Sunday, March 22, 2009

So Jade Goody has died.

Of cervical cancer.

At the age of 27.

Cervical cancer is one of the slowest forms of cancer there is. If caught early, cervical cancer is nearly 100% treatable.

But Jade Goody's cervical cancer was not caught early. You know why? Because Jade Goody was unfortunate enough to live in England, where regular (not annual, I hasten to point out, but regular, by which the NHS means every three years) pap smears are not given to young women until they reach the age of 25. Twenty-fucking-five.

Many forms of cervical cancer stem from strains of HPV, HumanPappillomaVirus. HPV is a sexually transmitted disease.

That's why in the US, pap smears are recommended for all women once they become sexually active. Because sexual activity automatically increases your risk of HPV exponentially. And because even without HPV, you are still at risk (I get irritated when I see people behaving as though HPV is the *only* cause of/risk factor for cervical cancer. It's NOT) once you become sexually active.

A loose scan of my memory gives me the names of three or four of my female friends, including myself (I'll get to that in a second) who were treated at one time or another for cervical dysplasia--precancerous cells on the cervix. To a woman treatment was short and simple, and fairly non-invasive. Easy.

Pap smears save lives. Period. End of fucking story.

At least, it's the end of the story for Jade Goody, dead at twenty-seven, leaving her two small sons behind. Who wants to be the one to explain to those boys that their mother is dead now because England couldn't be bothered to spend the money for a simple test that would have saved her life? And, far worse, that rather than simply admitting they can't afford it but urging women to get them anyway, by not even recommending the test until age twenty-five they imply strongly that the pap is a waste of time, that there's no point in getting one before you hit twenty-five, even in a country with one of the highest teen birth rates in the world (Goody surely could have afforded private insurance or to get the test on her own, but she'd been told it was unecessary)? Which would certainly imply a very high rate of teen sexual activity, wouldn't it? A country which decides to save money by crushing the lives of young women and treating them as though their health is unimportant, that the pap smear is unecessary and silly? Do you want to explain that to them? I sure don't.

It's not just paps, either. Right after we moved here my husband asked his doctor about getting an annual physical. At thirty-three, with histories of cancer and heart disease on both sides of his family, he'd been getting annual check-ups for three years as recommended. The doctor laughed at him. "Oh, yes, well, that's just insurance companies in America wanting to make more money," he said. "You don't need an annual check-up until you hit fifty."

(No, this is a different doctor from the one who told him, when he went in with bronchitis and could hardly breathe, "You look healthy enough. Give it a few more days, and if you start coughing up blood come back." But the point is the same, isn't it?)

So Jade Goody is dead at twenty-seven, because she grew up in a country that told her pap smears were a waste of time. Whereas I consider her death to be a waste of time; time she could have spent raising her children and living a life.

I got my first pap smear at eighteen, because I knew I was supposed to get them once I became sexually active; it was something which had been drilled into my head by teen magazines and Health teachers and the world at large. Because I didn't have health insurance I went to Planned Parenthood and paid $35, if memory serves (they bill you on a sliding scale there. Years later I also went to PP for an HIV test, don't remember what I paid for it; I didn't think I was at risk for HIV and I wasn't, but I am a bit of a hypochondriac so wanted to be certain.) It wasn't too bad; it didn't really hurt or anything. They sent me my results; all clear.

I got another at nineteen. Another at twenty, and twenty-one. Twenty-two I skipped, but went again shortly after turning twenty-three.

That's when they dinged me.

I had moderate-to-severe dysplasia, confirmed by a biopsy done with a colposcopy (which is like a really bright light and a dye or something that shows the doctor where the "bad" cells are during the examination so he can take samples from those spots). My gynecologist--a fantastic man who went on to deliver both my children--booked me in for a LEEP biopsy, whereby a loop of wire with an electric current running through it was used to remove the cells. The only really unpleasant thing about it was the lydocaine shot; not painful, but I had an uncomfortable reaction to the lydocaine. It took about an hour.

I did not have HPV, by the way.

I went back every six months for the first year or two to get another biopsy & colposcopy. After three years I was considered "clean" and could go back to regular annual paps. Those have been clean too, ever since, although of course I've only had one since I've been (not pleasant; no chair with stirrups, you have to lie down, tilt your hips up and spread your legs, with no little paper blanket or anything, which is both uncomfortable and undignified) here because history of cervical cancer or not, the NHS considers women's health to be unimportant (another friend of mine came up against a stone wall when trying to get a mammogram at thirty-five, after every other woman in her family had been disganosed at various times with early-onset breast cancer.)

