Awhile back, a reader asked me to discuss cervical cancer in pregnancy. I had put the topic on the back burner, waiting for a good segue into the subject from a patient care perspective. When it comes right down to it, cervical cancer during pregnancy in the U.S. is not very common. Although estimates vary, it is expected there will be about 11,150 new cases and 3,670 deaths related to cervical cancer here in 2007 at a treatment cost of about $2 billion. However, of these, only about 1-3% (100-300 cases annually) will occur coincident with a pregnancy. Fifty years ago, cervical cancer was the leading cause of cancer-related death in women in the U.S., but with the introduction and widespread adoption of the Papanicalaou (Pap) smear (and now liquid-based cytology), and the subsequent early detection of preinvasive cervical abnormalities amenable to relatively conservative therapy, the incidence and mortality have dropped significantly, a trend that has continued in the U.S. among all ethnic groups. To put the U.S. statistics in perspective, worldwide, it is estimated that this year there will be about 493,000 cases and 273,500 cervical cancer deaths, with 85-90% of these occurring in developing countries.
So, what compelled me to bring up this subject now? Recently, I saw a young woman (16 years old) early in pregnancy for an ultrasound to confirm her ‘dates’ and evaluate the baby’s anatomy. The baby looked just fine, but after I told her the baby was a girl, she got very upset. This was not the kind of upset that women typically get when they would have preferred a baby of different gender, but I did ask her if she had been hoping for a boy. She shook her head no, but continued to sob uncontrollably. So, I asked if there was something else she wanted to talk about. At that point she asked her boyfriend to leave the room and as soon as the door was shut, she told me that “he gave me warts, and the one’s inside turned into cancer, and the doctor told me they can’t do anything for me.” At that point (I was very relieved), I told her that I bet there was some misunderstanding, that she probably is going to be just fine, and that I would look into it for her before she left. This is a scenario I have seen too many times before, so I was fairly confident in what I had told her.
While she was being moved to a consultation room, I called to our clinic to get the ‘real story.’ As it turned out, this was her first pregnancy, she had conceived very shortly after becoming sexually active (her boyfriend was much older), she did have anogenital warts with heavy vaginal involvement, her Pap test had returned with low-grade squamous intraepithelial neoplasia, and she had been told that she probably wasn’t going to be treated during the pregnancy. This was a little different from what she had actually thought she heard which was that she had cancer and there was nothing we could do to help her and that she wasn’t going to be around to see her baby girl graduate from day care! So, I went back to the consultation room to talk with her and the conversation we had will be the subject of our next post….