NBBS: Well, welcome to the NBBS podcast. I'm Lewis Hassell, our host today, and I'm pleased to introduce to our listeners Dr. Joan Walker. Dr. Walker is a professor of gynecological oncology at the University of Oklahoma. She's a noted national and international expert on the topics of gynecological cancer with a particular interest in cervical cancer. Indeed, as we were talking beforehand, she said no person should have to die of this disease. So, I think that gives you an orientation about her philosophy and personality. Welcome to the NBBS podcast, Dr.  Walker.

Dr. Walker: Well, thank you, I'm glad to be here.

NBBS: I wonder if first off, we could talk a little bit about how big a problem cervical cancer is in the world.

Dr. Walker: It is. It’s the number one killer of women, unfortunately a completely preventable disease and yet 400,000 get cervical cancer every year, and the United States is no better, just like COVID. We have about 12 to 14,000 people get cervical cancer and 4000 die, and completely preventable and absolutely irresponsible.

NBBS: Well, you know, it seems that sometimes, at least in the United States and I suspect internationally, that different populations are affected differently. What's the reason behind the variations between ethnic socioeconomic groups and so forth with regard to this disease?

Dr. Walker: Well, again, just like COVID, vaccinate, vaccinate, vaccinate. We everybody between 9 and 45 is eligible to be vaccinated for HPV. And the optimum age is prior to puberty. So, between 9 and 12 is ideal. The vaccine is expensive. Probably $1000 to do all three vaccines. In Viet Nam, it’s about 4 million dong for 3 shots. If you are vaccinated really young, you don't need three shots. It works better when you're young. And it's a little controversial as to how many you need, just like COVID. But right now, older folks need three shots, but younger folks only need 2. 

There's more than one vaccine, but generally speaking, we're using Gardasil, which is a 9 valent HPV vaccine. And we have a clinical trial that we're doing here in Oklahoma where all of our cervix cancer patients are becoming vaccine advocates. There is an anti VAX movement in the United States, and I don't know maybe worldwide now since the COVID vaccine has brought that out. And a lot of mothers are afraid to get their kids vaccinated for, unfortunately, misinformation reasons. Therefore, we're trying to have every cervix cancer patient and everybody who's been affected by HPV (vulvar cancer, tonsillar cancer, or anal cancer). Doesn't matter what kind of cancer, we're trying to educate them with a video and trying to have them become advocates to communicate to their communities. 

In the US, it's a rural population problem. It's also a problem secondary to tubal ligation that women are really good about getting their Paps done when they get birth control pills. And they can't get their pills prescription filled unless they get their Paps done. And so we tend to have control over the screening for cervical cancer during childbearing years. And then if they get contraception, such as tubal ligation and don't have a need to get their prescription filled, they tend to disappear and never show up to a doctor's office again. 

And people who are infertile, people who are obese, people who are menopausal, and people who had their sterilization procedures, tend to get cervical cancer just because of the lack of health care. We have kind of a belief here that if it ain't broke, don't fix it in Oklahoma. And I am sure that's kind of the same problem in Africa and India and Southeast Asia. You know you only go to a doctor if you have a problem and so unfortunately, people don't come in until they're bleeding to death or have renal failure or some major problem.

NBBS: I think that's a very important point to recognize that in order to prevent this disease, there has to be preventive services and preventive examination a...