“Jessica died in March, the month marked as “Women’s Month” amidst all the celebrations, conferences and meetings occurring around the globe.”

**Jessica Pettaway**
*Source: Instagram*

I opened my instagram app to the explore page at 6 am on Monday March 18th. I was just about to join my morning prayer live when a beautiful face caught my attention. Her goddess locs were pinned up only allowing a few to delicately fall out of her stylish bun. This delicate essence was mirrored in her beautiful brown eyes highlighted by the brightest blue-green eyeshadow I had seen in a while. Her bronze skin was sunkissed. She looked like the picture of summer.

Curiosity caused my fingers to click and summer swiftly turned into a harsh winter as I read the caption, and then her comments. This brown eyed bronzed beauty was no longer with us in this earthly realm.

Her name was Jessica and her caption told the unfortunate story of a Stage 3 cervical cancer diagnosis before summer 2023. My heart sank learning that this beauty dealt with one of the most devastating diagnoses a person could receive but as if it were some sick joke I heard, ‘wait there’s more’. Jessica had been misdiagnosed with fibroids after significant vaginal bleeding, fatigue and weakness. Even after two further episodes of collapsing and being found unresponsive Jessica was discharged with the same diagnosis, ‘fibroids”. A biopsy was eventually suggested following multiple blood transfusions being needed due to significantly low haemoglobin levels. It was at that appointment an attempt at a cervical examination revealed a mass obstructing Jessica’s cervix. She was then given her diagnosis with her biopsy result; Stage 3 cervical cancer.

That sinking feeling in my heart accompanied me to work and sat with me through every patient consultation particularly the ones with ‘heavy periods’ as presenting complaints. Jessica died in March, the month marked as “Women’s Month” amidst all the celebrations, conferences and meetings occurring around the globe. I thought about Jade Goody who also died of cervical cancer and even went as far back as Henrietta Lacks whose cervical cancer cells (HeLa cells) served as a hallmark in the advancement of medical research.

Cervical cancer is the fourth most common cancer in the world and was responsible for 350,000 deaths in 2022 (WHO, 2024).

In the UK there were 853 deaths due to cervical cancer from 2017- 2019, (Cancer Research UK, 2019).

It is estimated that 94% of deaths due to cervical cancer come from low- and middle income countries where this high incidence is attributed to health inequalities due to reduced access to national HPV vaccination, cervical screening and treatment. Jessica lived in the United States of America, so why was this her fate? How many more Jessicas exist?

From Jessica’s account her initial symptoms were heavy bleeding and fatigue. These were not taken seriously by her medical professionals and echoed by the women around her were the phrases, “I get that too. It’s a normal thing.” This “normal” thing turned out to be cancer which unfortunately and unfairly claimed the life of a young woman leaving behind her two children and husband.

Many of us may recall the widely televised life of Big Brother’s Jade Goody who died of cervical cancer in March 2009. Jade’s story was different from Jessica’s in that Jade had three previous abnormal smear tests and made the decision to skip the fourth due to fear. At the time of her cancer diagnosis, Jade was informed that the cancer had been present for two years. Following Jade’s death in 2009 the United Kingdom saw a half a million increase in the number of women attending cervical screening and this was dubbed, “The Jade Goody Effect’.

**Jade Goody**
*Source: Big Brother Fandom*

Several years following Jade Goody’s death, in 2023 the National Health Service published data showing that 3 in 10 women invited for cervical screening did not take up that offer.

Jessica Pettaway’s misdiagnosis raises questions concerning the level of care and concern shown to women’s health in particularly heavy periods. This tragic story also highlights whether women are sufficiently educated on the importance of screening in prevention and treatment of cervical cancer.

High risk HPV are found in 99% of all cervical cancers which cause abnormal cells to develop on the cervix. These cells when left untreated can turn into cancer over time. Early detection is therefore important in treatment success and better outcomes.

The World Health Organisation (WHO) has outlined its “Global strategy to accelerate the elimination of cervical cancer as a public health problem” by following a 90-70-90 target to be met by 2030. This 90-70-90 target states that for countries to be on a path towards cervical cancer elimination, 90% of girls should be fully vaccinated with the HPV vaccine by 15 years old, 75% of women should have undergone high-performance cervical screening by the age of 35 and again by the age of 45 and 90% of women identified with cervical disease (pre-cancer and invasive cancer) should be treated.

The barriers that impede progress being made to meet the targets set by the WHO often surround low-income countries with limited access and resources. Jessica lived in the United States of America and Jade Goody lived in England yet they both met the same fate. In the United States, England and across the globe, barriers that prevent women and people with a cervix from attending screenings or being incorrectly diagnosed include: fear of the cervical screening process, stigma attached to an HPV diagnosis, lack of adequate knowledge concerning cervical disease progression and a failure on the part of medical professionals to take women’s health symptoms seriously.

