Cervical cancer is the fourth most common cancer among women. In 2022, there were an estimated 660,000 diagnoses and about 350,000 deaths worldwide. That works out to someone dying from cervical cancer every two minutes.
Somewhere in statistics like those are people like my Grandma.
One of my favorite places in the world was the log cabin my great-grandpa built in 1924, along the shores of Lake Sylvan outside Pillager, Minnesota. I spent a lot of time there with my grandparents.
In summer, we’d throw the windows open and let in the sounds of loons calling and fish leaping. I loved lying in the bottom bunk with a book. It was one of the few places I felt safe.
Grandma and Grandpa were always the kindest people in the room. She’d spend hours playing with us kids. Poverty shaped her life, but it didn’t break her. It taught her how to make do. She cooked as if she were feeding an army, kept a massive garden and canned enough food to get everyone through into the next growing season.
Grandma was never afraid to speak her mind, and she always said my favorite comic books—Archie, Scooby Doo and all the superheroes—were “brain pollution.” If she found them, she’d throw them away. I got really good at hiding them.
After Grandpa died, my mom moved up there. In 1990, I got a panicked call from my mom, as she told me something wasn’t right with Grandma.
When I arrived, Grandma was sitting in the living room, smiling and looking perfectly fine. But when she tried to speak, her words came out as gibberish, and she didn’t seem to realize we couldn’t understand her.
It took both of us to convince Grandma to go to the emergency room. The doctors confirmed it was a stroke, then told us her kidneys weren’t functioning.
Once she was stable, they transferred her by ambulance to the nearest hospital with dialysis, about an hour away. With dialysis, Grandma quickly felt better. Her speech returned. She was herself again.
But the question hung in the air: Why were her kidneys failing? That’s when the doctors said the word no one wants to hear: cancer.
I can’t help asking hard questions about prevention, because prevention is where we still have a chance to spare other families the moment I lived through.
Cervical cancer had spread throughout Grandma’s body. There was nothing they could do to stop it, only keep doing dialysis and keep her comfortable. We didn’t know that, because Grandma forbade the medical team from telling us her cancer was terminal.
A couple of weeks later, my mom called again. Grandma was unresponsive. She’d had another stroke. The nurses said she didn’t have much time. That hour drive felt endless. When I got to the hospital, I ran across the parking lot and down the halls to her room.
My mom told me what she knew and then stepped out to give me a few minutes alone with Grandma.
I sat on the edge of the bed and held her hand. I talked to her like she could hear me, though I didn’t know if she could. I reminisced about the cabin and the garden. And I told her where I used to hide my comic books—I don’t know why; it just came out.
I told her we loved her as tears stung my eyes. I said we’d hold on to what she taught us for the rest of our lives. I told her it was okay to go.
Her eyes opened briefly. I felt a slight pressure as she squeezed my hand.
And then she was gone.
The wedding of Dorothea Katzung and Merrill Carrier, in 1935
That’s why I can’t help asking hard questions about prevention, because prevention is where we still have a chance to spare other families the moment I lived through.
The World Health Organization recently launched a global push to eliminate cervical cancer, laid out in a 56-page report. Its approach focuses on vaccination, screening and treatment: three pillars that can save lives.
I’m grateful that these powerful and important tools exist, and it’s absolutely right that they’re being promoted. At the same time, medical access is limited for many people, and the tools themselves have some limitations. The HPV vaccine, for instance, targets the most common cancer-causing HPV types, but does not provide protection against all types.
HPV is the leading known cause of cervical cancer, but it isn’t the only factor linked to risk. One of the clearest cofactors is smoking, which according to some research is associated with women having double the risk of cervical cancer. Tobacco-related compounds have been detected in cervical mucus, and smoking-related damage to cervical cells has been documented. Smoking also affects immune function, which matters when the body is trying to clear an HPV infection.
It concerns me, then, that tobacco shows up only twice in the WHO report: first in a figure on page 25 recommending health information and warnings about tobacco use, and then on page 26 with a brief reference to tobacco cessation. Smoking—when use of combustible tobacco is the primary concern—is not specifically named at all.
We can prevent more cervical cancer by addressing tobacco smoke exposure as a significant part of the prevention story, not as a footnote.
My Grandma didn’t smoke. But she spent her life surrounded by people who did, and evidence also links secondhand smoke to cervical cancer. I can’t help wondering how much smoke she breathed in year after year, decade after decade, back when “smoke-free” wasn’t even a concept. I keep asking myself if the smoking by those of us around her contributed to her death.
January is Cervical Health Awareness Month. It’s the perfect time to say the whole truth out loud: We can prevent more cervical cancer by vaccinating, screening and treating. And we can prevent more still by addressing tobacco smoke exposure as a significant part of the prevention story, not as a footnote.
For those who can’t or don’t want to stop using nicotine, we need to educate them on options to reduce their risk, such as the array of smokeless products that are available to them.
But I needn’t have read the whole WHO report to know that these options would not be mentioned there.
Cancer prevention communication should routinely include a clear, plain-language reminder that avoiding smoke exposure and quitting smoking can reduce risk, not just for lung cancer, but for cervical cancer too. Prevention should include helping people who smoke quit, preventing smoking initiation and avoiding secondhand smoke. This should be communicated in every country, at every income level, and to adults who are long past the teenage vaccination window.
My Grandma was a strong woman with a lifetime of survival skills. But none of her life’s lessons provided a way to survive cancer.
We owe it to women and their families to do everything in our power to prevent cancers we already know how to prevent, while we keep pushing research forward for better treatments and cures.
Because “every two minutes” is not just a statistic.
It’s a family. It’s a hand held in a hospital room. It’s someone’s Grandma.
Top photograph via Rawpixel/Public Domain
