Book Review: The Immortal Life of Henrietta Lacks, by Rebecca Skloot

At the age of 16, I won a student summer job at the University of Aberdeen in the Department of Cell Pathology. It was the first time I had worked in a lab, and I jokingly refer to it as the summer I attempted to cure cancer. In all seriousness, it was very exciting for me as a high school student to work in a university laboratory and learn techniques such as pipetting (with much fancier pipettes than were available in my high school chemistry labs) and cell culture protocols, and to use sophisticated equipment to count cells and visualize them. I remember discussing the experiment I was to conduct that summer – the impact of a particular amino acid (arginine) side chain of a topoisomerase inhibitor (NU/ICRF 510) on cancer cells vs. non-cancer cells – and kept hearing the terms “HeLa” and “fibroblast” thrown around. I managed to figure out that “HeLa” cells were cancer cells and “fibroblasts” were non-cancer cells. I never stopped to wonder where the cells came from, or how they were obtained.

The book “The Immortal Life of Henrietta Lacks”, by Rebecca Skloot, tells that story with compassion and skill. The cells known as “HeLa” cells are so named because of the woman from whose tissue they originated: “He” for Henrietta and “La” for Lacks. Henrietta developed cervical cancer in the early 1950s and, in the course of diagnosis, some of her cervical tissue was taken for the purposes of research. This doesn’t sound particularly noteworthy, but three key pieces of information are missing: 1) the tissue was taken for research without Henrietta’s (or her family’s) consent, 2) researchers went on to send her cells around the world, and 3) companies began to charge for researchers to purchase her cells. Skloot expertly interweaves three story threads: the story of Henrietta Lacks and her family, the state of the scientific/medical world at the time and since, and also the portrayals of the family and relevant scientific advances in the media. This book is not only compelling (I didn’t want to put it down), but also informative and thought-provoking. I was inspired to download several academic papers that were mentioned in the book, and I now have a completely new perspective on Research Ethics Boards and submissions of ethics applications to conduct research. This book is a must read for anyone conducting human research, and I strongly recommend it for everyone else!

Photograph of Henrietta Lacks

- Catriona Hippman, Research Program Manager

You might find the following sites interesting that were referenced in the book:

ScienceBlogs

This week in Virology

National Day of Remembrance and Action on Violence Against Women

December 6 is the National Day of Remembrance and Action on Violence Against Women in Canada. On this day 22 years ago, 14 young women were senselessly murdered at l’École Polytechnique de Montréal. They died because they were women.

Today we commemorate all the women whose lives have been cut short by an unjustified act of violence, and promote awareness of an issue that still prevails in our so-called modern society. Violence against women does not only mean physical abuse, it can also take the form of emotional, verbal, sexual, financial, and cultural abuse, and it can occur across all ethnic, racial, social, age and economic groups.

In the 22 years since the horrific events in Montreal, we have made some progress towards ending violence against women, but I strongly believe that we need to put in a more concerted effort as a community. Campaigns like the ‘White Ribbon’ are helping raise awareness of this issue in men and boys, and sharing the different ways in to get involved and help prevent gender-based violence.

December 6 is a day of remembrance, but it is also a day to take action, to find out how you personally can help to end violence against women.

For more information about violence against women, and how you can help, The Woman Abuse Response Program at BC Women’s Hospital has put together a list of resources:
http://www.bcwomens.ca/Services/HealthServices/WomanAbuseResponse/default.htm

If you are experiencing abuse, or know someone who is, and need to talk -
call VictimLINK 1-800-563-0808 (24 hour crisis line)

Shivinder Dhillon, WHRI Coop Student
Emily Wagner, Infectious Diseases Research Manager

December 1 is World AIDS Day

The theme for this year’s World AIDS Day is ‘Getting to Zero: Zero New HIV Infections, Zero Discrimination and Zero AIDS related Deaths’. This year marks the launch of the ‘Getting to Zero’ Campaign, which will run until 2015 and work towards achieving the AIDS-related Millennium Development Goals.

There have been significant advances in the treatment of HIV/AIDS since the first cases of HIV infection surfaced 30 years ago. At that time, AIDS was considered a ‘silent killer’, but now, more and more people living with HIV are leading a healthy and normal life. Yes, ‘It’s Different Now’! With the increasing awareness about the spread and progression of the virus in the medical and the public sectors, the general attitude towards being HIV positive has changed. It is not considered a death sentence any more, and the ‘It’s Different Now’ campaign is taking it further by bringing the discrimination against HIV positive people to ‘Zero’.

This is not to say that we have conquered the disease but we are definitely on our way and it is important that we all play our part in reaching the ultimate goal of ‘Getting to Zero’. The first step in the eradication of HIV is to stop the spread. At an individual level, we can help by getting tested for the virus as most HIV transmission occurs from people who are unaware of their HIV status. Hence, the earlier one becomes aware of their HIV status the better it is for them and their community. HIV affects all of us in some form or the other and it is important to get more people tested and connected to care and treatment as fast as we can.

