This is actually a picture of cauliflower from Wikipedia
Ruby Carroll was a new patient who told me that she hadn’t had a Pap smear for a long time. “I think that there might be something wrong because I bleed when my husband and I have sex.”
On examination, I had to agree that something was wrong. There was an area on her cervix that resembled cauliflower. Instead of doing a Pap, I said: “Ms. Carroll, I fear that you are correct. There an area on you cervix that looks abnormal. I’ll do some little biopsies for tissue to send to the lab to be certain what’s there, if that’s ok with you. The biopsies will pinch a bit, and you’ll have some bleeding after.”
The biopsies did show cancer, so I referred her to a gynecologic cancer specialist for further evaluation and treatment. Ms. Carroll told him she was going to a naturopath who said he could cure her without surgery. A couple of years later I read Ruby Carroll’s obituary in the newspaper.
We know that cervical cancer is caused by some bad strains of Human Papilloma Virus (HPV). There are many strains of HPV; each one has its favorite places to live in our bodies. For instance, warts on our hands are caused by certain strains but the strains causing plantar warts are different. Two of the common strains that cause cervical cancer are 16 and 18. Fortunately, there are vaccines available to combat these and thus prevent this terrible disease. One of the immunizations, Gardasil®?9, adds coverage against 7 other, less virulent strains of HPV.
Cervical cancer takes years to develop, and its precursor goes through stages. The idea of Pap smears, and the more recent tests, is to find an abnormality in an early stage before it turns into cancer.
Women who have received HPV immunization as teenagers are much less likely to develop cervical cancer or its precursors. The immunization is not perfect, however, so it is still wise to get routine screening for cervical abnormalities.
Since some strains of HPV are a sexually transmitted, aren’t men also susceptible? Yes! Even though a man doesn’t have a cervix, there are other places where these cancer-causing viruses live. Cancer-fighting vaccines help protect men from anal, penile and some oropharyngeal cancers, so all teens should get immunized.
No medical treatment is entirely safe, but immunizations, as a whole, are amazingly safe. The FDA is responsible for collecting ongoing information about side effects of drugs, including immunizations. There has been a concern that Gardasil®?9 causes ovaries of young women to fail. Premature Ovarian Insufficiency (POI), in which a woman goes through menopause before she is 40, is quite rare, but it happens. It was alarming when a few cases occurred after receiving Gardasil®?9. However, analysis of large populations of young women has not shown an increased incidence of POI after this immunization.
HPV immunization is recommended in over 120 countries, but it is too expensive or unavailable for most people to get it in many of the poorest places. Unfortunately, there are other reasons why many susceptible people don’t get it in the USA, including denial (“my teen Riley is a good kid—they’ll never have sex until they’re married), lack of knowledge and misinformation.
Misinformation about immunizations has become rampant in the USA. The current epidemic of measles in unvaccinated people makes this obvious, with 3 deaths from measles so far this year. The incubation period for measles is less than 3 weeks, and infected people usually have symptoms, so it is fairly easy to diagnose and track measles. On the other hand, cervical infections with HPV can last years without causing symptoms until cancer is present—when it may be too late. Prevention is always best, and HPV vaccinations do just that.
©?Richard Grossman MD, 2026