Fear of the cervical screening process

It is understandable that some people may find smear test appointments uncomfortable and have concerns regarding the experience itself due to anxiety and misinformation surrounding the process. It is possible to request a longer appointment to discuss concerns before the start of the screening. It is possible to contact your local health provider and health organisations such as Jo’s Cervical Cancer Trust, Cancer Research UK, Macmillan Cancer Support, GOV.UK, American Cancer Society, Centre for Disease Control and Prevention, The National Cervical Cancer Coalition and Cancer Care Ontario who provide support and information and are able to answer any questions regarding screening.

Stigma Attached to an HPV diagnosis

There is stigma attached to sexually transmitted diseases and as a result this may deter women from attending screening and therefore delay treatment. Human papillomavirus HPV, is a group of viruses of which there are over 100 types which commonly affect the skin. HPV does not usually cause any concerns however certain types can affect the genitals and the cervix leading to genital warts and cervical cancer. Transmission of HPV is not dependent on the number of sexual partners that someone has or whether that person has had penetrative sex. HPV can be transmitted through any form of skin-to-skin contact of the genitals, vaginal, anal or oral sex or sharing sex toys. Most people are unaware that they have contracted the virus as there may be no symptoms and nearly 90% of sexually active men and 80% of sexually active women may be infected with HPV in their lifetime. There is no current treatment for HPV and in most cases the infection will clear on its own. In some cases however the infection may lead to warts or cancer. Testing for HPV is imperative to treat and prevent cancer progression. Aside from cervical cancer, HPV is found to be linked to penile cancer, anal cancer, vaginal cancer, vulvar cancer and some cancers of the head and neck.

Lack of adequate knowledge surrounding cervical disease progression

Although significant work has been done to raise awareness of cervical disease and related screening, the World Health Organization highlights the need for continued vigorous health promotion. After a cervical screening, the result may come back as abnormal. This means that changes were found in some of the cells located on your cervix. These cells are not cancer and can go back to normal on their own. However, in some instances, these cells may continue to progress into cancer in the future. HPV is initially tested for and if this comes back as positive, the pathologist will examine those cells in greater detail to decide whether they are normal or abnormal. An abnormal finding is followed up by a colposcopy appointment which is usually done in one day. The neck of the womb (cervix) is closely examined using a special instrument and a sample of tissue is taken, referred to as a biopsy.

Colposcopy Results:

Colposcopy results are classified using the term cervical intraepithelial neoplasia CIN. Three types of CIN classification exist dependent on how deep the abnormal cells have reached the skin covering the cervix. This is not cancer.

CIN 1 (low grade): Abnormal cells have reached ⅓ thickness of the lining of the cervix.

CIN 2 (high grade): Abnormal cells have reached ⅔ thickness of the lining of the cervix.

CIN 3 (high grade): Abnormal cells have reached the full thickness of the lining of the cervix.

**Cervical Intraepithelial Neoplasia Classification**
*Source: Cancer Research UK*

CIN 1 does not usually require treatment as cells return to normal over time. CIN 2 is usually monitored and CIN 3 is usually treated. Treatment involves destroying or removing the abnormal cervical cells. Cervical Cancer occurs when these abnormal cells grow uncontrollably and eventually form a tumour.

Failure on the part of medical professionals to take women’s health symptoms seriously

Jessica Pettaway was misdiagnosed with fibroids three times before a speculum examination revealed a large growth obstructing her cervix. Her symptoms of heavy bleeding and fatigue were not taken seriously enough. This cost Jessica her life. Heavy bleeding should always be thoroughly examined as it is a common symptom of many gynaeological diseases including cancer. Rigorous medical training recommends that when reaching a diagnosis, differentials (alternative diagnoses) be explored beginning from the worst case scenario. Was that approach implored by the medical professionals who treated Jessica? And if so, how was a cancer diagnosis missed until it was too late?

As women we often rely on our medical professionals who are trusted to act in our best interests and provide a thorough assessment of our symptoms leading to a correct diagnosis. Given that incidents like Jessica’s still occur it is more important to highlight the need for self advocacy particularly in women’s health.

A very heavy period is not normal.

Vaginal bleeding between periods is not normal.

Vaginal bleeding after sexual intercourse is not normal.

A very painful period is not normal.

Unexplained fatigue is not normal.

Unexplained weight loss is not normal.

Any symptom that raises any level of concern to you should be further investigated.

If your current doctor or medical professional has not reassured you and there are still concerns or the symptoms have not resolved, get a second opinion.

Medicine should be patient centred and women’s health should always be taken seriously.

Jessica Pettaway should not have been misdiagnosed with fibroids causing her life to be cut short.

The next time a woman complains about her health, she should be taken seriously.

Author - Antonia Miracle Evans (Founder of Shiloh Living)

See “About” Section to learn more about Antonia.

Cervical cancer— still a public health concern.

SHILOH LIVING LIMITED