To learn more about the ‘It’s different Now’ campaign and find HIV testing centres, go to http://itsdifferentnow.org/

Shivinder Dhillon, WHRI Coop Student
Emily Wagner, Infectious Diseases Research Manager

My Pap test came back abnormal! Do I have cancer?!

In November 2009, my doctor’s office called and asked me to discuss my recent Pap test.  I didn’t think too much of it at the time and agreed to come in the following day.

At my appointment, my GP advised that my Pap test had come back abnormal.  I still wasn’t alarmed.  I work in women’s health research, in the area of infectious disease.  Many of the studies I work on involve participants getting Pap tests, so I see these results all the time. Although I am not a doctor or a nurse, I know that many things can cause an abnormal Pap test.  Things like infection… perhaps I have a yeast or bacterial infection?  An STD?  Unlikely, but it’s good to get checked and be sure…  Perhaps when my doctor did the Pap test, she didn’t get enough of the right cells and the Pap test was unreadable?   All these thoughts ran through my head as likely causes.

However, this wasn’t the case.  My doctor said that my Pap test indicated CIN II/III.  Hmmm….  Cervical intraepithelial neoplasia, grade 2 or 3, or moderate to severe cervical dysplasia.  This is the point in my visit where I forgot everything I had learned in my career and lost the plot.  I HAVE CANCER!!!!  “No, my doctor assured me, “you do not have cancer.  However, there are some changes on your cervix that, over time, could turn into cancer.”  My doctor advised me that, as Pap smears are not diagnostic tests, simply a very effective screening tool, she was referring me for a colposcopy to take a closer look at these changes.

A few weeks later, I arrived at the Colposcopy Clinic for my appointment.  I was very nervous and still convinced I had cancer.  After watching the extremely dated, but very reassuring video, I was led into the clinic.  The nurse asked me a few questions (date of birth, last menstrual period, any allergies?  That sort of thing) and led me to get changed.  I was provided with two gowns (I never know whether to do them up at the back or the front!) and some very stylish paper booties.

After waiting what seemed like forever, I was led into an exam room.  I was greeted by a lovely nurse and the gynecologist who let me know what I could expect during the exam.  A colposcopy is much like a Pap test.  Same fabulous position (bottom so far down the exam table that it feels like it’s going to fall off, let your knees just “flop” open, please, feet in the always cold stirrups), and mostly the same procedure.  A speculum was inserted, just like a Pap test, but a colposcope was used to take a really close look at my (I’m convinced) cancer-ridden cervix.  (A colposcope is a large, electric microscope that is positioned approximately 30 cm from the vagina.  It has a really bright light on the end which helps the doctor see the cervix (and any changes) really clearly)

The very cool thing about this procedure was that I could watch the entire thing on a monitor mounted on the wall to the right of me.  It’s not every day a girl gets to see her cervix, and let me tell you, it was very cool!

The doctor then washed my cervix with a vinegar solution so that any abnormal areas would show up more clearly.  And there it was… a white blob that looked like a jelly fish had exploded on my lovely pink cervix.  Now I was really scared.  Surely this was cancer!  However, the doctor advised that his impression was that I did not have cancer.  Yes, there were some moderate changes that he wanted to take a biopsy of so that the pathologist could look for changes in the cells that might indicate that cancer is present or likely to develop.

The biopsy felt like a little pinch. Unfortunately, I did watch the biopsy being taken on the monitor and I wish I hadn’t.  As the cervix is quite vascular (has a lot of blood vessels), it does bleed a bit when a biopsy is done.  Magnified about 4 billion times, it looks like it should really hurt.  I honestly felt like a little pinch, but that picture told me it should hurt a lot more than it did.  The biopsy itself was about half the size of a pencil eraser.  My doctor would have the results back in a few weeks, the gynecologist said.

Off I went with some mild spotting and cramping that would last a day or two.  A little less frightened and reassured that I likely did not have cancer (although I still wasn’t entirely convinced).  And VERY relieved that I am religious in getting my annual Pap test!  What if I had skipped a couple of years??? You know, things get busy… life takes over…

A few weeks later, back at my doctor’s office, I was told that the biopsy showed CIN II or moderate dysplasia.  This meant that the abnormal cells involved about one-half of the thickness of the surface lining of the cervix.  It also meant that I did not have cancer!  It did, however, mean that these changes would need to be treated.  If the biopsy showed CIN I, these changes likely would have gone away on their own.  I would have another Pap test in 6 months or so and my doctor would have kept a close eye on things.  But, with CIN II, treatment is usually required.

Several weeks later, I was back at the Colposcopy Clinic for a LEEP.  A LEEP procedure uses a thin wire loop electrode to painlessly and quickly cut away the affected tissues on the cervix.

After watching another dated but nevertheless informative video, I was taken into the clinic room.  I opted not to watch this procedure!  Again, it’s much like having a Pap test.  Nothing hurt, but the freezing that they put in my cervix felt “pinchy” and the adrenaline made my heart pound a little.  Other than that, it was pain free and I was out the door in 15 minutes.  Three days of mild cramping and spotting followed.  No sex, exercise, or swimming for three weeks to prevent infection and to allow my cervix to heal, and no strenuous exercise for one week.  NO PROBLEM!

