On 29 June 1988, in Bowen v. Kendrick, the US Supreme Court ruled in a five-to-four decision that the 1981 Adolescent Family Life Act, or AFLA, was constitutional. Under AFLA, the US government could distribute federal funding for abstinence-only sexual education programs, oftentimes given to groups with religious affiliations. As a federal taxpayer, Chan Kendrick challenged the constitutionality of AFLA, claiming it violated the separation of church and state. The Supreme Court found that although AFLA funded programs that aligned with certain religious ideologies, it was constitutional because it did not encourage government involvement in religion, and it held a valid secular purpose in seeking to prevent adolescent pregnancy and premarital sexual relations. By upholding AFLA, Bowen v. Kendrick enabled the US government to continue funding abstinence-only education, which researchers have found to be ineffective.

In 1994, the Eastern Virginia District court case Bailey v. Blue Cross Blue Shield of Virginia established that insurance companies could not deny coverage for experimental stem cell therapy treatments. The plaintiff, Mary Bailey, was diagnosed with advanced stage breast cancer and sought treatment involving high-dose chemotherapy and an advanced stem cell treatment, which was a novelty at the time. Stem cells are cells that have the potential to develop into several different types of cells in the body. The defendant was the health insurance company Blue Cross Blue Shield, which denied coverage for Bailey’s treatment. The district court sided with Bailey and ordered that BCBS could not deny coverage for her specific treatment. While Bailey v. Blue Cross Blue Shield of Virginia resulted in Bailey receiving compensation for her treatment, it also increased national awareness of stem cell therapy with chemotherapy.

On 15 April 1999, physician Gillian Thomas published the editorial “Improved Treatment for Cervical Cancer – Concurrent Chemotherapy and Radiotherapy,” henceforth “Improved Treatment,” in The New England Journal of Medicine. In that editorial, she discusses the potential benefits of combining chemotherapy drugs with radiation to treat women with cervical cancer. At the time, healthcare professionals rarely treated cervical cancer by combining chemotherapy or radiation. Two months prior to Thomas’s publication, the US National Cancer Institute, headquartered in Bethesda, Maryland, released an announcement advocating for combining chemotherapy with radiation based on clinical trial results. In “Improved Treatment,” Thomas summarized the results of those clinical trials that had led to the announcement and communicated a new way to treat invasive cervical cancers, which persists as of 2019.

In 1930, physician Joseph Colt Bloodgood founded the Amanda Sims Memorial Fund, or the ASMF, a United States cancer awareness organization that focused on spreading information about ways to detect and prevent cervical cancer in women, in Baltimore, Maryland. In partnership with nurse Florence Serpell Deakins Becker, Bloodgood promoted awareness of the early symptoms of cervical cancer among women and advocated for regular pelvic exams. The ASMF partnered with numerous women’s organizations throughout the United States, providing educational information to women of varying backgrounds. Though the ASMF existed for only five years, it was one of the first organizations to directly reach out to women to explain the importance of regular pelvic exams and early detection of cervical cancer, creating a platform for later organizations to continue that mission.

In “Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use,” hereafter “Explaining Recent Declines,” researchers John S. Santelli, Laura Duberstein Lindberg, Lawrence B. Finer, and Susheela Singh discuss what led to the major decline in US adolescent pregnancy rates from 1995 to 2002. Working with the Guttmacher Institute, a reproductive health research organization, they found that the decline in US adolescent pregnancy rates between 1995 and 2002 was primarily due to improved contraceptive use. They published their article in 2007 after the US government had increased funding for abstinence-only education between 1998 and 2007. “Explaining Recent Declines” challenged US policies by asserting that there was minimal evidence to support abstinence-only sex education as the primary strategy to prevent adolescent pregnancy.

This thesis answers the following question: How does the history of cervical cancer show that prevention helps reduce rates of cancer-related deaths among women? By studying the history of cervical cancer, people can understand how a cancer that was once one of the top killers of women in the US has declined to become one of the lowest through the establishment of and effective communication of early prevention and diagnostics, both among the general public and within the medical community itself. This thesis is organized based on key episodes which were pertinent to the history of cervical cancer, primarily within the United States and Europe.

In 2006, United States pharmaceutical company Merck released the Gardasil vaccination series, which protected recipients against four strains of Human Papillomaviruses, or HPV. HPV is a sexually transmitted infection which may be asymptomatic or cause symptoms such as genital warts, and is linked to cervical, vaginal, vulvar, anal, penile, head, neck, and face cancers. In 2006, based on research conducted by researchers Ian Frazer and Jian Zhou in the 1990s, Merck released a four-strain version of Gardasil, which protected boys and girls aged nine and older against the major HPV strains HPV-6, HPV-11, HPV-16, and HPV-18. In 2014, Merck released Gardasil 9, a nine-strain version that protected from the original four HPV strains plus strains HPV-31, HPV-33, HPV-45, and HPV-58. Gardasil is a preventative measure and reduces the risk of contracting HPV and HPV-related cancers by up to ninety-seven percent.

On 20 August 2007, in Frazer v. Schlegel, the United States Court of Appeals for the Federal Circuit decided that researchers Ian Frazer and Jian Zhou owned the rights to the vaccine patent for Human Papillomavirus, or HPV, instead of a research team led by Richard Schlegel. Frazer v. Schlegel reversed the decision that the Board of Patent Appeals and Interferences had previously made, awarding the patent to Schlegel on the basis that Frazer’s patent application contained inaccurate science. However, once appealed, the Federal Circuit judges found Frazer’s science to be accurate, granting him rights to the vaccine patent. In 2006, the US Food and Drug Administration, or FDA, approved the first HPV vaccine, which has since been effective in protecting women from cervical cancer by up to ninety-seven percent if they were vaccinated before contracting HPV. The Circuit’s decision gave Frazer ownership of the patent for the HPV vaccine, which physicians have administered over 120 million doses of to people in the US.

From 1936 to 1945, the Women’s Field Army, hereafter the WFA, educated women in the US on the early symptoms, prevention, and treatment of reproductive cancers. The WFA was a women-led volunteer organization and a branch of, what was then called, the American Society for the Control of Cancer, or ASCC. The WFA, headquartered in New York City, New York, recruited hundreds of thousands of women volunteers across the country. They distributed pamphlets, showed movies, and participated in other grassroots efforts to foster an understanding of reproductive cancers, namely breast and cervical cancer, among other women. The Women’s Field Army aided in reducing the number of cancer-related deaths by spreading cancer prevention awareness and teaching women about their reproductive health and the early detection of cancer, which was one of the first widespread educational resources about reproductive cancers for women.