As a mother and a grandmother, Denelle Hershey was constantly putting others before herself. Her life revolved around taking care of the needs of her family.
But that all changed in December 2016 when she was diagnosed with stage III cervical cancer.
“I made an appointment with Dr. [Steven] Hott because I had been bleeding for months and I knew something was wrong,” Hershey said.
Hershey, now 42, hadn’t had a pap smear in 14 years, abiding by the common saying, “If it isn’t broke, don’t fix it.” She had a tubal ligation procedure after having her daughter several years earlier and had the same partner for years, so she didn’t think regular screenings were necessary.
Hott did four biopsies before making that fateful call to Hershey.
“He called me personally about two weeks later and said ‘It’s cancer. It’s cervical, you need to get down to Indianapolis to see the oncologist OB-GYN,’” Hershey remembered.
After getting a cone biopsy, Dr. Sarah Goodrich, of St. Vincent Hospital in Indianapolis, confirmed it was stage III cervical cancer. A cone biopsy is when a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope.
When she got the news it was cancer, it changed everything, Hershey said.
“I was scared,” she said. “I just saw my life flash before my eyes.”
Hershey's treatment, which included five weeks of daily external treatment including chemotherapy and five internal radiation treatments in Indianapolis, began in January 2017.
“You generally want a multi-disciplinary approach to treatment. You want gynecological oncologists, radiation oncologists and medical oncologists all on board in regards to cervical cancer patients,” said Dr. Christopher Leagre, an oncologist with the St. Vincent network that administered Hershey’s treatments in Indianapolis. “You look at a lot of factors — their age, health and nature of their cancer — and those things help you decide what options are available.”
Despite some severe side effects from the chemotherapy — including two blood clots in her lungs and a four-day hospital stay — by March 23, 2017, Hershey was in remission. The recovery process has been long and painful, and she now has to be on blood-thinners to reduce the risk of more blood clots forming.
“I was just a go, go, go type of person and then, boom, I got sick. It’s been hard to adjust to a totally different life,” Hershey said, adding she hasn’t been able to return to her job at Buffalo Wild Wings since her treatment started.
But, many doctors and legislators are trying to make sure other women do not have to suffer from cervical cancer like Hershey did.
“Cervical cancer is an entirely preventable cancer,” said Dr. Jeanne Schilder, the Mary Fendrich Hulman professor of gynecologic oncology and professor of obstetrics and gynecology at the Indiana University School of Medicine.
Risk and prevention
HPV, less commonly known as human papillomavirus, is a group of more than 150 related viruses that is spread through sexual contact, according to the American Cancer Society.
In 2018, the American Cancer Society estimated about 13,240 new cases of invasive cervical cancer will be diagnosed nationally. About 4,170 women will die from the disease.
According to the Indiana State Department of Health, from 2008 through 2012, 1,250 Indiana residents were diagnosed with an invasive cervical cancer.
More than 80 percent of people have been exposed to HPV, Schilder said, but in most people, the body can clear the infection by itself.
Yet, high-risk types of HPV infection can be deadly. HPV is the single greatest risk factor of cervical cancer, but can also contribute to penile cancer in men, and cancers of the anus, mouth and throat in both men and women, said Dr. Annette Moore, an oncologist with the Community Health Network.
Hershey’s cancer was attributed to HPV. “I had [HPV], my mother had it and both my sisters had it,” she said.
The HPV vaccine could have changed that, if Hershey had been vaccinated between the eligible ages of 9 to 26 years old.
With regular screenings and the HPV vaccine, cervical cancer could become non-existent, Schilder said. Pap smears are recommended every three years, but a patient's health history and other factors should be taken into account, she said.
“I think it’s really, really crucial that every single woman has a discussion with her doctor about what is right for her,” Schilder said. “People tend to put it off — no one wants to have a pelvic exam, that’s not a fun thing to do, but it is important.”
There are also several myths about the HPV vaccine.
“If we could prevent other cancers, people would be running and knocking down our doors to have an examination done, and that goes hand-in-hand with the HPV vaccine,” Schilder said. “As OB-GYNs and gynecological oncologists, we are incredibly supportive of anybody who is eligible to get the HPV vaccine to get it. It is something that’s very underutilized.”
So why aren’t more people getting vaccinated, or getting their children vaccinated?
“There’s a stigma attached to the HPV vaccine,” Schilder said. “People have seen it as something that would lead to promiscuity.”
Moore said she fields a lot of questions about the vaccine from parents and grandparents, one of which is the concern it will encourage children to become sexually active.
“It doesn’t make any sense that by vaccinating kids at age 11 and 12 means that they are suddenly going to become more promiscuous,” Moore said.
The stigma and lack of education surrounding HPV and cervical cancer led to several bills being introduced in the Indiana Legislature regarding the vaccine, said District 13 Rep. Sharon Negele.
“The more I started researching the subject, the more I became aware that we weren’t doing a very good job in Indiana at eradicating cervical cancer,” Negele said. “A lot of states have been working hard at improving their rates and Indiana is just stagnant. We’re just not doing a good enough job.”
Negele, who represents portions of Benton, Fountain, Jasper, Montgomery, Newton, Tippecanoe, Warren and White counties, decided to get her own daughter vaccinated after reading more about HPV.
“I felt confident that it was the right thing to do. Fast forward, my daughter is of course in her mid-20s now, and I’m a legislator, and the subject started coming up with legislation regarding the HPV vaccination. The approach that was taken over the last two years was really based on the HPV vaccination rates and how Indiana was going to improve that, and there was just this huge push back. I couldn’t fathom why there was a push back.”
Negele said there were people who believed very strongly the science behind the vaccine wasn’t strong enough, that the HPV virus was contracted through “inappropriate behavior” and that the age to vaccinate was somehow going to lead to increased sexual activity.
“I was just shaking my head,” she said.
After watching yet another HPV-related bill get defeated on the floor, Negele began to wonder how legislators could craft and word a bill that would actually make a difference in Indiana’s vaccination and cervical cancer rates.
In January 2017, Negele authored House Bill 1278, focusing on cervical cancer prevention and education. The bill, which passed unanimously and was signed by Gov. Eric Holcomb in April, requires the Indiana State Department of Health to develop a strategic plan to identify and significantly reduce morbidity and mortality from cervical cancer. The strategic plan is due at the end of this year.
“What we are trying to accomplish is creating this strategic plan on how to tackle — in a three-pronged approach — education, prevention and screening,” Negele said. “I just happened to be the last legislator to take this flag to the finish line, so to speak. There were a lot of other legislators who had worked hard on it.”
On Jan. 18, Negele and Commissioner of the Indiana State Department of Health Kristina Box introduced a proclamation recognizing January as Cervical Cancer Screening and Awareness Month.
“There’s this huge momentum going,” Negele said. “My goal is to just keep the subject alive, keep people thinking about it and continue to create more and more awareness.”