Cervical cancer is more deadly than previously thought | Hacker News Reader

Cervical cancer is more deadly than previously thought

arstechnica.com

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Cervical cancer is highly preventable. For more information and testing options see Planned Parenthood https://www.plannedparenthood.org/learn/womens-health/pap-te...

If you have kids, get them the HPV vaccine as soon as they're eligible.

Or if you're an adult (either sex) and sexually active.

Yes, definitely. I'm 34, male, and paid the $500 out of pocket for myself.

Does it do anything against Amy hpv strain you have? Or does it curb future infections of strains one doesn't have?

It's less effective against strains you're already infected with, but not entirely ineffective against them. That's why widespread vaccination at an age before sexual maturity is suggested.

Keep in mind that HPV is not necessarily a permanent infection. HPV infections are commonly cleared, putting you at risk for reinfection, which the vaccine will help protect against. It will also help protect you from further infections by the covered strains.

For men, the vaccine is only approved for adults up to the age of 26. My primary physician claimed it's assumed that anyone above that age already has one or more strains of HPV.

I don't know if you can pay for it out of pocket if you're too old. I'd assume you would also want to be tested first, instead of just randomly getting vaccines, but apparently there's no HPV test for men; the approved tests are all for women.

From the CDC

>However, some healthcare providers do offer anal Pap tests to men who may be at increased risk for anal cancer, including men with HIV or men who receive anal sex.

>I don't know if you can pay for it out of pocket if you're too old.

Yes you absolutely can. You can also get the shingles vaccine even if you're too young.

I paid for it when I was 26. A bit over $600 for the shots, and paid my doctor's copay each visit.

I thought it was one of my better uses of excess income that isn't guaranteed in the future.

I'm an internet stranger proud of your actions. Thanks for doing your part.

Planned Parenthood is being eradicated in this country.

On that subject I wanted to ask:

Are the services that Planned Parenthood provide so economically unviable that they require the life support and political will of the US Government?

Why can't a competitor or even a Bill Gates philanthropic initiative be a private sector version of the same thing?

Here's a case that proves Planned Parenthood's unique function. PP offers rapid HIV testing. I get a test every year because you catch that shit early, the available treatments give you a nearly normal life.

Now this last year, I didn't go to PP for my annual lady check up for reasons that are long and boring.

So I asked my primary care physician during the annual everything else check up for a rapid test. She didn't have it and was surprised PP did. So instead of a finger prick I got a blood draw and waited. Weeks later I got a test report for everything else tested for (liver / diabetes / etc.) except the HIV and other STD tests. I ended up having to call to get the results.

So compare the 10 minute HIV test with immediate results versus the 8 week odyssey for finding out my sexual health status.

Planned Parenthood is brilliant at what they do. They do it well. Primary care physicians are shiat at reproductive health.

Yeah, the advantage of PP is that (1) they are specialized and (2) they have a large patient volume that allows them to negotiate medical products in bulk. That allows them to provide reproductive health care cheaper and more efficiently with just as good if not better patient outcomes than any other service.

Okay, that sounds like a user experience problem, of which federal funding has nothing to do with?

A private organization could offer the same thing without needing to be "in network" like your PCP? I'm guessing

Normally, out of network means not covered by my insurance. Or covered at a greatly reduced rate.

If there were a private organization that was as earnest and competent at providing full service reproductive care up to and including abortive treatments, I would definitely consider them as an option. Such an organization does not exist as of today. I can't postpone medical care until such time an organization like that exists.

Ah! I have another story that demonstrates how awesome Planned Parenthood is. So I came back from overseas and needed a non-emergency but urgent visit. I had insurance. Overseas insurance. I called around to OBGYNs around town without having a local PCP. Obviously having just come from overseas, I didnt' have a local doctor. Nobody would take me. I told them I would pay 100% cash. Still no takers. Planned Parenthood did. They took my appointment, gave me a price, I paid 100% of the charge, and they filled out my foreign insurance paperwork in a foreign language.

Why is Planned Parenthood so much better at providing reproductive care and so much more accessible than OBGYNs?

Typically companies that can depend on the state to keep the lights on offer worse service.

Conceptually.

This sounds like a user experience situation, a commitment to customer service, that has nothing to do with their federal funding. Yes they would have to adjust or find a real revenue stream, but I think it is mutually exclusive, unless it just simply is economically unviable.

I would totally hope there is no disruption in service. I'm just trying to understand what advantages Planned Parenthood actually has in the marketplace - outside of being a political football - that prevents alternatives from being available.

