Published Feb 22, 2024

Irregular Periods Dismissed By Doctor, Miami Woman, 34, Diagnosed With Cervical Cancer 14 Years Later

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Understanding Cervical Cancer & HPV

Avi Grant-Noonan, a 34-year-old loving wife and mom to a special needs child, was diagnosed with a rare type of stage three cervical cancer, 14 years after her symptoms of abnormal bleeding and irregular periods were dismissed by her gynecologist.
The Honduras-born Miami resident, who went years without knowing she had HPV, is sharing her cervical cancer story to urge other women to get yearly exams and not to ignore symptoms.
According to the National Cancer Institute (NCI), cervical cancer forms in the cells of the cervix, the lower, narrow end of the uterus (womb) which connected the uterus to the vagina.
Cervical cancer has also been linked to the human papillomavirus (HPV), an STI. And while it’s true that nearly all cases of cervical cancer are caused by HPV, people should also be aware that HPV puts both men and women at risk of developing several other cancers as well including cancers of the vagina, penis, anus and throat.

A 34-year-old loving wife and mom to a special needs child was diagnosed with a rare type of stage three cervical cancer, known as adenosquamous cell carcinoma, more than a decade after her symptoms of abnormal bleeding and irregular periods were dismissed by her gynecologist.

Avi Grant-Noonan, a Honduras-born Miami resident, was initially told at 20 years old that her symptoms were nothing to worry about, but she was ultimately diagnosed with cancer 14 years later, after changing her OBGYN. Now she’s sharing her story to urge other women to get yearly exams.

We love how her decision to share her story is raising awareness for cervical cancer, which has been linked to the human papillomavirus (HPV), an STI, something Grant-Noonan unknowingly had for years.

HPV & Cancer Risk: The Basics

Grant-Noonan, who is now in remission, opened to Business Insider in a recent interview looking back on how she first noticed missed periods and abnormal bleeding after giving birth to her daughter in 2007.

Despite her symptoms lasting for years, her gynecologist reassured her that she was healthy. Since Grant-Noonan felt as if she was thinking too much about her symptoms, she focused on raising her daughter.

The market planning analyst told Business Insider, “I put my own health on the back burner. But at the time, I didn’t want more kids, so it was fine.”

She also noted that she missed some routine pap smears and had lost about 80 pounds in just six months between 2017 and 2018, something she likened to running a lot.

It wasn’t until she had a miscarriage in 2019, that she decided to put her health first again.

“I was like, ‘I don’t feel right, there’s something going on.’ That’s pretty much when my journey started with cancer,” Grant-Noonan, who was diagnosed with cervical cancer in 2021, said.

Grant-Noonan is thankful she found a new gynecologist, who performed two pap smears (both which were negative) in 2020.

The following year, she her doctor did a colposcopy, to look at the cervix, vagina, and vulva through a special magnifying device—an exam which revealed her diagnosis.

Her treatment took a total of three months and concluded on November 5, 2021.

On January 2022, after a PET scan, she was declared to be in remission with no evidence of disease found.

Speaking to Cervivor.org last year, on how she’s doing after her cancer battle, she explained, “Fast forward to January 2022 – IN REMISSION. Words I thought I would never hear when I was first diagnosed with stage 3 cervical cancer. What a day! While everyone said I made cancer look easy, I can tell you it was not easy.

“28 rounds of external radiation, four chemos (scheduled for six but my body couldn’t take them all), and five internal radiation took my fertility away but it was all worth it for this exact moment. For the next couple of years, I will be getting a PET scan every three months and following up with my oncologist at the Miami Cancer Institute.”

She concluded, “I have completely changed my diet and lifestyle. We take one day at a time and plan vacations and weekend getaways – enjoying life to the fullest. Cancer changes the way you see life.

“What I want other women to know: Get your yearly exams – life doesn’t stop and we are all always taking care of others but we have to make ourselves a priority.”

Understanding Cervical Cancer

According to the National Cancer Institute (NCI), cervical cancer forms in the cells of the cervix, the lower, narrow end of the uterus (womb) which connected the uterus to the vagina.

“Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue,” the NCI explains.

“Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.”

It’s important to know there are two main types of the disease, squamous cell carcinoma (up to 90% of cervical cancers) and adenocarcinoma.

Squamous cell carcinoma forms in the cells of the ectocervix (outer part of the cervix) and adenocarcinoma develops in the glandular cells of the endocervix (inner part of the cervix).

Cervical cancer is often difficult to detect as it doesn’t normally have symptoms until the disease has spread.

The NCI explains that symptoms of early-stage cervical cancer may include:

vaginal bleeding after sex
vaginal bleeding after menopause
vaginal bleeding between periods or periods that are heavier or longer than normal
vaginal discharge that is watery and has a strong odor or that contains blood
pelvic pain or pain during sex

Symptoms of a advanced cervical cancer may include:

difficult or painful bowel movements or bleeding from the rectum during bowel movements
painful urination or blood in the urine

dull backache
swelling of the legs
abdominal pain
fatigue

“These symptoms may be caused by many conditions other than cervical cancer. The only way to know is to see a health professional. If it is cervical cancer, ignoring symptoms can delay treatment and make it less effective,” the NCI explains.

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The Importance of Pap Smears

Pap smears are one way to detect cervical cancer early. During the test, a doctor will collect a sample of cells from your cervix (using a small brush or spatula). The cells are then examined under a microscope for abnormalities, including cancer and changes that could indicate pre-cancer.

This is an important procedure because symptoms of cervical cancer might show up until the disease is at stage 3 or 4. By helping doctors catch signs of the disease early, Pap smears can lead to broader and more effective treatment options.

