WASHINGTON — A man who battled childhood cancer received the first known , in a study aimed at restoring the fertility of cancer's youngest survivors.
Jaiwen Hsu was 11 when a leg injury turned out to be bone cancer. Doctors thought could save him but likely leave him infertile. His parents learned researchers at the University of Pittsburgh Medical Center were freezing testicular cells of in hopes of preserving their future fertility — and signed him up.
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Hsu, now 26, is the first to return as an adult and test if reimplanting those cells might work.
"The science behind it is so incredibly new that right now it's kind of a waiting game," said Hsu, of Vienna, Va. "It's kind of eagerly crossing our fingers and hoping for the best."
Jaiwen Hsu sits with his mother, Jeng Hsu, before a stem cell implant procedure Nov. 10, 2023, at the UPMC Magee-Womens Hospital in Pittsburgh.
It may seem unusual to discuss future fertility when a family is reeling from the diagnosis of a child's cancer. But 85% of children with cancer now survive to adulthood and about 1 in 3 are left infertile from chemotherapy or radiation.
Young adults with cancer can bank sperm, eggs or sometimes embryos ahead of treatment. However, children diagnosed before puberty don't have that option because they're not yet producing mature sperm or eggs.
Boys are born with stem cells inside spaghetti-like tubes in the testes, cells that start producing sperm after puberty sparks a rise in testosterone.
With , Pitt reproductive scientist Kyle Orwig studies how to preserve and potentially use testicular cells to restore fertility.
It starts with a biopsy-like removal of a small amount of testicular tissue that contains millions of cells — some of them precious sperm-producing stem cells. from about 1,000 prepubertal boys.
Jaiwen Hsu, second from right, celebrates his 12th birthday with siblings at the Children's National Hospital in Washington.
It's impossible to tell if enough stem cells are in each tiny sample to matter. In 2019, Orwig used preserved testicular tissue from a young male monkey that, in an animal version of IVF, led to the birth of a healthy baby monkey.
By 2023, Orwig was ready to reimplant now-grown cancer survivors' cells when Hsu — not ready to start a family yet but curious about his long-ago study participation — reached out.
"We're not expecting a miracle result," cautioned Orwig, whose colleagues transplanted Hsu's thawed cells in November 2023.
In a , Orwig reported the injection, guided by ultrasound to the right spot, was safe and easy to perform. His work has not yet been reviewed by other scientists.
Orwig said it's too soon to know if the experiment worked and standard tests likely won't tell, as animal testing found assisted reproduction techniques were needed to detect and retrieve small amounts of sperm. Still, he hopes the ongoing research will alert more families to consider fertility preservation so they'd have the option if it eventually pans out.
Jaiwen Hsu sits in August 2011 at the Children's National Hospital in Washington weeks before his last round of chemotherapy for bone cancer.
Belgian researchers announced a similar experiment in January, implanting pieces of testicular tissue rather than cells in a childhood cancer survivor.
"These developments are of great importance," said researcher Ellen Goossens of Vrije Universiteit Brussel. While animal research "was very promising, transplantations in humans will be the only way" to tell if this really works.
Similar research with immature ovarian tissue is underway for female childhood cancer survivors, too, noted Dr. Mahmoud Salama, who directs the Oncofertility Consortium at Michigan State University.
Hsu said even if his experimental transplant doesn't work, it will guide further research. He's grateful his parents years ago "made a call that gave me the option to make the choice for myself today."
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Could the FDA's recently approved Pap smear alternative reduce racial disparities in cervical cancer deaths?
Could the FDA's recently approved Pap smear alternative reduce racial disparities in cervical cancer deaths?
January marks Cervical Health Awareness Month. Around with cervical cancer each year, according to data from the Centers for Disease Control and Prevention, and in 2022, from the disease despite it being considered highly preventable.
White women are more likely to be diagnosed with cervical cancer than any other group, shows. However, a 2022 study published in the found greater rates of diagnosis were mostly due to higher levels of screening. Black women have the lowest screening rates, the study found, "strongly driven by insurance and site of care, underscoring the value of addressing systemic inequity."
For decades, a Pap smear has been the standard way to detect cervical cancer. The uncomfortable and, for some, painful procedure entails using a small brush or spatula to lightly scrape the cervix to gather cells. Cells are then examined under a microscope for precancers or other abnormalities. This procedure also tests for the human papillomavirus, which can cause cell changes on the cervix that lead to cancer if not treated early.
But soon, a self-swab approved in May 2024 by the Food and Drug Administration might help people avoid the invasive procedure—and save lives. Patients will be able to use an at-home kit to swab their vaginal walls and send it to a lab to be tested for HPV. It's part of the National Cancer Institute's , which will study the accuracy and effectiveness of self-testing at 25 clinical sites nationwide. Participant enrollment began this past summer.
"Self-collection can expand access to screening and reduce barriers, which will give more people the opportunity to detect, treat, and ultimately survive cancer," Karen E. Knudsen, CEO of the American Cancer Society, said in a press statement after the announcement.
partnered with Stacker to explore disparities in cervical cancer deaths and what a new testing mechanism could mean for prevention. Data is from the .