They have presence in every state. Granted in North Dakota, they may have only 1 office. Anywhere in the country, I'm traveling in and out of network, or find myself as an edge case with a weird situation, raped on a business trip in an unfamiliar city, I know they are there for me with unbiased medical service & care.

https://www.plannedparenthood.org/about-us/local-state-offic...

I can't think of any other reproductive service public or private that has such nationwide coverage.

(Edit: sort of an afterthought... Planned Parenthood isn't the political football, it's the women in this country. I never hear about special restrictive legislation affecting the men who rely upon Planned Parenthood.)

I'm still scratching my head a little, so lets reframe it another way:

Why isn't it news that Planned Parenthood has a monopoly on this health service contract? (Perhaps their extended operational history made them the most qualified)

Why is the only part of that contract in question related to one of the services they provide?

I'll skim wikipedia, I suppose. I understand the convenience they offer and I don't expect to get the answers here. I think it will be non-news after they get defunded and continue operating on a fraction of the budget, I mean, or not.

I found this for you...

https://www.plannedparenthoodaction.org/blog/how-federal-fun...

PP doesn't have a monopoly on federal funding. In Oregon, at least, one provider for Medicaid services is Providence Hospital. Providence is a Catholic hospital which means they don't provide surgical or medicinal abortions. I can get a routine OBGYN check through Providence but if I'm pregnant and don't want to be, then Providence will refuse care.

On a personal note, I have a medical condition called endometrial hyperplasia which can be treated with an progesterone infused IUD or difficult-to-manage progesterone pill treatment taking only some days of the 28 day cycle. Due to the need for routine biopsies, I ultimately decided to go with the pill (although I'm 2nd guessing the choice because it's so easy to screw up the pill dosing). I could tell the Providence doctor was really uncomfortable with the idea of providing an IUD. Many Catholics believe the IUD is an abortive type birth control and refuse to provide it. I may be going back to PP if I decide that an IUD is the better way to handle my condition. If I were more stupid or less able to deal with remembering odd calendar based dosing regimes, the IUD would be the only solution.

(Edit: I'd also recommend reading this article about the oversized impact of Catholic hospitals in Washington State.

https://www.propublica.org/article/catholic-hospitals-grow-a....

Apparently PP was paid $2million to open a branch across from a hospital being taken over by Providence! Also note lack of emergency contraception for rape victims and mismanagement of miscarriages in Catholic hospitals.)

thanks! that was very insightful

Additionally federal funds at least in 2009 were about 1/3rd of PP's budget. http://www.factcheck.org/2011/04/planned-parenthood/

so defunding it is symbolic at best

competitors can exist, and I'm assuming might already?

Wellll, 33% of your revenue being cut means a lot of people get fired and services degrade so I would not say it's symbolic.

Abortions also count for only about 3% of their spending. Yes, they are a lightening rod for controversy.

Yes, this place seems to be a competitor but not sure what the costs and such are: http://www.realoptions.net/

No, that place is a Crisis Pregnancy Center (an anti-abortion facility set up to look like a real repro health clinic). You can tell from the scaremongering about abortion they do here, for instance: http://www.realoptions.net/options/abortion/

They are not an alternative to Planned Parenthood, they are a vile unethical pretend-clinic taking advantage of the confusion of desperate women.

I had visited that page and kind of suspected that. I just was fairly shocked that such a thing would exist in the heart of Silicon Valley (Mountain View, aka the home of Google).

I wish these people would put all this "love of life" energy into actually taking good care of all the unwanted children that already exist... From what I have read and heard from people in the know our foster and adoption systems are beyond broken.

> Wellll, 33% of your revenue being cut means a lot of people get fired and services degrade so I would not say it's symbolic.

And if they have borrowed, then immediate bankruptcy

No it isn't, and if you believe it is then you've been watching fake news. Only the portion of PP's budget that comes from the Federal Govt is being cut.

>"The researchers found that black women have a mortality rate of 10.1 per 100,000. For white women, the rate is 4.7 per 100,000. Past estimates had those rates at 5.7 and 3.2, respectively."

Let's check the numbers here.

5.7 per 100,000 is 10.1 per 177,000. The rate of cervical cancer among black women with intact cervices is given as 10.1 per 100,000, and the change in estimate is ascribed solely to changing the methodology to consider only women with cervices, so 77,000 of that 177,000 had hysterectomies, or 43%. The corresponding number for white women is 30%.

This number seems far too high. I can't find a reliable source for the US, but [0] says "up to a fifth of women have had their womb removed by the age of 55" in the UK. Is the rate of hysterectomies really 43% for black women, or is someone lying about the statistics?

