Gender, Health, and Popular Culture: Historical Perspectives

Controlling Cervical Cancer from Screening to Vaccinations: An American Perspective

Controlling Cervical Cancer from Screening to Vaccinations: An American Perspective Kirsten E. Gardner I n the United States, contemporary conversations about cervical cancer are informed by a rich history of cancer awareness efforts that target female audiences. Since at least 1913, women have been encouraged to consult physicians at the first sign of irregular vaginal discharge, which is an early warning sign for cervical cancer.1 Beginning in 1957, many American women began participating in cervical cancer screening. This mid-century innovation allowed for earlier detection of cervical cancer via a vaginal smear, more popularly referred to as a “Pap smear.”2 Most recently, in 2006 the U.S. Food and Drug Administration (FDA) approved Gardasil, a vaccine that promised to prevent infection from significant human papillomaviruses (HPVs), thereby interrupting cervical cancer.3 The twentieth-century history of cervical cancer in the United States illustrates the change and continuity evident in public awareness about women and cancer. Specifically, for nearly a century, cancer-awareness materials for women have emphasized that cancer poses a particular risk to females, especially due to the susceptibility of female reproductive organs to cancer. Additionally, women have worked conscientiously to inform one another about the risk of cancer and have frequently cooperated with the medical profession in emphasizing the importance of early detection.4 Finally, early detection has been proven successful when applied to cervical cancer cases. Since the advent of the Pap smear, cases of cervical cancer in the United States have consistently declined, with the highest incidence in populations that have not been screened.5 109 The Transmission of Health Information 110 The 2006 announcement of a cervical cancer vaccine created public excitement about advancements in cancer research.6 Popular newspapers, magazines, and media sources covered the story and suggested that the vaccine had potential to nearly eliminate cervical cancer in the United States. Although many women had a general knowledge about cervical cancer, its risk, and the recommendations for routine screening via Pap smears, few had knowledge about the nearly two decades of research on HPV. Therefore, when Merck began an advertising campaign to teach American women about the vaccine, it also fostered scientific literacy about HPV—a sexually transmitted virus with a high incidence in the United States, identified as a cause of cervical cancer and genital warts. Story after story explained that the vaccine would block four strands of the virus that have been linked to as many as 70 per cent of American cervical cancer cases.7 In its efforts to sell a new product, Merck became the leading public authority on HPV and the benefits of a cervical cancer vaccine.8 Equally significant, it assumed a role in public education, translating scientific and clinical findings into accessible language that would capture the public imagination. Merck’s central role in the HPV conversation that emerged in 2006–07 demonstrated the impact of private industry on cancer education in the twenty-first century. Today, private industry plays an ever-increasing role in American health education campaigns. Comparing the announcement of Gardasil’s FDAapproved vaccine (2006) to the announcements promoting the Pap smear and cervical cancer screening (1957) clearly makes this point. In the former, the FDA made its approval announcement, the media offered coverage, and then Merck launched an aggressive advertising campaign.The marketing strategies of the Merck Gardasil campaign likely taught many more women about HPV than any contemporary public health campaign might have accomplished. Merck embraced print, media, and Internet advertising and quickly informed the country about the medical impact of the discovery of HPV. It emphasized that the vaccine could interrupt the virus, thereby preventing the potentially fatal impact of cervical cancer. The vaccine was championed as a scientific breakthrough, promising to impact cervical cancer mortality throughout the world. As John Niederhuber, acting director of the National Cancer Institute (NCI),explained,“Thisrepresentsatriumphof basicscienceandof molecular biology research.”9 In the 1957 educational campaign, on the other hand, the American Cancer Society (ACS) co-operated with government agencies to coordinate awareness efforts, open detection centres, and encourage women Controlling Cervical Cancer from Screening to Vaccinations Kirsten E. Gardner 111 to comply with screening guidelines, but there was little, if any, intervention from private companies. In addition to highlighting the centrality of private interests in contemporary cervical cancer awareness,Merck’s campaign reflected important shifts in popular representations of women in the cancer-awareness campaign. For much of the...