#MyDukeCancerStory: Virginia Woman Speaks Out

Leigh Zagorski poses for a sunset selfie with husband John "Andy" Belsha. The couple resides in Norfolk, Virginia.Leigh Zagorski poses for a sunset selfie with husband John "Andy" Belsha. The couple resides in Norfolk, Virginia.

Leigh Zagorski, 32, was born and raised in Norfolk, Virginia. After graduating high school, she entered the restaurant industry, starting out at 18 years old as a server and working her way up the ranks to management. While the money was good, benefits were most often nonexistent or cost prohibitive—leaving Zagorski usually without coverage.

Zagorski relied on Planned Parenthood for her annual check-ups. After a routine exam in February 2018, she learned that her preliminary pap smear results indicated abnormal cells.

“I was somewhat surprised but not overly concerned,” share Zagorski, who had married her longtime love just months before in October 2017. “Because I hadn’t had an abnormal pap smear before and because I have had friends who’ve had abnormal paps, I assumed everything was going to be fine.”

Zagorski underwent a colposcopy, a procedure to examine the cervix, vagina and vulva for signs of disease. Her doctor also performed a cervical biopsy, which indicated abnormal cells on the surface of the cervix. Zagorski was referred to a local oncologist who diagnosed her with CIN3, a high-grade cervical dysplasia, a condition most often caused by the human papillomavirus (HPV).

The human papillomavirus is common in women and men. According to Centers for Disease Control and Prevention (CDC) 90 percent of sexually active men and 80 percent of sexually active women will be infected with at least one type of the more than 100 strains of HPV, just two types, 16 and 18, causing the majority of HPV-related cervical cancer.

Although there is no cure for HPV, typically the immune system clears up the HPV infection. However, in some cases the infection persists, leading to cervical dysplasia, which then lead to the development of cancer of the cervix. If left untreated, cervical dysplasia can progress to cancer of the cervix.

“Initially, I was more disturbed that I had HPV than even the idea of possibly having cervical cancer,” shared Zagorski. “But when I looked at the statistics, I discovered HPV is more common than people really understand.”
Zagorski’s oncologist scheduled her for a cone biopsy, an outpatient procedure in which a cone-shaped wedge of abnormal tissue, along a small amount of what is hoped to be normal tissue, are removed from high in the cervical canal. Tissue is viewed under a microscope to determine all abnormal cells have been removed.

“Unfortunately, results showed no clear margins,” said Zagorski. “It seemed like things were now getting quite serious. I wasn’t comfortable with the outcome; and I needed a second opinion. After some online research, I reached out to Duke Cancer Institute's Dr. Previs.”

Rebecca Previs, MD, a gynecologic cancer specialist, reviewed Zagorski’s pathology and found a small focus of squamous cell cancer, the most common type related to HPV. Zagorski was diagnosed with the earliest possible stage of cervix cancer, stage A1. Previs and Zagorski discussed treatment options.

“Treatment of early stage disease consists of surgery, and the type of surgery can depend on a number of factors, including the stage of cancer, the size of the tumor and whether a woman wants to leave open the possibility of having children,” shared Previs, who joined Duke in 2017. “Each patient is different and I try to tailor treatment options to the specific patient. Sometimes radical surgery is required and the entire cervix is removed. However, since Leigh and her husband wanted to leave open the possibility of having children, we opted for a more conservative approach.”

Zagorski decided to a repeat of the deep cone biopsy, but this time Previs would also perform a sentinel lymph node biopsy, a surgical procedure to determine whether her cancer has spread into the lymphatic system.

“After the procedure, we received the best news possible,” said Zagorski, her voice cracking and her eyes welling with tears. “There was a chance the tissue would not be free of cancer. I can’t tell you how relieved I was to hear that the repeat cone specimen had no dysplasia or cancer and that my lymph nodes were also negative.

According to Previs, although cured of cancer, Zagorski must be monitored very closely for recurrence.

“Vaccinating our young girls and boys before they are sexually active can prevent the most common types of HPV, which is responsible for most cervical cancers,” said Previs, who also indicated that HPV can also lead to throat, anal and penile cancers. “Pediatricians and parents should make sure that boys and girls are vaccinated as the vaccine prevents nine of the most common types of HPV. As with most cancers, the best treatment is prevention. Studies suggest that the vaccine is almost 100 percent effective.”

Previously, the HPV vaccine, which became available in 2006, was only indicated for children and young adults between the ages of nine and 26. Based on new evidence of the vaccine’s effectiveness, the FDA expanded in the fall of 2018 the availability of the vaccine to include adults up to age 45. Previs also recommends young, healthy women undergo a first pap smear at 21 years old.

“Because I didn’t have healthcare insurance, I was not vaccinated against HPV when I was in my 20s,” said Zagorski, reflecting on the then $1,500 out-of-pocket cost for the vaccine. “The first thing I did after my diagnosis was to sit down with my step-daughter to talk about HPV. And now, when the opportunity presents, I tell young women, ‘Go to your doctor. Get your pap smear. This is no joke. HPV is nothing to be embarrassed about.’”