Harald zur Hausen studied viruses and discovered that certain strains of the human papilloma virus (HPV), a sexually transmitted disease, can cause cervical cancer, in Europe during the twentieth and twenty-first centuries. Zur Hausen spent his research career identifying the viruses that cause diseases, particularly cancer-causing viruses (oncoviruses). He primarily focused on HPV and cervical cancer. Zur Hausen hypothesized that HPV was cancerous and discovered that two strains, HPV 16 and 18, caused cervical cancer. That discovery led to improved diagnosis of cervical cancer and the later development of the HPV vaccines, Gardasil and Cervarix. In 2008, zur Hausen won the Nobel Prize in Physiology or Medicine.
On 15 April 1999, physician Gillian Thomas published the editorial “Improved Treatment for Cervical Cancer – Concurrent Chemotherapy and Radiotherapy,” henceforth “Improved Treatment,” in The New England Journal of Medicine. In that editorial, she discusses the potential benefits of combining chemotherapy drugs with radiation to treat women with cervical cancer. At the time, healthcare professionals rarely treated cervical cancer by combining chemotherapy or radiation. Two months prior to Thomas’s publication, the US National Cancer Institute, headquartered in Bethesda, Maryland, released an announcement advocating for combining chemotherapy with radiation based on clinical trial results. In “Improved Treatment,” Thomas summarized the results of those clinical trials that had led to the announcement and communicated a new way to treat invasive cervical cancers, which persists as of 2019.
In 1930, physician Joseph Colt Bloodgood founded the Amanda Sims Memorial Fund, or the ASMF, a United States cancer awareness organization that focused on spreading information about ways to detect and prevent cervical cancer in women, in Baltimore, Maryland. In partnership with nurse Florence Serpell Deakins Becker, Bloodgood promoted awareness of the early symptoms of cervical cancer among women and advocated for regular pelvic exams. The ASMF partnered with numerous women’s organizations throughout the United States, providing educational information to women of varying backgrounds. Though the ASMF existed for only five years, it was one of the first organizations to directly reach out to women to explain the importance of regular pelvic exams and early detection of cervical cancer, creating a platform for later organizations to continue that mission.
This thesis answers the following question: How does the history of cervical cancer show that prevention helps reduce rates of cancer-related deaths among women? By studying the history of cervical cancer, people can understand how a cancer that was once one of the top killers of women in the US has declined to become one of the lowest through the establishment of and effective communication of early prevention and diagnostics, both among the general public and within the medical community itself. This thesis is organized based on key episodes which were pertinent to the history of cervical cancer, primarily within the United States and Europe.
In 2006, the article “HPV in the Etiology of Human Cancer,” hereafter “HPV and Etiology,” by Nubia Muñoz, Xavier Castellsagué, Amy Berrington de González, and Lutz Gissmann, appeared as the first chapter in the twenty-fourth volume of the journal Vaccine. Muñoz and colleagues discuss the role of the Human Papillomavirus, or HPV, in uterine cervical cancers. The authors introduce the mechanisms of HPV infection that lead to genital and non-genital cancers, establishing a link between HPV and multiple human cancers. The authors end by mentioning how other factors, such as pregnancy, smoking, and age, can influence HPV progressing into cervical cancer, which can be fatal. In the article, Muñoz and colleagues use meta-analyses of case studies and clinical trials to show which specific types of HPV are linked to cervical and other human cancers and the impacts of cofactors on the development of those cancers.
In 2006, the United States branch of Merck & Co. received FDA approval for Gardasil, a human papillomavirus, or HPV, vaccine that protects against HPV and the cervical cancer that can come with it. In 1891, George F. Merck founded the US branch of the company to distribute chemicals with high purity for use in research, in New York City, New York, and other areas nearby. HPV is a common sexually transmitted infection that can cause genital warts, regular skin warts, cervical cancer, and other cancers. Since 2016, Gardasil has been the only HPV vaccine in use in the US and over people received 28 million doses in the country between 2014 and 2017, reducing people’s chances of contracting cancer.
Walter Schiller studied the causes of diseases in the US and Austria in the early twentieth century and in 1928, invented the Schiller test, or a way to diagnose early cervical cancer in women. Cervical cancer is the uncontrollable division of cells in the cervix, or lower part of the uterus. While living in Austria until his emigration to escape the Nazis in 1937, Schiller concluded that there was a form of cervical cancer, later named carcinoma in situ, that physicians could detect earlier than when tumors start to appear. To determine whether women exhibited that early form of cancer, Schiller stained women’s cervixes with a type of iodine that would stain healthy cervical tissue and not cancerous cervical tissue. Cervical cancer is more deadly to women when it is caught later in its progression, and was difficult to detect in Schiller's time. Schiller’s research enabled physicians to diagnose cervical cancer early, helping women receive treatment quicker and ultimately helping to popularize annual diagnostic exams in the US.
In 1913, journalist Samuel Hopkins Adams published “What Can We Do About Cancer? The Most Vital and Insistent Question in the Medical World,” hereafter “What Can We Do About Cancer,” in Ladies’ Home Journal. Cancer is a disease that is the result of abnormal cell division in different parts of the body, such as the breasts or the cervix. During that time, many women did not discuss or disclose early symptoms of reproductive cancers, such as breast lumps and abnormal vaginal discharge, out of shame or disgust. Thus, people often considered cancer to be a taboo topic. “What Can We Do About Cancer?” provides a representation of what people in the early 1900s thought to be the early warning signs of cancer in women. Although, as of 2021, researchers have made advancements that have increased the scientific understanding of cancer and how it develops, Adams’ article provided women in the US during the 1900s with recommendations on early methods of cancer detection.
A licensed obstetrician and gynecologist, Pearl Tang worked to improve the health of women and children in Maricopa County, Arizona, during the twentieth and twenty-first centuries. Her work with the Maricopa County Health Department ranged from immunizations to preventing cervical cancer. Tang obtained federal grants and community support to establish various child and maternal health clinics throughout Maricopa County as chief of the Maricopa County Bureau of Maternal and Child Health. Tang established mobile clinics, including a clinic she called the Maternity Care Bus, to address the lack of access to medical care among rural women in Arizona. She also focused on family planning through education and the distribution of contraception. Tang's efforts in Maricopa Country increased the delivery of maternal, child, and family planning care and helped lower Arizona's infant mortality rate.
From 1977 to 1987, Harald zur Hausen led a team of researchers across several institutions in Germany to investigate whether the human papillomavirus (HPV) caused cervical cancer. Zur Hausen's first experiment tested the hypothesis that HPV caused cervical cancer rather than herpes simplex virus type 2 (HSV-2), the then accepted cause. His second and third experiments detailed methods to identify two previously unidentified HPV strains, HPV 16 and HPV 18, in cervical cancer tumor samples. The experiments showed that HPV 16 and 18 DNA were present in cervical tumor samples. Zur Hausen concluded that HPV, not HSV-2, caused cervical cancer, which enabled researchers to develop preventions, such as the HPV vaccine.