Having multiple sexual partners increases one’s risk of developing cervical cancer.
The award-winning musical film Evita captivated moviegoers in 1996 with its melodramatic cinematography and memorable songs such as “You Must Love Me” and “Don’t Cry for Me Argentina”; both of which were performed by pop icon Madonna, who also portrayed the film’s titular character. While the movie eloquently told the turbulent life story of former Argentine first lady Maria Eva “Evita” Perón, it glossed over the exact reason of her earthly demise. Initially publicized as appendicitis, Evita’s cause of death was later determined to be cancer of the cervix (Lowenfels, 2002).
Cervical cancer occurs when healthy cells in a woman’s cervix – the lower part of the uterus that connects to the vagina – mutate into cancer cells. In contrast to healthy cells (which die and get replaced by new cells), cancer cells have no lifespan and can multiply out of control. This excessive accumulation of cells eventually results in a lump, also known as a tumor. When cancer cells metastasize or break away from the tumor and invade neighboring tissues, new tumors called metastatic tumors are formed in other parts of the body. These tumors can cause fatal consequences by disrupting the life-giving functions of the affected part or organ.
It is widely accepted that the human papillomavirus (HPV) plays a definite role in causing cervical cancer. “HPV is a virus that can be passed on to a partner through sexual intercourse,” explained Diosdado Mariano, MD, Head of the Women’s Care Center and the Department of Obstetrics and Gynecology at De Los Santos Medical Center. The virus can also be transferred by means of anal sex and skin-to-skin genital contact.
“There are many types of HPV,” Dr. Mariano continued. “Some can cause cancer while others cause vaginal and vulvar warts.”
Though most types of HPV do not trigger major health problems, HPV 6 and HPV 11 can cause genital warts for both men and women. These skin growths are highly contagious and can be itchy, uncomfortable or even painful. Moreover, types 16 and 18 of the virus are said to be responsible for at least 70% of all cervical cancers.
“It usually takes 15 to 20 years for cervical cancer to develop in women with normal immune systems while, for those with weakened immune systems (such as women with untreated HIV infection), it only takes 5 to 10 years,” Dr. Mariano noted. “In both cases, it’s hard to know when someone first became infected since there are no signs or symptoms of the cancer in its early stages.”
According to the World Health Organization (WHO), some of the symptoms of advanced stage cervical cancer include irregular, intermenstrual (between periods) or abnormal vaginal bleeding after sexual intercourse; back pain; leg pain; pelvic pain; fatigue; weight loss; loss of appetite; vaginal discomfort; having vaginal discharge that emits a foul odor; and a single swollen leg.
There are, however, identified―mostly lifestyle-based―risk factors that contribute to the development of this disease. Among them are having multiple sexual partners, being sexually active before the age of 18, having a weaken immune system due to another condition like HIV or AIDS, and smoking.
During the course of Evita Perón’s life, she exhibited a couple of these risk factors that could have led to her cancer. At the tender age of 15, Evita moved to Argentina’s capital of Buenos Aires to find work as an actress. Due to the nature of show business, it can be postulated that her sexual activities began at quite an early age. Furthermore, she married a man who had multiple sexual partners in then-future Argentine president Juan Perón. Ironically, despite several accounts that Juan had constantly berated Evita for her supposed promiscuity prior to their marriage, his sexual past could have been far more destructive. It was reported that his first wife Aurelia had also died from cervical cancer; hence, there is a possibility that he had actually infected her with cancer-causing HPV―perhaps even both of them (Mirkin, 2015).
Signs of the Times
In the early 1940s, Georgios “George” Papanicolaou, MD developed a revolutionary and inexpensive way to screen for cervical cancer. The Papanicolaou smear test, now commonly known as Pap smear, consisted of a physician using a device called a speculum to visualize the vagina and cotton swab to scrape some cells from the cervix for later examination in a laboratory. This non-surgical test has since been widely accepted as an efficient method to detect abnormal cervical cells that include precancerous lesions and early forms of cancers. Sadly, during Evita’s time, such a test was not yet a standard in medical care in Argentina (Altman, 2000).
After fainting during a public appearance in January 1950, Evita underwent an appendectomy to treat what was believed to be appendicitis. She never again fully regained her strength, though. Perón continued to feel weak and frequently suffered from severe vaginal bleeding―both symptoms of advanced cervical cancer. All the while, she had no idea why she was so sick in the first place (Altman, 2000).
“Nowadays, a woman undergoing regular Pap testing and other screenings should not die from cervical cancer,” Dr. Mariano asserted. “Upon the detection of any precancerous lesions, it should be promptly treated so that cancer can be avoided.”
It is generally advised that women aged 21 to 65 years should have yearly Pap smear testing to help preempt and prevent cervical cancer. If a patient has had negative Pap smear results for 3 consecutive years, however, she may take the test every three years thereafter. Meanwhile, upon the age of 30, women may take Pap testing every five years if the procedure is combined with HPV testing; otherwise, the 3 year recommendation applies. On the other hand, those who have had a total hysterectomy or who are aged 65 and older must seek the advice of a physician to confirm if there is still a need for Pap testing.
Aside from a Pap smear, the WHO also lists two other screening tests for effective cervical cancer prevention. HPV DNA testing, which also consists of the use of a cotton swab to scrape cells from the cervix for subsequent analysis, is done to look for high-risk HPV types (HPV 16 and 18, among others) that may lead to cancer. On the other hand, during a Visual inspection with Acetic Acid (VIA), a Gynecologist applies a diluted acid solution on the patient’s cervix to examine for any color changes that can indicate if she has abnormal tissues. If there are abnormal tissues, these are then targeted for biopsy and sent to the laboratory for histopathologic examination.
Knowing is Half the Battle
Throughout Evita’s health ordeal, it is unfortunate to know that she was unaware of her real condition. As her decline coincided with the 1951 Argentine general elections, it is said that Juan had hidden his wife’s cancer diagnosis from her after realizing that Evita’s popularity was crucial to his reelection bid (Altman, 2000).
Later, it was discovered that the cancer had already spread throughout her body. After a biopsy―wherein tissue samples were surgically removed for further testing―confirmed the initial diagnosis, additional treatments such as radiation therapy and chemotherapy were then performed on her (Lowenfels, 2002).
Alas, while Juan Perón was successfully reelected as president, Evita soon passed away – ignorant to the truth – on July 26, 1952 at the age of just 33 years old. Since knowing is half the battle, with prompt treatment being the other half, Evita ultimately lost out on both fronts.
“Studies show that cervical cancer is the second deadliest cancer among Filipino women,” Dr. Mariano reiterated. “Given the current unavailability of a cure for this cancer, the need to inform the people of the various preventive measures becomes much more urgent.”
Currently, there are vaccines that help protect against cancer-causing HPV. As these are most effective prior to HPV exposure, administration of the vaccines is recommended starting the age of 9 onwards.
Nevertheless, HPV vaccination does not replace cervical cancer screening or―more importantly―annual visits to the Gynecologist. Moreover, women are also advised to practice safe sexual practices and avoid tobacco use as these are known factors that increase the risk of having cervical and other cancers.
“With proper prevention, screening and treatment, no unnecessary tears will be shed due to cervical cancer,” Dr. Mariano affirmed.
De Los Santos Med’s Women’s Care Center offers Pap smear testing and vaccination against cervical cancer. This specialty clinic is open Mondays to Saturdays from 8AM to 5PM.