Robert W. Yelverton, MD, FACOG
Mission Accomplished? Not Yet! Why the HPV Vaccination is So Important
I grew up and played as a boy in Southern, Mississippi. As a young man I was educated (and played) in Oxford at the University of Mississippi (Ole Miss). In 1963, in Jackson, Mississippi, I was forced to stop playing and began my education in medicine and, as it turned out, in social realism, both at the University of Mississippi School of Medicine. These were turbulent times in my native state, the “Mississippi burning” years, with open racism and bigotry, much of it sanctioned or a least tolerated by the state. Again, this was the year 1963. Medicaid and Medicare were not passed into federal law until two years later in 1965, and Mississippi did not fund Medicaid until 1969, which was two years after my graduation. During my medical student days the vast majority of my patients were uninsured. The University Hospital was always filled to capacity with critically ill patients. The majority of Mississippians were impoverished and had no insurance of any kind. Almost all of the patients cared for by the University hospital had no insurance or funds to pay for their stay. I stayed on for four more years as an intern and OB/GYN resident.
The one medical memory that stands out from those times was the unusual number of patients that came to us from all over the state with advanced cervical cancer. Pap smears were unheard of in the far reaches of the Mississippi Delta. The numbers were increased because a young physician, Dr. Dick Borneo, trained in gynecologic oncology, had just joined our staff. When rotating on gynecology oncology as a first year resident the number patients with advanced cervical cancer I admitted to the service for treatment would boggle the mind. Stage III/IV cervical cancers, patients with genital radiation fistulas from prior treatment, renal failure, bowel obstruction were everywhere. Dr. Borneo threw himself into an unbelievable schedule of radical hysterectomies, fistula repairs, and radical vulvectomies. As a result of this epidemic of cervical cancer, I performed several hundred vaginal hysterectomies, the standard treatment of the time for cervical carcinoma in situ. While the training in advanced surgical skill was excellent, the experience led to a nagging and recurrent depressive thought… and in a very big way. I fully realized that even with the medical knowledge and technology of the mid-19th century, these cases and resultant deaths in many could have been prevented with a simple Pap smear performed prior to the onset of their advanced disease.
At the time of my medical education, cervical cancer was the leading cause of cancer deaths in women in the United States. However, in the past 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly. This decline is largely due to the result of many women getting regular Pap tests, which of course, if done on a regular basis will find a cervical precancerous lesion before it becomes invasive and more difficult to cure. However, this is no time for us to take a victory lap and post a “Mission Accomplished” sign. In 2010, the last year we have statistics, almost 12,000 women were diagnosed with cervical cancer and almost 4,000 died from the disease.
We now have the opportunity to virtually irradiate cervical cancer with a very effective vaccine against the human papillomavirus (HPV) strains that cause cervical cancer. Last year, the Center for Disease Control (CDC) announced that in spite of being introduced in only 2006, the use of the HPV vaccine has reduced the prevalence of the human papillomavirus nationwide by 56%. However, I was disturbed when I noted that only 12% of eligible females in my native state of Mississippi had completed the trivalent series of HPV vaccine. That placed Mississippi at the bottom of the list of states. I uttered an expletive when I then noted that Florida, my adopted state, was next to the last on the same list with only 25% of eligible females receiving the complete series.
Florida public health officials, physicians in OB/GYN, pediatrics, or primarily care practices need to increase their efforts to cover Florida with a goal of 100% eligible receiving the vaccine. I have requested the ACOG District XII Healthcare for Underserved Women, ably Chaired by Julie DeCesare, MD to take on this project. They have laid down the plans for an aggressive attack on this problem.
Vermont managed to vaccinate 74% of their eligible population in the first 8 years of availability. So CAN Florida! Please take this on as a personal project in your offices.