Dead to Me (2019): The Result She Didn't Follow Up

Jen Harding is newly widowed after a hit-and-run. She meets Judy Hale at a grief support group. Judy was the driver, and their friendship is built on that hidden fact and on the crimes that follow.

The third season opens moments after the two women are hit by a car. The hospital scans taken that night show shadows nobody was looking for. Judy is sent for a biopsy, and her doctor tells her it is cervical cancer that has already reached her liver. She goes through chemotherapy while she and Jen manage a federal investigation and Jen's pregnancy, and she tops up her treatment with an assortment of alternative protocols.

Spoilers below. This page says what the scans show Judy Hale in the second half of Dead to Me, and how the series leaves her.

A year before any of this, Judy had an abnormal Pap result and did not go back.

That is the piece of the story worth stopping on, because cervical screening is unusual. Most screening finds a cancer earlier. NCI describes the goal of cervical screening differently: to find precancerous cell changes at a point where treatment can prevent a cancer from developing at all. Sometimes a cancer is found instead, and NCI notes that cervical cancer found early is usually easier to treat. By the time symptoms appear, it may already have begun to spread.

So the test is not the intervention. The follow-up is. A result that nobody acts on cannot do the job it exists to do.

The show does not moralise about Judy's reason for not going back, and neither will we. Life was chaotic and she did not want to think about it. That is the ordinary reason. If there is a letter you have been ignoring, going to find it is the whole of the advice on this page.

The fear that keeps people from opening the envelope is usually the wrong fear.

NCI is direct about it. Most people who get an abnormal cervical screening result either have an HPV infection or early cell changes. Those changes can often be monitored, because they frequently go away on their own, or treated early to stop a cancer forming. The most common abnormal Pap finding, ASC-US, means only that some cells do not look completely normal, and NCI lists irritation, some infections, polyps and hormone changes as things that can cause it.

NCI's summary is worth keeping in mind: most people with abnormal screening results do not have cancer, but if your result was abnormal, it matters to get the follow-up your provider recommends.

One practical note from the same page. Results usually come back in about one to three weeks. If you have not heard, NCI says to call and ask.

Follow-up is not one fixed thing. NCI says the current guidelines are risk-based, so your provider weighs your result alongside earlier results, any past treatment, and your age. From there you may be advised to come back for a repeat HPV test or cotest in one or three years, to have a colposcopy and biopsy, or to have treatment for high-grade changes.

The middle option is the one people picture worst. NCI's description is undramatic. A speculum is used to see the cervix, as in a smear. A vinegar solution is applied, which makes abnormal areas show up. The doctor then looks through a colposcope, an instrument with a bright light and a magnifying lens, positioned near the vagina rather than inside it.

Cervical cancer screening covers who should be screened and how often. Cervical cancer also has symptoms of its own, but they are not a substitute for screening, for the reason above.

Two corrections travel with this show. The patient is Judy Hale, not Jen Harding — a doctor mixes the two up in the story, and some summaries have kept the mistake. And the disease in Judy's liver is the cervical cancer having spread there, not a second cancer of the liver.

The show gets this right where many do not. NCI's rule is that metastatic cancer keeps the name of the primary cancer, and for many cancers is also called stage 4. It is treated according to where it started. See metastatic cancer. Calling Judy's disease "liver cancer" would point at a different illness with different treatment.

Where the drama takes over is the clock. An abnormal result, a biopsy, a full course of treatment and the scan that ends hope are all compressed into one season that is also carrying a cover-up and a pregnancy. Judy stays mobile and camera-ready almost throughout, and the money, insurance and work problems that would dominate her life barely appear.

What the show does get is the texture: infusion chairs, wig conversations, a friend who is bad at being a caretaker, and the scene where Judy is told the treatment has not worked while Jen insists there are always options.

Cancer Explained runs without ads or sponsors. If this page sends one person back to a screening result they have been avoiding, that is worth more than any of the rest of it. Support our work.

Dead to Me is one of the more accurate cancer storylines on television, and it is built on the single most preventable thing in this whole subject. Screening only works if somebody acts on the result. If that describes a letter in your kitchen drawer, go and find it.

• NCI — Cervical Cancer Screening
• NCI — HPV and Pap Test Results: Next Steps after an Abnormal Cervical Cancer Screening Test
• NCI — Metastatic Cancer: When Cancer Spreads

This page discusses Dead to Me for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].