I met my former husband when I was 19, and he was 32. I don’t believe either of us knew how to talk about my diagnosis or how to manage the anxiety I felt prior to every biopsy spanning more than a decade. In hindsight, I am certain that our relationship was significantly eroded by how we dealt with my diagnosis – a cancer that no one talked about in 1982, and many still do not talk about to this day.
While being a cancer survivor didn’t inspire me to become a nurse, it did have a tremendous impact on my specialty area, which is vaccination.
Much of my career as a nurse has been spent as a public health nurse focused on prevention, frequently involving immunization. In public health, we refer to levels of prevention; primary, secondary and tertiary. I’ve had the honor of working clinically at all three levels
With cervical cancer primary prevention is accomplished through HPV vaccination. Secondary prevention is screening through Pap smears and HPV testing with prompt referral for treatment. Tertiary prevention is understanding and addressing quality of life issues and limiting the impact of the disease. I was able to do that through my DNP (Doctorate of Nursing Practice) clinical scholarly project (CSP).
My CSP grew out of a comment from a friend who said, “Nobody talked to us about the impact of our cervical cancer treatment on our sexual health. We would really like it if you would look into that. We didn’t even know what questions to ask.”
The CSP was a descriptive study of the perceptions of cervical cancer survivors with the intent of, ultimately, improving the quality of care in the sexual domain through a more patient-centered approach. The study, “Questions I wished I’d asked: Cervical cancer diagnosis and treatment option information for women by women,” was based on a model used to assess cancer survivors’ health in the sexual domain. The assessment model was modified into a survey with input from cervical cancer survivors. Eighty-nine survivors responded to the survey.
What we found was women at the lower end of the educational scale felt they weren’t offered the opportunity to ask questions. We also learned that the gender of the provider made a difference. Women providers were more likely to discuss preservation of fertility after treatment. And unfortunately, but not surprisingly, approximately 50 percent of the survivors reported that sexual health was not discussed during their diagnosis and treatment.
I am currently the work group leader for the HPV vaccination initiative for the Arizona Cancer Coalition and work with Arizona Chapter of the National Cervical Cancer Coalition. The goal is to increase the immunization rates for HPV vaccine. Fewer than half of the adolescents in the U.S. were fully immunized-protected from HPV-related cancers in 2016.
Eighty percent of people are exposed to HPV in their lifetimes. In the United States, 12,000 women are diagnosed with cervical cancer annually, and 4,000 women die from the disease. Men are impacted, too – most frequently with HPV-related oropharyngeal (base of the tongue and throat) cancer. Currently, there is no screening for HPV oropharyngeal cancer with close to 15,000 cases diagnosed each year.
These cancers are why adolescents need to be vaccinated. HPV vaccination is cancer prevention.
We teach our children to drive safely and wear a seatbelt, to ride a bike safely and wear a helmet. Parents need to consider HPV vaccine the same way – teach healthy and safe relationship behaviors and protect their children from cancer in their futures with HPV vaccination.
January is Cervical Health Awareness Month. Registered nurses of all practice areas can sign up for the free continuing education webinar, which focuses on how to educate adolescents and their parents about HPV and the benefits of the vaccine, by going to www.brandman.edu/preventhpv. The webinar is at 6 p.m. Pacific Standard Time on Thursday, Jan. 24.
Gail Hock, DNP, APRN, PHCNS-BC, is a Brandman faculty member and a cervical cancer survivor. Her work as an educator expands registered nurses’ knowledge about the human papillomavirus (HPV), the cause of nearly 90 percent of all cervical cancers.
If you know someone that needs information or support about HPV related cancer please have them visit the National Cervical Cancer Coalition website.
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