martedì 16 novembre 2010

Evita and the Pap smear


Evita Peron (Wikipedia)

Evita Duarte Peron, the wife of Juan Peron, the famous argentinian politician and statesman in the late 1940ies, died from aggressive, widespread cervical cancer at the age of 33, in 1952. At the time of her death, because of her genuine interest in the poor, she was greatly loved and respected by large numbers of the working class. When authorities announced her demise, the entire country went into mourning. After her death, thousands of people stood in line to view her body. 
The tumor must have been extremely aggressive, judging by the early age of onset and the rapid clinical course. On a first surgery, it was interpreted as an appendiceal carcinoma but the correct diagnosis was made one year later, on a second operation, when, probably, the tumor was not operable anymore.
Evita Perón had several risk factors that led to the eventual development of cervical cancer. Sexual activity presumably began at an early age. She married a man who had had multiple sexual partners. Even more important, Juan Perón's first wife, died from cervical cancer when she was only 28 years old. In addition, there was another possible risk factor; Evita's mother died of cervical cancer at age 77. We now know that infection with human papillomavirus (HPV), a common sexually transmitted disease, is the main cause of cervical cancer. Did Peron carry a particularly aggressive strain of HPV, the virus that we now know causes cervical cancer, and unknowingly transmit the infection to both his wives? 
What we do know today is that Evita’s death due to cervical cancer would likely never have happened if she had had a Pap smear in the due time.  The Pap smear was invented by George Papanicolaou in about 1920 and a regular screening based on pap smear examination was first started in 1939 at the New York Hospital. This diagnostic procedure was still unpracticed in Argentina in the late 1940ies otherwise Evita could have ben saved!
Dr. George Papanicolaou (Wikipedia)
How many women are nowadays, i.e. 70 years later, in the same situation as Evita's in most of the countries of the developing world where women do not have access to cervical cancer screening programmes?.

Suggested readings:
Lerner BH. The illness and death of Eva Perón: cancer, politics, and secrecy. The Lancet 2000;355(9219):1988-91.
Rodriguez AO. Curr.Opin.Obstet.Gynecol. Eva Perón: cervical cancer and the effect on a nation. 2009;21(1):1-3.
Fisher JW, Brundage SI. The challenge of eliminating cervical cancer in the United States: a story of politics, prudishness, and prevention. Women Health. 2009; 49 (2-3);246-261



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