Gordon Watkins Douglas researched cervical cancer, breach delivery, and treatment of high blood pressure during pregnancy in the US during the twentieth century. He worked primarily at Bellevue Hospital Center in New York, New York. While at Bellevue, he worked with William E. Studdiford to develop treatments for women who contracted infections as a result of illegal abortions performed throughout the US in unsterile environments. Douglas also established the first contraception and pregnancy termination clinic at Bellevue Hospital shortly after the legalization of abortion as a result of the 1973 US Supreme Court ruling in Roe v. Wade. Furthermore, Douglas showed that fetal and maternal cells exchange between the pregnant woman and fetus during pregnancy, which led to the later development of non-invasive prenatal testing in the early twenty-first century.
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, United States pharmaceutical company Merck released the Gardasil vaccination series, which protected recipients against four strains of Human Papillomaviruses, or HPV. HPV is a sexually transmitted infection which may be asymptomatic or cause symptoms such as genital warts, and is linked to cervical, vaginal, vulvar, anal, penile, head, neck, and face cancers. In 2006, based on research conducted by researchers Ian Frazer and Jian Zhou in the 1990s, Merck released a four-strain version of Gardasil, which protected boys and girls aged nine and older against the major HPV strains HPV-6, HPV-11, HPV-16, and HPV-18. In 2014, Merck released Gardasil 9, a nine-strain version that protected from the original four HPV strains plus strains HPV-31, HPV-33, HPV-45, and HPV-58. Gardasil is a preventative measure and reduces the risk of contracting HPV and HPV-related cancers by up to ninety-seven percent.
On 20 August 2007, in Frazer v. Schlegel, the United States Court of Appeals for the Federal Circuit decided that researchers Ian Frazer and Jian Zhou owned the rights to the vaccine patent for Human Papillomavirus, or HPV, instead of a research team led by Richard Schlegel. Frazer v. Schlegel reversed the decision that the Board of Patent Appeals and Interferences had previously made, awarding the patent to Schlegel on the basis that Frazer’s patent application contained inaccurate science. However, once appealed, the Federal Circuit judges found Frazer’s science to be accurate, granting him rights to the vaccine patent. In 2006, the US Food and Drug Administration, or FDA, approved the first HPV vaccine, which has since been effective in protecting women from cervical cancer by up to ninety-seven percent if they were vaccinated before contracting HPV. The Circuit’s decision gave Frazer ownership of the patent for the HPV vaccine, which physicians have administered over 120 million doses of to people in the US.
From 1936 to 1945, the Women’s Field Army, hereafter the WFA, educated women in the US on the early symptoms, prevention, and treatment of reproductive cancers. The WFA was a women-led volunteer organization and a branch of, what was then called, the American Society for the Control of Cancer, or ASCC. The WFA, headquartered in New York City, New York, recruited hundreds of thousands of women volunteers across the country. They distributed pamphlets, showed movies, and participated in other grassroots efforts to foster an understanding of reproductive cancers, namely breast and cervical cancer, among other women. The Women’s Field Army aided in reducing the number of cancer-related deaths by spreading cancer prevention awareness and teaching women about their reproductive health and the early detection of cancer, which was one of the first widespread educational resources about reproductive cancers for women.
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.