W.Va. Has High Rate of Cervical Cancer Despite Preventive Vaccines

Human Papillomavirus – more commonly known as HPV — is the most common sexually transmitted infection in the United States. It is so common that almost all sexually active individuals will get it at some point, which puts them at risk for developing various cancers. The good news: HPV is preventable. The bad news: vaccination rates are low nationwide, with particularly troubling statistics coming out of West Virginia.

Shelly Dusic found out she had cervical cancer two weeks after she got married. She was 22.

“And I was probably the most grateful person to find out I had cancer you’ve ever seen,” says Dusic. “Because for the six years prior to that, I’d been told by four doctors that I’d never live to see 30, that they didn’t know what was wrong with me. [I had] been through seven diagnostic surgeries and we didn’t know what was wrong.”

Her first symptoms of having HPV – irregular, heavy periods, debilitating pain in her right side – started when she was about 16. She had a hysterectomy to address the cancer when she was 23.

Dusic was quick to point out that her case was not “normal.” The average age of cervical cancer diagnosis in the United States is 48.  

“But being exposed to the virus that causes cervical cancer in your teens or early 20s is very common,” she says.

HPV viruses (there are more than 100 related strains) cause almost all cases of cervical and anal cancers, according to the National Cancer Institute. HPV can also cause other cancers, including cancer of the mid-throat. Once someone is infected with HPV, they will carry it until the virus leaves their system – or doesn’t; there is no cure.

“We need to get the word out that we have a vaccine that can prevent cancer,” says Kathryn Moffett, head of the pediatric infectious diseases at West Virginia University School of Medicine.

“Giving the HPV vaccine is not about giving your child permission to be sexually active,” says Moffett. “Those are very important conversations to talk to your kid about making good choices, and waiting on things and being monogamous – those are all really important things. It’s about prevention – give it before anyone is even remotely considering doing anything. Give it at 11 and 12 when they get a really brisk response and they get a response to all the serotypes in the vaccine – then you are protected.”

Moffett says millions of doses of the vaccine have been given in the ten years since the vaccine was approved, but that West Virginia continues to experience low vaccination rates. There are no known serious side effects to the vaccine.

“Unfortunately, we are number one in HPV-related cervical cancer deaths and number four in HPV-related infections in the United States,” says Moffett. “That’s bad.”

Part of West Virginia’s high cervical cancer rates may be due to other risk factors. Smoking, for instance, increases the risk of cervical cancer, as does poverty and being overweight, according to the American Cancer Society.

Shelly Dusic was diagnosed with cervical cancer in 2002 – four years before the first vaccine came out.

“The day the FDA approved the vaccine for HPV, I bawled like a baby,” says Dusic. “Because for the first time there was hope that no other woman had to go through what I went through, and no one should.”

According to the CDC, about 79 million Americans are infected with HPV. About 14 million people become newly infected each year, with no cure yet in sight.

Dusic is now 36 and hasn’t been sick since her surgery. She loves being well. But she says she still has trouble walking through the aisles of Walmart and passing the baby section.

“And I think about the things that that vaccine could have saved,” she says. “It would be worth it.”

Dusic is now a Health Information Specialist for the WV Breast and Cervical Cancer Screening Program, which has been partnering with the WV Immunization Network to try and increase HPV vaccination rates in Appalachia.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

Colorectal Cancer Screening Saves Lives

Google colorectal cancer survival rates and a rather shocking American Cancer Society chart pops up.

On the one end is stage I, on the other stage IV. Several subgroups are in between. For stage I patients, the five-year survival rate is 92 percent. For stage IV, that number drops to 11.

“If you’re screened early enough you can prevent yourself altogether from having cancer,” said Kevin Tephabock, senior manager of primary care systems for the American Cancer Society. His job is to work with health care facilities in West Virginia, Virginia, Delaware, Maryland, and Washington D.C. to improve cancer screening rates. Currently only about 63 percent of West Virginians are getting screened.

“For years, colonoscopy was the gold standard…and colonoscopy helps significantly. It decreases colorectal cancer mortality about 30 percent,” he said. “However, many people were not comfortable with the idea of having a colonoscopy. So now there is actually some new testing out there that’s available.”

Called Fecal Occult Blood Tests, they basically test for blood in feces. They are available at primary care facilities and can be taken home by the patient, used, then returned to the doctor or lab. If a polyp or cancer is suspected, further testing is needed.

Screenings are covered by insurance. A new nationwide initiative called 80 by 18 is attempting to increase screening rates to 80 percent by 2018. (Governor Tomblin was the first U.S. governor to sign the pledge.) State officials hope to achieve this goal, in part, by working with primary care facilities.  

“In West Virginia one of our bigger barriers is just geographically,” said Tephabock. “We have somewhat of a shortage in terms of GI docs…and so someone in southern WV may have a very difficult time finding a GI doc.”

The screenings find precancerous polyps that can then be surgically removed. That’s it. You continue getting your screenings every year, but other than that, no major life changes.

Credit Kara Lofton / WVPB
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WVPB
Chris Stadelman receives treatment for stage IV colorectal cancer at Charleston Area Medical Center Cancer Center

“As I’ve told several people it’s a day and a half of really unpleasant experience, but it’s a whole lot better than carrying a chemo pack around every two weeks for the rest of your life,” said Chris Stadelman, Governor Tomblin’s Director of Communications.

Stadelman was diagnosed with stage IV colorectal cancer last year at the age of 44 – too young to have needed a screening by federal guidelines.

“I have now been through 28 rounds of chemotherapy,” he said. “Going every two weeks for about 4 hours in the David Lee Cancer Center and then have a 46-hour infusion that’s done through a shoulder badge, a little pack, that I take with me.”

He has been in treatment since October of last year. All the test results so far have been as positive as can be expected. He will likely be in treatment for the rest of his life.

“I had a sense something was wrong and I waited and I waited,” he said. “So paying attention to something that may seem like nothing – well I’m too young for that to happen – clearly a lot of us are not too young for that to happen so I think it makes sense to go ahead and get those screenings if you sense anything might possibly be wrong.”

Credit Crystal Collins / WV Public Broadcasting
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WV Public Broadcasting

Stadelman hid his diagnosis for months. He said he’s not entirely sure why. Then added, “I don’t want people to treat me any differently. I want to go about my job the same way…But the more I thought about it I have, because of my job with the governor’s office, because of my experience in media, I have opportunities and connections to help someone else.”

Stadelman laughed and said he takes some credit for Tomblin being the first governor to sign the 80 by 18 pledge. WVU cancer center received a major CDC grant in August to aid in those efforts. The governor has also written to all 49 other governors asking them to sign it as well.

“I think that one to one connection makes such a difference. You can read the studies and hear about what you’re supposed to do, but knowing someone this has happened to makes a big difference for anyone. I have some credibility when it comes to telling people to go get your colonoscopy and get checked and pay attention to things.”

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

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