About six months later, I had a follow up colposcopy appointment.  Everything looked great and there were no abnormal cells remaining.  Hooray!  Since that time, I have only had normal Pap smears.

This whole experience taught me that I have been doing a great thing for myself in getting my Pap tests done faithfully.  I am very thankful I live in a place where access to Pap testing is free and encouraged.  It is one of the most important things we women can do to protect ourselves from cervical cancer.  Along with Pap testing, those of younger generations will also have the HPV vaccine. My young daughter, hopefully, will not have to go through the same worry that I did.

I only wish that other women, in less fortunate places, had the same access to these live saving screenings and diagnostic procedures, not to mention the HPV vaccine.

Thanks for allowing me to share my story with you.  I sincerely hope that it will encourage you to call your doctor, and book an appointment to get your Pap test today!

Melissa Lambrecht, WHRI Research Assistant

For further reading, I have included some links below to a few great websites that discuss HPV and Pap testing.

http://www.bccancer.bc.ca/PPI/Screening/Cervical/paptests/default.htm

http://www.bccancer.bc.ca/PPI/Screening/Cervical/hpv.htm

http://www.sexualityandu.ca/

http://www.hpv.com/pdc/hpv/index.jsp

http://www.hpvinfo.ca/

http://www.phac-aspc.gc.ca/std-mts/hpv-vph/fact-faits-eng.php

Why Maternal Age Matters

National study measures how advanced maternal age affects mothers and their babies

Women over 35 face higher risks of birth complications but good prenatal care can help manage the risks, a new report suggests. A report released from the Canadian Institute for Health Information entitled In Due Time: Why Maternal Age Matters, looked at more than one million births across Canada from 2006 to 2009 in order to examine the impact that advanced maternal age can have on both mothers and their babies.
While many older mothers are able to have healthy birth experiences, the risks associated with pregnancy and childbirth begin to rise around age 35 and increase dramatically for mothers aged 40 and older. According to the largest Canadian study ever done on risks associated with advanced maternal age:

- Almost one in five births in Canada is to a mother over the age of 35

- Fifty percent of first-time mothers over 40 have a cesarean delivery

- Babies born to older mothers more likely to face adverse birth outcomes

- One in every eight mothers 40 or older developed gestational diabetes (compared to 1 in 12 for the 35 to 39 age group and 1 in 24 for the 20 to 24 age group)

- One in every nine babies of older moms (age 40+) are born prematurely (compared to 1 in 11 in the 35-to-39 age group and 1 in 13 in the 20 to 34 group)

- Mothers age 40 and older were at least three times more likely to develop certain complications than younger mothers

For expectant women 35 or older, especially fist-time mothers, these findings highlight the need for good prenatal care and prenatal screening for potential problems.
Read the full report: http://secure.cihi.ca/cihiweb/products/AIB_InDueTime_WhyMaternalAgeMatters_E.pdf

Kathryn Dewar, Health Services Delivery Research Manager

September 26 is World Contraception Day

Today, September 26, marks the 5^th anniversary of World Contraception Day. It is celebrated in about 70 countries worldwide and aims for ‘a world where every pregnancy is wanted’. Various events are undertaken in different countries to spread awareness of the absolute importance for the use of contraception among young people.

But according to a survey conducted by the Parenthood Foundation involving 6000 young adults from 26 different countries, it has been found that the percentage of young adults who do not use contraception is shockingly on the rise. In the US alone, the percent of young people not using contraception during sex has increased from 38% in 2009 to 53% today!

Despite all the measures being taken across the globe to spread awareness on contraceptive use, where do our efforts lack? Is the sex education that teenagers get in schools adequate and appropriate? Is the US policy of “abstinence-only” sex education effective in preventing unplanned pregnancies? Do teenagers feel empowered to ask questions about their sexuality and their options? Worldwide, are contraceptives difficult for young people to obtain?

This survey raises many questions, but provides important insight into what appears to be a startling lack of information and/or personal empowerment among young people.

Shivinder Dhillon, WHRI Co-op Student
Emily Wagner, Infectious Diseases Research Manager

HPV Vaccine is a ‘life-saving’ vaccine – AAP

The American Academy of Pediatrics has taken an aggressive stance in response to false statements about HPV vaccines that have been made recently in the US Republican presidential campaign, including misinformation such as the HPV vaccine is dangerous and can cause mental retardation. As the AAP states in their September 13 press release, there is absolutely no evidence to support these false claims.

The facts are clear. HPV is the most common sexually transmitted infection in the world. HPV is responsible for thousands of deaths each year from cervical cancer, in women from all walks of life across the globe. In Canada, two HPV vaccines have been approved: Gardasil and Cervarix. These vaccines are proven to be safe and effective in preventing infections from the types of HPV that can lead to 70% of cervical cancers. Kudos to the AAP and many other organizations and scientists who have spoken up to set the record straight on HPV vaccines.

Shivinder Dhillon, WHRI Coop Student
Emily Wagner, Infectious Diseases Research Manager