My other friends who'd also had cervical cancer, who'd had crosurgery (freezing) or LEEPs like I had or cone biopsies? All had the same outcome. One incidence; closer checkups after, eventually sliding into regular annual checks again. We were all very lucky to live somewhere that paps are taken seriously. We were all very lucky indeed.

We were also all, to a woman, under twenty-five.

The youngest was eighteen. The oldest was me, at twenty-three.

Think about that for a minute. If I had grown up here instead of there, I might very well not be alive now. I might be alive but without my two children; had the cancer spread I probably would have ended up with a hysterectomy.

Dead or infertile by the age of twenty-five. All of us. All because in order to save money the NHS pretends there's no point in doing a test, an important test which has been proven to save countless lives. Think for a minute about the women you know; have any of them had it? How old were they?

There's been a movement here since the Goody diagnosis to lower the age for pap smears to twenty, in accordance with what the other UK countries do. Which is better, but not enough.

Pap smears should be done annually once you become sexually active. End of story. On a message board a little while back some women were having a discussion about this, and one was saying (at twenty-one, I think) that she was terrified to go get the pap, that she cried at the thought of anyone who wasn't her fiance seeing her ladyparts, that she was panicky and sick and blah blah blah. And you know, I felt bad for her; I can't imagine what that kind of fear would be like. It's not one I've ever had. A doctor is a doctor. To me it's no different than having my hands examined.

But I told her something. She didn't like it and probably still thinks I'm a big old bitch for it, but I didn't apologize then and I won't apologize now, because it's true. If you're not mature enough to suck it up and get a pap smear, you are not mature enough to be sexually active.

Seriously. Responsibility is part of it (the same holds for birth control). Pap smears are part of being a grown woman and not a child. I have two daughters, and you bet your ass they're going to get their paps every year when the time comes, if I have to drag them in and hold them down on the table myself. Because they are so, so, so hugely important.

It's just too bad the NHS doesn't think so. And that now another young woman is dead because of it. I never watched Jade Goody on TV or really knew very much about her; reality TV isn't my thing, in general. But I am absolutely furious that she is dead, when she didn't have to die. I am furious that her government killed her by pretending she wasn't at risk for a disease which strikes thousands of young women every year. I am furious that they behave as though my experience and the experience of so many others is unimportant or an aberration; I cry to think of all I might have missed had I been born and raised here instead of America.

A young woman is dead today, of an entirely preventable and treatable illness. And I feel sick about it. And I hope the NHS does too, because they should be fucking ashamed of themselves.

PLEASE, if you are reading this and you are female, or if you're reading this and you know some females :-), PLEASE encourage them to get their pap smears. Please. It is so important.

NOTE: Last night I noticed Mrs. Giggles--whom you all know I adore--linked to this entry and wrote an excellent and very informative post about Pap smears and the types of cells/cell abnormalities found in them. It's well worth a read. But more importantly, Mrs. G. makes a point that I neglected to make: whether or not you are sexually active, you should be getting your pap smears annually. I don't care if you're a nun, once you reach a certain age--Mrs. G suggests 18--you need to do them. And she is 100% correct. I'm ashamed that I didn't mention this myself. Please...get the test, whether you're having sex or not.

(I'll be in a better mood tomorrow, I promise, and I'll post the OMFGAWESOME cover and back copy for UNHOLY GHOSTS, and you do not want to miss those!!!)


writtenwyrdd said...

that is awful. And to think that so many people are going on about how the US healthcare system is so broken and we must fix it by socializing medicine. I've always maintained that we have a good system, we just need to find ways to cut the cost and supply everyone who is underinsured or lacking with coverage. Straight welfar isn't the answer; it's breaking my state's budget and they are in arrears in payments to hospitals. (Of course, Maine is a huge welfare state. We are something like 20% higher than any other state in percentage of state budget aimed at welfare. And the system cannot continue like this or it will collapse!)

BernardL said...

The only people who seem to think universal health care is a great thing are the ones who aren't living under it.

kirsten saell said...

I live in Canada, and I have a friend who was treated for cervical cancer at age 18. She didn't have HPV, and she had only had sex a few times.

