Angelina Jolie is getting people talking, but this time it's not about her new film or what designer dress she's wearing. Jolie, 37, went public after undergoing a preventative double mastectomy, as she was a carrier of a defective BRCA1 gene. From a lineage of women who suffered and passed away from breast cancer, Jolie's radical, rather rational decision may be one of her best life choices yet. Supported by her partner, family and an incredible medical team, Jolie decided to look cancer right in the eye, and not to let fear govern her life.
It is that much more remarkable that Jolie chose to share her story with the entire world. Her op-ed in the New York Times, discussed her decision-making process and treatment procedures, with the ultimate goal of helping other women like her make informed health choices. The media attention this story has attracted, referred to by one reporter as a "cultural and medical earthquake" is unraveling rapidly.
And now, two weeks later, Michael Douglas has followed suit, stepping forward to discuss his past diagnosis of oral cancer. At first, Douglas was open and forthcoming about the likely sexually transmitted nature of the cause, the human papillomavirus (HPV). His spokesperson later denied that Douglas said oral sex was the cause of his cancer, but simply one of the many possible causes of oral cancer, even though audio recordings say otherwise.
It would be impossible to tell if HPV caused Douglas' cancer, considering he was a smoker and a drinker. Regardless of his specific case, the story sheds light on an important issue: cancer prevention, and indirectly, HPV. HPV accounts for 5.2% of the worldwide cancer burden and is the most common sexually transmitted infection (STI), affecting three out of four sexually active individuals some point in their lives. The vast majority of adults don't know that they have the virus since HPV is often asymptomatic. HPV is implicated in all cases of cervical cancer. What many people are not aware of is that certain strains of HPV are also causally implicated in a high percentage of vaginal, vulvar cancers, penile cancers, anal cancers and increasingly, head and neck cancers (tongue, tonsils, throat) commonly referred to as oral cancers.
What Jolie and Douglas have in common is that both are using their celebrity status to bring attention to the very realistic threat of cancer. For now, we must rely on celebrities like Douglas to get the public's attention about important health threats. But, what happens after the media stories fade and the 15 minutes are up? Both celebrities have provoked discussion, but where do we go from here?
The World Health organization proclaims that the burden of cancer mortality can be reduced through an increased focus on prevention, which offers the most logical and cost-effective long-term strategy for cancer control. This implies that there are modifiable risk factors linked to cancer, which means there are actions that we can adopt or avoid to prevent cancer (e.g. diet, avoid tobacco, wear sunscreen, to name a few).
Take for example the HPV vaccines, which offer a primary preventive approach to cancer and genital warts. Two vaccines have been developed and approved for use to protect against certain types of HPV. Long-term prospective trials are still in progress, though some studies have reported 100 per cent efficacy against specific HPV types and precancerous lesions up to 10 years post vaccination. Government health officials (the Centers for Disease Control and Prevention (CDC) in the U.S., and the Public Health Agency of Canada) have recommended and approved the HPV vaccine for both boys and girls, aged 9 to 26 years old.
With a cancer prevention vaccine readily available, deemed safe and effective by our health officials, and even free in some countries, it is rather remarkable that vaccine uptake rates remain low or suboptimal. That's right, there is a vaccine that prevents cancer, the disease we all loathe. Yet, still parents and young adults are not getting vaccinated. Concerns have been raised around social issues including age of sexual debut, religion, and sexual promiscuity. We can debate the ethics, the uneasiness with accepting that your child might be having sex, which many have, but what remains is a vaccine proven safe and effective to prevent cancer. A lack of knowledge combined with myths and misinformation may be at the crux as to why vaccination uptake rates remain low. If HPV vaccine rates remain low or further decrease, protection of our children and future generations will not be achieved.
Jolie and Douglas have used their star power to focus our attention and bring these issues to the limelight. Unfortunately, a mini media frenzy is not sufficient to inform and educate the public on the matter. We need smart advocacy and knowledgeable individuals who can properly educate the public about the importance of immunization. We need to take advantage of the new tools of social media to disseminate accurate and timely information. We need our health care professionals to be well-informed to talk to patients about the ways they can take care of themselves to prevent these deadly diseases. It is now up to public health policy initiatives, coupled with evidence-based interventions to effectively communicate what can be done to prevent cancer.
We spend boundless charity and government research dollars searching for cures for cancer, an effort that should not be abandoned. But let's stop and take a look around. We have tools and strategies in place to prevent cancer, and we are standing on the sidelines, and failing to take action. An ounce of prevention offers a pound of cure. We can beat this deadly disease, or at the very least, step into the rink, with our gloves and helmet on, that much more prepared and ready to fight.
Samara Perez is a doctoral student in Clinical Psychology at McGill University, supervised by Dr. Zeev Rosberger. Her area of research focuses on understanding the psychosocial factors related to HPV vaccine decision-making.