Creating Awareness for HPV Self-Test Kits: On the Forefront of Gynecology Oncology Care, A Generational Story
By Omoluyi Adesanya, MPH/MBA, Class of 2020
The Brown School and Olin Business School
Introduction: Personal Story
As a generational farmer, my grandmother never knew the importance of medical care centered on maternal health and obstetrics/gynecology. As she grew up, most females consulted with midwives rather than with OBGYN physicians to ensure good health.
Not only did my grandmother not have the opportunity to attend college, but her laborious farming occupation meant that, she could not afford to go to the nearest hospital on a routine basis. Living in rural Illinois, she faced a healthcare challenge which still persists today– limited access to healthcare facilities.
Fast forward to 2017, at 90 years old and having no prior health issues, my grandmother’s diagnosis of a rare OBGYN cancer was a surprise to our family. If my grandmother had access to adequate maternal health facilities or lived in a non-rural community close to an OBGYN physician, perhaps she might not have been diagnosed with cancer. During my grandmother’s era, HPV vaccinations, for example, were not yet adopted as a preventative public health measure, however two generations later, my own all-girls high school in Texas mandated HPV vaccination as a health requirement for students. If adequate policies to improve females’ health, HPV vaccinations, and HPV self-test kits were made available during my grandmother’s generation, perhaps her medical condition and millions of other such cases could have been prevented.
Through her sustained perseverance, my grandmother traveled more long distances to get access to treatment and thankfully, her outcome was positive — she was able to overcome cancer.
Domestically in the United States, access and affordability hinders women from reaching their medical provider. Furthermore, much of the general public is not aware of the current HPV screening technologies that are infiltrating the healthcare market.
As a graduate student in the field of public health, my grandmother’s story motivated me to help contribute to fixing the gaps in population health outcomes for women. Having conducted a literature review on HPV self-test kit adoption and implementation, I became inspired to further the project by getting personal candid opinions from my own grandmother and mother to understand the impact of OBGYN cancer across generations:
Luyi Adesanya: Currently there are 570,000 new cases of cervical cancer around the world and 90% are linked to HPV. Growing up, did you know about HPV and/or cervical cancer?
Grandmother: Growing up as a child, I never knew what HPV and/or cervical cancer was, I never was aware of their impact on health.
Mother: No, not at all. HPV was not even a known disease at that time when I was growing up or even during my period as a young mother.
Luyi Adesanya: Studies have shown that rates for cervical cancer and HPV can be much higher in urban areas but also, rural communities face poorer health outcomes. Given the fact that you have lived in a rural farm community, how often did you visit your local hospital or doctor as a child and now as an adult?
Grandmother: I was born in 1924 and I never visited a hospital until 1930 in order to get glasses for school. However, I was not born in a hospital either, I was born at home. During my era, the doctor performed house calls including at-home delivery of babies.
Mother: As a daughter of rural Illinois farmers, we would only go to the doctor as children to get immunization or school check-ups. My four sisters and I did not have any type of wellness or annual primary care visits. My parents did not see the importance of visiting the doctor that much as we were overall, pretty healthy.
Luyi Adesanya: The National Institutes for Health recommends women receive health check-ups and screenings beginning at age 13-15. Growing up in a rural area, how often did you go for well-woman visits?
Mother: As an adult, living closer to a hospital center made medical services more accessible and affordable, less costs for transportation and it was easier to follow-up on appointments. As a child, living further from a hospital center, my health services were less accessible and less affordable because it was costly to drive to the nearest hospital (25 miles away) and harder to find time for follow-up healthcare visits.
Grandmother: Growing up, the nearest small hospital was 12 miles away from my home and required traveling on country roads. Also, there was no obstetrician or gynecologist at the hospital since it served only a small proportion of the surrounding rural towns. Due to these factors, I never went for well-woman exams.
My first time visiting an OB-GYN was for the birth of my first daughter when I was 20 years old. I also did not go for well-woman routine exams until later in life. My friends, who are the same age, do not go for routine well-woman exams, perhaps because in our generation, it was not as common.
