Greensburg Daily News, Greensburg, IN

January 18, 2013

January is cervical cancer awareness month.

Rob Cox
Greensburg Daily News

Greensburg — Each year in the US, approximately 4,220 women die from cervical cancer from an average of 12,170 annual diagnoses.

For Dr. Mahnee Dinsmore, MD, of Decatur County Memorial Hospital’s (DCMH) Women’s Care Clinic, those statistics alone are sufficient reason to observe a National Cervical Cancer Awareness Month.

“With cervical cancer,” Dinsmore explained during a brief interview with the Daily News Friday afternoon, “there tends to be much more time to detect and treat compared to other cancers. Unlike in breast cancer, this is a type of cancer that doesn’t readily spread into the lymphatic system.”

“In fact,” she added, “metastatic cervical cancer is fairly rare (metastasis occurs when cancer in one part of the body — such as breast cancer — spreads to other body parts and systems).”

In the early 1900s, cervical cancer caused more deaths among women than any other type of cancer, giving rise to the pap smear test.

“If the pap smear were invented and developed today, in the world of modern medicine,” the doctor said, “it would rarely — if ever — be used. It’s simply not accurate enough. It’s too random.”

In fact, throughout its decades of use, the pap smear has historically led to severe over-treatment.

“Doctors would find something abnormal on a pap smear,” Dinsmore explained, “and surgically remove it. Problem is, in the process, we damaged a lot of cervixes. Certainly, we did stop a few cancers, but, overall, it’s fair to say we did more damage than good.”

She continued, “Cervical abnormalities aren’t uncommon, but an abnormality doesn’t automatically equate to cancer. Abnormalities can be caused by a virus or by some other cause that the body’s own immune system can effectively eradicate without medical intervention.”

Fortunately, modern medicine now realizes that cervical cancer is caused by the Human Papillomavirus (HPV).

“Now,” Dinsmore said, “we also have HPV tests, and those screenings are critical, because we now understand that cervical cancer is virtually always the result of HPV.”

HPV tests not only detect the virus’ presence, but they also allow doctors to identify the strain. Such differentiation is important, Dinsmore said, because only a handful of HPV strains actually cause cancer.

“There are maybe four or five strains that cause cancer,” she explained, “That’s out of, maybe, 172 total strains. Those four or five strains are responsible for 99.9 percent of all HPV-related cancers.”

Dinsmore was quick to point out that 172 is a rough estimate, as HPV is constantly changing and evolving.

“It’s similar to the rhinovirus — the virus that causes the common cold,” she said. “We don’t have a vaccine or cure for that because there are so many strains, and those strains are constantly changing, with new ones regularly coming into existence. HPV is similar. I might tell you there are currently 172 known strains, but adjust that number to 200 next month.”

Still, the number of cancer-causing strains remains fairly steady, and, as with most cancers, early detection is key to the odds of survival.

Women whose cervical cancer is detected in the localized stage, Dinsmore explained, have a 90 percent survival rate, while 57 percent of women with regional disease survive; only 18.7 percent survive metastatic cervical cancer.

Of the differences between localized disease and regional, Dinsmore expounded, “Localized disease is where the cancer is still confined to the cervix. I’ve seen patients who are still in the localized stage whose entire cervix is overtaken by cancerous cells.”

“In regional cervical cancer,” she continued, “there is more tissue involvement. The disease has spread out from the cervix to also involve the uterus, maybe the pelvis. What many people don’t realize is that death from cervical cancer usually doesn’t involve metastasis, but rather, regional disease that spreads to involve other systems. Women with regional disease, for instance, can be in danger of renal failure. Most patients die when the disease spreads beyond the uterus.”

Dinsmore also stressed that HPV-related cancer isn’t exclusive to women.

“This is not a woman’s cancer,” she said, adding that Ear, Nose and Throat doctors have found that almost all modern cancers of those areas are caused by HPV.

“A virus doesn’t care about your gender,” she said. “Men are just as vulnerable to cancer-causing HPV strains as women.”

Moreover, according to Wikipedia ( “Two HPV [strains] (HPV-16 and HPV-18) cause 70% of cervical cancers, 80% of anal cancers, 60% of vaginal cancers and 40% of vulvar cancers. These HPV types also cause most HPV induced oral cancers, and some other rare genital cancers.”

As such, Dinsmore advocates HPV vaccination in both males and females.

HPV vaccine (of which there are two currently available) are recommended for girls and boys and men and women between the ages of nine and 27.

“Beyond age 27,” Dinsmore said, “the vaccine simply doesn’t provide any protection. That’s ashamed, because the median age of diagnosis for HPV-related cancers is 48. Older patients are more likely to be settled and stable, and less likely to engage in risky behaviors. We’d love to be able to vaccinate older people, but it just won’t work.”

Still, Dinsmore is optimistic that the vaccine might eventually be developed to be effective in older populations.

The HPV vaccine has caused moderate controversy among some conservatives, evangelicals and others who’ve argued that such vaccinations promote promiscuous behavior among teens and young adults.

Dinsmore dismissed such contentions.

“I don’t think a teenager worries about whether his or her current behavior will result in cancer when they reach their 40s or 50s,” she said. “Most teens tend to think of themselves as invincible. So do I think teens will see HPV vaccination as a ticket to sleep around? Certainly not.”

“That logic,” she continued, “is just too tough a sell to a teen. What works better to motivate teen vaccination is to remind them that it will prevent genital warts. They definitely respond to that.”

At the moment, such controversies are almost moot, as widespread HPV vaccination has thus far proved economically untenable.

“The economies of vaccination are a real problem with HPV,” Dinsmore said. “My current reimbursement for a single, $200 HPV vaccination is $7. That means I need to give 30 other types of immunization to break even. It’s only economically viable in health-department settings. It’s a tragic situation; these are cancers we could virtually eradicate through immunization, yet we aren’t doing so because we can’t afford it. Something needs to be done to change that.”

Dinsmore conceded, too, that a certain stigma can be attached to HPV and cervical cancer because of the connection to sexually transmitted disease.

“Every person who walks this Earth is the result of a sexual encounter,” she said. “Denying our sexuality is unhealthy; we’re all sexual beings. Sex is nothing to be ashamed of, but it is ashamed to die of a highly-survivable disease that’s imminently treatable.”

Contact: Rob Cox at 812-663-3111 x7011.