[0]https://www.womens-health-concern.org/help-and-advice/factsh...

https://www.ncbi.nlm.nih.gov/pubmed/8414322 is a study that shows a difference in the rate of hysterectomy, but not quite so dramatic of one as that. But it seems there's a lot of evidence that black women have hysterectomies at a higher rate than white women.

At one point, it was so common for an African-American woman to get an involuntary hysterectomy that it got its own euphemism: The Mississippi Appendectomy [0]

[0] https://mississippiappendectomy.wordpress.com/about/ (That's the first result from big G, but you should be able to find more were you so inclined).

Come on! All people who got their womb removed in the 1920s and 30s are dead now. They don't affect any statistics anymore, especially not those concerning women who had their womb removed by the age of 55.

I agree with GP, a rate of >40% hysterectomies sounds unbelievable.

Someone born in 1924 would be 15 in 1939 and ~93 today. So, not everyone that got it in the 30's would be dead.

However, "A hysterectomy is the second most common surgery among women in the United States. The most common surgery in women is childbirth by cesarean delivery (C-section). Each year in the United States, nearly 500,000 women get hysterectomies" so it really is common.

Over 50 years that would be around 25 million women. Total female population is ~160 million or around 16%. But you only really care about adult women which would have higher rates. So, a baseline of 20% with some sub populations being 2x higher seems completely believable.

You would like to think that forced sterilization is an old timey problem. It's not.

The state of California forcibly sterilized ~150 female inmates as late as 2010 [0].

More to read up on... [1]

[0] https://en.wikipedia.org/wiki/Compulsory_sterilization#Unite...

[1] http://www.ourbodiesourselves.org/health-info/forced-sterili...

Edit: would love to know why this post was down voted. Is there a wellspring of support for sterilization without consent? Completely mystified at this point.

It's probably too simplistic to be the explanation, but I think they must have overlooked some huge effect rather than many smaller ones that mostly work in the same direction, so, at the risk of making a fool of myself: could it be that a large fraction of people with cervical cancer have their cervix removed but still die from cervical cancer because their cancer already has metastized? (That would imply that a significant fraction of those dying from cervical cancer don't have a cervix at the moment they die)

What a bad title. It's not a math error, it's a methodological choice. Furthermore this is basically the linked NYT article cut in half.

https://www.nytimes.com/2017/01/23/health/cervical-cancer-un...

I agree. Hideous title. How did cervical cancer become more dangerous? Oh. It didn't.

Ars Technica sure has come a long way since the Hannibal days of deep diving CPU internals...

What are the chances of getting cervical cancer if you do have a cervix?

>"The researchers found that black women have a mortality rate of 10.1 per 100,000. For white women, the rate is 4.7 per 100,000. Past estimates had those rates at 5.7 and 3.2, respectively."

Mortality rate isn't really the chances of dying from the cancer though. It looks like a variation on the old frequencies vs probabilities confusion.

Methodological choice aside, I am primarily shocked by the size of the racial disparity (I mean, I have expected it, but not this big).

Black are generally more prone to the claws of sociological economic Literacy disparities.

Lesser education or of poorer quality, + poverty = bad/no sex ed.

This is true to most minorities that suffer(ed) from discrimination.

It's am uphill battle to Remedy this. I wonder where Hispanics would land. I assuse in-between.

Shocking numbers. Really.

They also have worse access to screening and preventative care.

Why wouldn't it just be genetically related like so many other diseases whose prevalence vary by race?

Because unlike regionally based illnesses we didn't discover a genetic disposition. And these things are well researched due to the need to control for variables. Hpv is prevalent globally, not at all a regional issue. Our genes treat it equally, because its prevalence normalised its effects.

Regional differences might actually cause a nasty strain of hpv to arise, and it would again effect us equally if infected.

It's pretty interesting to look at research on this; it's not just SES and literacy. Nor is genetics to blame in many situations. I don't have access right now to the enormous pile of literature I have at home about this (printed on paper!!!) but as an example look at variation in wait time in emergency rooms, for kids, by race/ethnicity. To address your question about Hispanics directly in this situation, Hispanic kids waited 10.4% longer than white kids for care in the same emergency rooms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796312/

ED wait times are an interesting little side branch of study because they're a proxy for how people are treated by the medical establishment; they're not genetic or based on lifestyle choices; they don't rely on educational level etc.; and they're unconscious: no one in the ED is a jerk saying "let that person wait longer because of their background!"

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