My mom dragged me in when I was 15, before I was active (as far as she knew, anyway, heh), because she's very health conscious. It wasn't fun, but it wasn't awful, either, and it's such a freaking simple, inexpensive test. Here, the health care system covers the cost--even if I was paranoid and wanted one every two months.

Wonder how much the chemo, radiation, surgery and other treatments for Jade Goody's cancer cost the NHS. Wonder how many pap-smears that would have bought.

There are issues with socialized health care not being able to balance the small costs of early or non-invasive treatments with the immense costs of dealing with shit that gets way out of hand. There was a special surgical MRI that would have cost the BC government something like a million bucks, so they refused to get it. The difference in recovery times after brain surgery (one week in hospital vs. 5 months, two of which were in ICU) would have paid for the machine in two surgeries, but they "couldn't justify the cost". So yeah, socialized medicine can be stupid when it come to treating rare conditions.

But I think the NHS's reluctance to fund pap-smears is more a funtion of their ambivalence toward women's health than a lack of money. It's a hell of a lot cheaper to test for it and treat early than to do otherwise.

December/Stacia said...

I know, Written. I cringe every time I hear people in the US calling for socialized medicine; my experience with it has been that you do not get what your taxes pay for, not at all, not remotely. I have stories that would turn your hair green. I would love to see Medicare expanded; I would love to see a form of low-coat insurance. I would LOVE to see major tax breaks and incentives for companies which offer health coverage to their employees; I honestly believe that's the best thing. But straight gov't control of medicine? No way.

Exactly, Bernard. Trust me, socialized medicine is *so* not the answer.

And I believe that is a big part of it, kis; the simple sexism of it and the disrespect for women in general and their heathcare in particular. I think if there were a male cancer this widespread and preventable it would be standard from a very early age. But the problem is here, unlike the US, there are no alternatives either. Because of the NHS there are no Planned Parenthood-style clinics, you know? It's just shameful that so many people are allowed to slip through the cracks. And don't get me wrong, it's shameful that people go without healthcare in the US (although a public hospital will treat you wether you can afford it or not). There should be an answer, but I don't believe this is it. I'm glad Canada at least doesn't disgregard the importance of women's health, and that you get your paps. :-)

kirsten saell said...

Well, Canada definitely has a different system than the NHS. Here, medicine is mostly still privatized (we don't call it that, but it is). It's the insurance that's socialized, and everything that's covered by insurance is free for users. Anything deemed medically necessary is covered--including taking your kid to the doctor when he just has a cold (people do that, and it drives me crazy).

Sometimes there are long waits for things like MRIs and you can't pay to jump the queue in your own province, but if you have the money to pay for the procedure and a plane ticket, you can get it done in another province. If health care didn't cover paps in under-25s, you could pay to have it done in a "private clinic" or at your regular doctor's office, since they're still private practitioners.

There are things the Canadian system could do a LOT better, but it is nice not to worry about having to pay to find out if your kid has measles or just a rash.

Of course, we pay a lot more in taxes than Americans do, too.

Venus Vaughn said...

Something as important as this doesn't belong on your blog. Well, I mean, hey, it's your blog, you can put whatever you want on it. But where it really belongs is in an open letter to the editor of your (no longer local) paper, and in a message to your (no longer local) member of the House of Parliament.

Saying something this important on here is bitching to your friends over coffee. Say it to someone who can do something about it. Say it to someone who can make a change.

When you get a toe in - or any kind of response - then bring it back here to rally the masses.

laughingwolf said...

i have two daughters, mid 20s, and suspect they are sexually active [since both have boyfriends], and i know they are sensible enough to get tested regularly... but i'll ask to be sure

December/Stacia said...

Thanks, Kis, that's really interesting! I didn't know the specifics of the Canadian system.

Thanks, Venus, I appreciate that. You know what I found outrageous as well? Aside from seeing new collection buckets at Boots for women's health research, and a Facebook group and petition to lower the age to 25, I haven't seen ANY talk about this aspect of the Goody situation. Nowhere. They mention what she died of but hardly any of them mention how preventable it is, and that her death could have been prevented had she been tested earlier.

I really appreciate your point, but I do also think saying it on my blog does something. See Laughingwolf's comment below, and on livejournal I had a few people who said they were booking themselves appointments because of the post or they'd never realized how important it really is. So I'm hoping even just saying something to my readers does something. :-)

LW, thanks. I hope they do get them done; I'm sure they do, as I can't imagine you raising irresponsible girls. :-)