Editor's note: Pap smears are a cervical cancer screening tool and are recommended for people with cervixes, not all of whom identify as women. In this article, we have used gender-neutral terms when possible. We use gendered language in the characterization of data to stay true to how sources collected and presented the information.
An opportunity to improve screening rates
Early detection is the key to preventing cervical cancer deaths. Yet, data spanning June 2016 to May 2019 published in the in October 2023 suggests that only two-thirds of at-risk people are up-to-date on screenings. For Black people, that number drops to about half.
One factor that impacts screening rates includes whether people have insurance coverage. A found that 42% of uninsured women had received a cervical cancer screening in the past year, compared to 64% with private insurance and 56% of those with Medicaid. However, even when screening rates are equal, have contributed to lower survival rates among those who are diagnosed with cancer.
Within the health care system, racial bias and discrimination contribute to disparities in mortality rates. Differences in the quality of screening techniques and a lack of representation of people of color in the development of screening guidelines and clinical trials are just a few forms of systemic bias.
Research from the released in January 2020 showed that even when adjusting for age, sex, and stage of diagnosis, Black people are 33% more likely to die from cancer than white patients. For American Indians and Alaska Natives, the risk of dying from cancer is 51% higher.
Where a patient lives can also affect screening rates. In 2022, less than half of rural residents received a Pap smear in the prior year, compared to about 2 in 3 urban residents, according to another study published in the , which looked at data from 2019 to 2022.
The hope is that self-collection will improve screening rates among underserved populations in the U.S. Similar strategies have been adopted in Denmark, Sweden, and the Netherlands to much success. In Australia, more than since an initiative was launched in 2022. By March 2024, more than 1 in 4 screenings were done using collection kits in Australia.
Racial disparities require more than one solution
In 2022, there were about 21 cervical cancer deaths for every million women living in the United States, according to the CDC. Broken down by race, Native Hawaiians and Pacific Islanders have the highest rates of cervical cancer deaths in the U.S.
Again, lack of access to quality care plays a role. Because Native Hawaiian and Pacific Islanders get tested less frequently, they are more likely to receive a late-stage cancer diagnosis, according to This is particularly true among Native Hawaiians. While screening rates are generally similar across the state of Hawai'i, in 2022, just 79% of Native Hawaiian women between 25 and 65 years old were up-to-date on cervical cancer screenings, compared to 88% of white women.
The problem is most acute in the six U.S. territories in the Pacific Islands, which includes Guam, American Samoa, and the Federated States of Micronesia, according to data analysis on more than 400 cervical cancer cases published in 2024 in . Researchers found nearly 7 in 10 cervical cancer cases were diagnosed at a late stage from 2007 to 2020.
Black and Indigenous women also have elevated death rates from cervical cancer after an abnormal screening. While insurance coverage and socioeconomic factors are at play, medical distrust also plays a role. This is particularly true in the , which the medical community built on the backs of enslaved people in the Antebellum South.
J. Marion Sims is widely credited with developing many of the modern-day tools still used in gynecology today, including the speculum, a hinged tool inserted into the vagina and expanded to get a better view of the cervix. The first version was made of bent metal spoons, which Sims used while examining enslaved people in Montgomery, Alabama.
In recent years, many have reevaluated Sims' legacy in the field, largely due to the , whom he rarely gave anesthesia during painful procedures. His studies reinforced the false belief that , leading to pain being .
This history is a testament to the importance of , the ability to communicate and collaborate with people from different backgrounds and understand how their identity and culture play a role in their views and understanding of health care A case study of 40 Black and Hispanic women in Texas found when provided with culturally competent education and a self-sampling kit for HPV, screening rose from about 6 in 10 to 9 in 10 among both groups.
Improving preventative care across the country
In the Lower 48, cervical cancer deaths are higher in states with large uninsured populations and a high percentage of Black residents.
In Mississippi, which has the highest poverty rate in the nation, there are about 4 cervical cancer deaths per 100,000 women. The state health department's provides free Pap screenings at some clinics for uninsured people between the ages of 40 and 64. Kentucky, which has the third-highest cervical cancer rate in the country, for those 21 and older who do not have insurance and whose household income is less than 250% of the federal poverty level. Over 16% of the state's population lives below the poverty line.
However, while self-screening will undoubtedly increase early detection, it is just one factor in curbing cervical cancer deaths. Other preventative measures need improvement, including HPV vaccination rates, which have proven to be one of the .
Globally, cervical cancer rates are higher in low- and middle-income countries. In 2020, the World Health Organization launched the Cervical Cancer Elimination Initiative, which includes the goal of vaccinating 90% of girls worldwide for HPV by the age of 15.
Self-exams don't replace pelvic exams, and encouraging follow-up appointments after an abnormal test is also important. A study of more than published in Preventative Medicine found that between January 2015 and August 2019, only half who tested positive for cancer-causing HPV cells followed guidelines and received a biopsy within six months. Three in 10 had not followed up within 18 months.
While it's clear continuous care and monitoring are necessary to prevent cervical cancer deaths, a holistic approach valuing the importance of self-care in cancer prevention is also vital.
Story editing by Alizah Salario. Additional editing by Kelly Glass. Copy editing by Kristen Wegrzyn.
originally appeared on and was produced and distributed in partnership with Stacker Studio.
