On January 29, 2013, our group had the privilege of
speaking with a cervical cancer expert, Dr. Brendan Mitchell, M.D. Dr. Mitchell
graduated St. Louis University School of Medicine in 1990, and he completed his
residency in 1994. He is now a specialist in women’s care in obstetrics and
gynecology in the Kansas City area. He expressed that he chose this medical
specialty because it is a good balance of both the surgical and primary care
aspects of medicine, and he said that delivering babies was one of his favorite
parts of his job. Dr. Mitchell is active in the pro-life movement, and he
expressed that this issue is of great importance to him. Dr. Mitchell cooked a
delicious dinner, and we enjoyed lighthearted conversation and conducted our
interview while sharing a meal. Before beginning the interview, we explained
grid computing and how our project on cervical cancer was involved in the
research grid “Mapping Cancer Markers.” Dr. Mitchell expressed that he had read
about grid computing, and he was impressed and interested in our project.
Dr.
Mitchell stated that he does not have any current patients with cervical cancer
and that cases of cervical cancer are not very common in his practice. However,
in the past, he has seen cases of cervical cancer in both practice and
residency. He stressed that most of the patients who are diagnosed with
cervical cancer are those that have forgone pap smears for numerous years, and
all test positive for HPV (Human Papilloma Virus). Because our project is for
evolution, we asked Dr. Mitchell for a reason that doctors treating cervical
cancer should know about evolution. He responded that there are different
strains of HPV that have evolved through time, and evolution helps doctors
understand how the virus will affect the host through different processes.
“Finding a cure is pretty
important; however prevention and early detection are the keys to eliminating
cervical cancer. Prevention has already helped us immensely,” Dr. Mitchell
stated. The primary method of prevention of cervical cancer, according
to Dr. Mitchell, is a routine Pap smear. The results are either normal or
abnormal, and the “abnormal” range includes many different diagnoses. “The
biggest misconception regarding cervical cancer is that an abnormal Pap smear
automatically means cancer,” said Dr. Mitchell. The Pap can come back
identifying ASCUS, or atypical squamous cells of undetermined significance.
This ASCUS can either be positive or negative for high-risk HPV. If negative, a
repeat Pap should be performed. If positive, it can be either LGSIL, or
low-grade squamous intraepithelial lesion, or HGSIL, high-grade squamous
intraepithelial lesion. Dr. Mitchell says that both of these can be further
investigated by a colposcopy.
In this procedure, the vagina is opened
and the cervix is sprayed with vinegar. The vinegar dehydrates the abnormal
cells, making them appear white. A biopsy of these cells is then taken, which
can be negative or positive for cervical intraepithelial neoplasia. If
positive, there are 3 grades of classification. Grades 1 and 2 are things to
just watch with the possibility of converting back to normal cells. Grade 3 is
referred to as carsinoma “in situ”. This can be further classified into micro-
or macro-invasive cervical cancer. From there, Dr. Mitchell would refer the
patient to an oncologist. In Dr. Mitchell’s practice, he has only seen about 2
patients with cervical cancer that regularly receive yearly Paps. Those who
don’t see a doctor every year and come in without having a Pap in the last ten
years are much more likely to present with cervical cancer.
He
said he couldn’t stress enough to his patients that yearly checkups and
vaccines are what save lives. “New
vaccines and implementing new vaccines each year is crucial. It’s difficult to
implement these new vaccines because of the social stigma that comes along with
the HPV vaccine. Parents don’t want to vaccinate their kids because they think
it will influence their behavior and might think it’s alright to be sexually
promiscuous,” Dr. Mitchell said. This side of the vaccine has made it less
widespread, especially among those with strong religious convictions regarding
premarital sex.
Interviewing
Dr. Mitchell was very informative and enjoyable. The interview aspect of this
project was beneficial in that we were able to learn about Dr. Mitchell’s first
hand experiences with cervical cancer, and we expanded our knowledge of the
subject. We were pleasantly surprised to learn that the number of individuals
battling cervical cancer is much lower than we initially expected and that he
believes the number of cases each year is decreasing. We also learned that
yearly exams are key to identifying any problems, and this made us feel more
aware and educated about our own health. Our group is very appreciative that
Dr. Mitchell was friendly, open, and honest when sharing his time and expertise
with us.
