The sad story of Jade Goody

Sad; appalling; tragic. It’s hard to find the right words to describe the story of Jade Goody, a British reality TV celebrity who’s dying of cervical cancer at age 27 after ignoring test results because, as she confessed publicly, she was scared.

Most people on this side of the Atlantic have probably never heard of Jade Goody. In Britain, however, she has been tabloid and headline fodder ever since making her debut in 2002 in the reality show "Big Brother." Over the past seven years she has appeared in TV shows, released several exercise DVDs, written her autobiography and even launched a perfume. She’s gained a reputation for being brash and outrageous.

But she’s now more likely to be remembered for how her life is ending: with an aggressive form of cervical cancer. The cancer has spread to her liver, bowel and brain.

With only a few weeks left to live, she’s saying her goodbyes. More than 1 million people watched the televised special last week of her wedding Feb. 22 to boyfriend Jack Tweed.

Worldwide, cancer of the cervix is one of the leading causes of cancer deaths among women. Most of these fatalities occur in developing nations, where screening is less common. Survival rates are relatively high, however, in the United States and in other industrialized nations such as the United Kingdom. About 11,000 new cases occur in the U.S. each year, and about 3,800 women die from it. By comparison, more than 180,000 women in the U.S. are diagnosed with breast cancer each year and nearly 40,500 will die.

The Papanicolaou test, or the Pap smear, has been widely credited with reducing the cervical cancer death rate by detecting abnormal cells early, before they’ve had a chance to progress into full-blown cancer. Between the mid-1950s and the early 1990s, the death rate from cervical cancer fell by 74 percent in the U.S., largely as a result of the introduction of screening.

It would be easy to spin Jade Goody’s sad story as an example of what can happen when a woman doesn’t get screened – except this isn’t the whole story.

For one thing, it appears that Jade did undergo screening. Three times, in fact, during which abnormal cells were found and removed. After the fourth positive Pap screening, apparently, she was simply too frightened to go back for the procedure.

She said as much in an interview last August with Heat magazine: "They had sent a letter to me ages ago, telling that I needed to go in for an operation, but I had been too scared to do anything about it."

Did she have her head in the sand? Maybe not. After all, she’d already had pre-cancerous cells removed from her cervix three previous times, starting at age 16. In the same interview with Heat, she says that the first time "nearly traumatised me for life, it was so painful."

It begs the question: Could the outcome have been different if the cancer had been found sooner, before it had spread?

We’ll never know. But it does raise a lot of questions. Was there adequate followup when she didn’t return for care after her fourth suspicious Pap test? You’d think that after even two abnormal test results, let alone four, her case would have been flagged as high risk and received more intensive monitoring. By some accounts, she had been hospitalized more than once in the past four years for blood loss; were doctors aware of her previous history - and if not, did she think to tell them?

Did it even occur to anyone that she might have been scared?

Possibly Jade herself didn’t understand the importance of following through. One of her statements in the Heat interview – that she thought once the abnormal cells were removed, "they should not come back" – suggests she might not have known or understood she was still at risk.

It’s worth noting that not all cancers are created equal. Cervical cancer can be divided into at least four subtypes – squamous cell and adenocarcinoma, which are the most common, and small cell and neuroendocrine, which are more rare. Furthermore, although the majority of cervical cancers grow slowly, some do not. The relatively high survival rate for this cancer (and some other cancers as well) tends to obscure the fact that for a smaller number of people, it’s still fatal.

Jade Goody’s specific type of cancer hasn’t been publicly disclosed, but given the extent to which it has spread, some observers are speculating that it is more aggressive than most. Although much is still unknown about why cancer cells behave the way they do, a growing body of research suggests that this is often influenced at the molecular level; in other words, it’s coded into the cancer itself. This doesn’t mean that screening and early detection are useless, because for millions of people, they clearly have a benefit. But there are limits to what screening and early detection can accomplish, and increasing the cervical cancer screening rate in Britain, as many advocates have urged, may not be the solution that some think it is.

In the end, we are left with the story of one young woman whose life is ending far too soon. Perhaps saddest of all, the thing that should haunt us the most, is that she may be going to her death believing it’s her fault. To be sure, she made a bad decision not to seek followup care – but there are plenty of other contributing factors to go around, some of which were simply out of her control. And to put the blame on her shoulders alone is a burden no one should have to bear.

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