Mother: I never went to a well-woman visit until I was in my 20s because as a child my parents did not have insurance for my sisters and me. I received my own health insurance in my early 20s, during my first job. It was at this time, that an OB-GYN provider explained the importance of preventative care and I continue to go to my well-woman exams once a year. I am fortunate enough to have good health insurance that covers 100% specialist OB-GYN visits.
My own sisters who are within five years of my age, even though their mother was diagnosed with cancer at age 90, still do not see the need for routine care visits or well-woman exams.
Luyi Adesanya: The HPV vaccination was introduced in 2007 and studies have shown that the vaccines protect against two to nine types of HPV and greatly decrease the risk of cervical cancer. In 2007, my all-girls high school in Texas mandated the vaccine as a part of our school health enrollment record. When you were younger, were there any laws or policies passed to help improve women’s health?
Grandmother: In the 1920s and 30s, the only laws were to enforce polio shots in order to go to school. Epidemics affecting many were influenza and whooping cough. That era was pre-vaccination for whooping cough and influenza and many people died per year. There were no other mandated laws/policies that improved health, especially none focused on women’s health.
Mother: There were no vaccinations, to my knowledge, during my childhood or adolescent years to improve women’s health. My family never discussed national health issues; however, during my mid-20s breast cancer screening and mammogram availability was initiated. As a child, necessary vaccinations were DTP, Tetanus, Polio and Smallpox. MMR and chickenpox vaccinations were not available, nor were vaccinations for improving women’s health.
Luyi Adesanya: Are you aware that a vaccine for HPV exists?
Grandmother: No but I think it is a good thing that the medical field is enforcing more immunizations for adolescents as this will ensure they take better care of their own health.
Mother: Yes, however I was not aware of the HPV vaccine until my daughter was one of the first age brackets in 2007 to be mandated to have the HPV vaccine. Due to the large amounts of studies on vaccinations and it being a school requirement, I had no concerns with my daughter getting the HPV vaccination.
Luyi Adesanya: Unfortunately, a couple years ago, Grandmother, you were diagnosed with cancer at age 90. Many women your age have never been screened or provided with the appropriate care for optimal maternal health. After hearing about your cancer diagnosis, what were some challenges you had to overcome in order to become a cancer survivor?
Grandmother: I was a generational dairy-farmer and I was never aware of information regarding OB-GYN cancers and was never routinely screened. At the age of 90, I was diagnosed with cancer and for me, it was shocking. Through thorough treatment from my healthcare team, support of my family and continual belief in my faith, I was able to survive cancer. I do wish females could have better access to screening in order to improve awareness.
Luyi Adesanya: What were some challenges with hearing this diagnosis of your own mother that you had to overcome?
Mother: What that did was to reassure and confirm the importance of staying on top of my routine well-woman exams. I believe it is necessary and crucial especially with the history of my own mother’s health.
I also believe the national guidelines for women over 65 should become stricter to prevent and ensure screening for OB-GYN cancers.
Many of my family members were skeptical in having my mother undergo treatment however, with my husband and children being in the medical field, I was inspired to follow through and thankfully, the treatment has prolonged her life for almost five years. She has been able to witness new births and weddings of grandchildren and great-grandchildren and, she has a higher quality of life.
Luyi Adesanya: The HPV Self-Test Kit was brought to the market in 2001, yet many providers and patients do not know it exists. If there was an HPV self-test kit available for home use, that is easy to administer, do you think it would have improved your health outcome?
Grandmother: If HPV Self-Test Kits improve screening access for women, I think it is a good idea. Screening for women of older generations and living in rural areas like myself, should be improved. Due to my age and my limited healthcare knowledge, I would want to ensure that the self-test kit is easy to use.
Mother: Insurance companies should cover HPV Self-Test Kits and the kits would need to be easy to use. Lastly, the kits should be easily accessible for all populations, especially those who face challenges with reaching their OBGYN provider such as the elderly and individuals living in rural and urban communities.
In St. Louis, HPV and cervical cancer rates are rising and many patients do not have adequate screening access for the virus. The health outcomes for present and future generations can improve with increased awareness about HPV Self-Test Kits.
When looking at the global adoption of these kits, many countries in Europe, in addition to Australia, already offer HPV Self-Test Kits as a screening tool; therefore, the United States should be eager to adopt these kits in order to ensure optimal health for the nation.