One of the leading causes of cervical cancer is the human papillomavirus (HPV), one of the most common viruses which can be transmitted through sexual contact. HPV is the biggest risk factor for cervical cancer, and there are usually no early signs or symptoms of the disease. However, cervical cancer can be detected through regular check-ups, such as pap smears.

According to the Centers for Disease Control and Prevention, it’s recommended that women start getting Pap tests at age 21. “If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test,” the CDC explains.

Meanwhile, anyone between 20 and 65 years old is urged to speak with their doctor on which testing option is best for them. The CDC explains, “An HPV test only. This is called primary HPV testing. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.

“An HPV test along with the Pap test. This is called co-testing. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test. A Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test.”

For women older than age 65, the CDC says your doctor may suggest you don’t need further screenings if: “You have had at least three Pap tests or two HPV tests in the past 10 years, and the test results were normal or negative, and you have not had a cervical precancer in the past, or you have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.”

What Is HPV?

Nearly every sexually-active person will get HPV at some point in their lives, but most people with the infection do not know they have it and never develop symptoms or health problems from it. The virus is spread via sexual activity and can manifest as warts on your genitals or mouth.

Get the Facts: HPV Can Cause Cancer in Men Too

When people talk about HPV and cancer risk, they tend to focus on cervical cancer. And while it’s true that nearly all cases of cervical cancer are caused by HPV, people should also be aware that HPV puts both men and women at risk of developing several other cancers as well including cancers of the vagina, penis, anus and throat.

Oral and throat cancers, for example, are both on the rise in young, non-smoking adults, and Dr. Allen S. Ho, an oncologist at Cedars-Sinai Medical Center, says HPV is the cause.

“The fastest-growing segment of the people developing oral cancers are young non-smokers, ” Dr. Ho told SurvivorNet in a previous interview. “HPV, a very common virus, one responsible for the vast majority of cervical cancers, is now identified as a cause of this rapid rise of oral cancers.”

Learning about the HPV Vaccines

Thankfully, we have three types of HPV vaccines – Gardasil 9, Gardasil and Cervarix. All three went through years of extensive safety testing before being approved by the U.S. Food and Drug Administration (FDA), and the CDC reports that HPV vaccination has the potential to prevent more than 90 percent of HPV-attributable cancers.

The HPV vaccines, like other immunizations that guard against viral infection, stimulate the body to produce antibodies that attack if they encounter the HPV infection by binding to the virus and preventing it from infecting cells.

The HPV vaccine prevents against certain cancers. It’s given to children which has created the misconception that it promotes sex at a young age.

HPV vaccines do not prevent other sexually transmitted diseases or treat existing HPV infections/HPV-caused disease, but their implementation can reduce the rates of certain cancers.

And while Dr. Susan Vadaparampil, the associate center director of community outreach, engagement and equity at Moffitt Cancer Center, previously told SurvivorNet there are few medical strategies that totally prevent against getting cancer in the first place, she emphasized that data from countries with high rates of vaccine coverages shows decreases in HPV-related pre-cancer and cancer, particularly so in the case of cervical cancer.

“We have a safe and effective vaccine to prevent HPV-related cancer,” Dr. Vadaparampil told SurvivorNet. “It is widely available, and costs are typically covered by private or public insurance.”

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Eileen Duffey-Lind, a pediatric nurse practitioner at Dana-Farber Cancer Institute/Boston Children’s Hospital, echoed Dr. Vadaparampil’s sentiment.

“No one should die of a preventable cancer like those tied to HPV, especially since we have a highly effective and safe vaccine available,” Duffey-Lind previously told SurvivorNet.

Who Should Get the HPV Vaccine?

According to the CDC, the HPV vaccine is recommended for all preteens (both girls and boys) 11 to 12 years old in two doses administered between six and 12 months apart. The series of shots can also be started as early as 9 years old.

That being said, the CDC also says that teens and young adults through age 26 who didn’t start or finish the HPV vaccine series also need the vaccine. And people with weakened immune systems or teens and young adults who start the series between the ages of 15 and 26 should get three doses instead of two.

Additionally, the HPV vaccine is sometimes administered in adults up to 45 years old, but it is not recommended for everyone older than 26. Still, a person older than 26 might decide to get vaccinated after talking to their doctor about possible benefits even though it is less effective in this age range since more people have already been exposed to HPV by this time.

The Importance of Getting a Second Opinion

After receiving a cancer diagnosis, it’s important to remember that you can and should talk to other cancer specialists about your disease.

“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care,” National Cancer Institute Chief of Surgery Steven Rosenberg told SurvivorNet in a previous interview. “Because finding a doctor up to the latest information is important.”

As we highlight in several areas of SurvivorNet, highly respected doctors sometimes disagree on the right course of treatment, and advances in genetics and immunotherapy are creating new options.

Also, in some instances, the specific course of treatment is not clear-cut. That’s even more why understanding your disease’s potential approaches is crucial.

At the National Cancer Institute, a patient referral service will “guide patients to the right group depending on their disease state so that they can gain access to these new experimental treatments,” Rosenberg says.

Cancer Research Legend Urges Patients to Get Multiple Opinions

Furthermore, getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.

Other reasons to get a second opinion include:

To see a doctor who has more experience treating your type of cancer
You have a rare type of cancer
There are several ways to treat your cancer
You feel like your doctor isn’t listening to you or isn’t giving you sound advice
You have trouble understanding your doctor
You don’t like the treatment your doctor recommends or are worried about its possible side effects.
Your insurance company wants you to get another medical opinion
Your cancer isn’t improving on your current treatment

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The bottom line is that being proactive about your health could be life or death. Learn as much as possible from as many experts as possible so you know you did your best to take control of your health.