Healthy Skepticism Library item: 11122
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Wortman M, Daggett A.
More study of vaccine needed before it is mandated for HPV
Rochester Democrat and Chronicle 2007 Feb 20
http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/20070220/OPINION02/702200326/1039/OPINION
Full text:
Merck’s new HPV vaccine, Gardasil, protects against four types of the human papillomavirus – an important scientific achievement.
But before advocating a public policy for its widespread administration, we need to understand some cervical cancer and genital wart “basics.”
Invasive cervix cancer is a terrible and fortunately rare disease. Genital warts, while unseemly and embarrassing, are among the more “benign” STDs. Since the 1954 invention of the Pap smear by Dr. George Papanicolaou, invasive cervical cancer, once the leading cause of cancer deaths in women, is now a rare disease, according to the National Cancer Institute.
In 2006, 3,700 women died of this disease. The same year 79,560 women died of lung cancer, 56,660 of colon cancer, 40,410 of breast cancer and more than 16,000 women died of each of the following three cancers – rectal, ovarian and pancreatic. Uterine cancer claimed 7,310 women while cervical cancer was 14th on the list.
Invasive cervical cancer typically follows a succession of stages that starts with abnormalities detected on Pap smears. These pre-cancerous changes, called dysplasias, are caused by HPV types 16 and 18, as well as more than a dozen others. Gardasil protects against types 16 and 18 – which are responsible for an estimated 70 percent of cervical dysplasias. The other protection provided by Gardasil is against genital warts (types 6 and 11) which is a self-limiting and easily treated infection. The cause for excitement among the medical community is the protection this vaccine may provide against invasive cervical cancer.
It takes about 10 years for a cervical dysplasia to progress to invasive cervical cancer. The average age of women with invasive cervical cancer is 50 to 55.
The vast majority of American women with invasive cervical cancer are poor and didn’t get regular Pap smear screening. Additionally, most cases of cervical cancer are associated with lifestyle choices – early onset of sexual activity, multiple partners, partners with multiple partners, cigarette smoking and obesity.
This brings up four important points. First, cervical cancer is largely prevented by Pap smear screening.
Second, cervical cancer isn’t a communicable disease.
Until now vaccines have been required only for communicable diseases in our state. Third, we need to encourage and enable screening in precisely those women who tend to avoid this test – poor women who don’t have access to regular screening. Fourth, we need to encourage lifestyles that reduce the risk of cervical cancer.
Gardasil costs about $500 – the cost of the three vaccinations and the office visits for its administration. Its use does not obviate the need for regular Pap smears. That’s a lot of money for an unproven vaccine against a cancer for which we already have an excellent screening tool. Before state legislators begin mandating its administration, they need to be reminded that apart from the potential risks, the long-term efficacy in reducing invasive cervical cancer is yet unproven.
Within the past few weeks, Texas Gov. Rick Perry issued an executive order, bypassing the state legislature, requiring all sixth-grade school girls (ages 11 and 12) to receive the Gardasil vaccine beginning in September 2008.
In the ensuing competitive and hysterical political frenzy, some 20 state legislatures, including New York’s, are now looking at mandatory vaccination.
The bottom line is this – if we want to avoid cervical cancer we need to stress the importance of lifestyle changes – responsible sexual activity, smoking cessation and regular visits to a woman’s health care provider.
We especially need to improve Pap smear screening among poor women, who suffer disproportionately from invasive cervical cancer.
It would be an expensive rush to medical judgment for a state, county or city legislature to propose the universal administration of an incompletely understood vaccine at a considerable cost to taxpayers. We need only to look at the recent past to discover other “wonder drugs” that after widespread use and careful scrutiny turned out to have unintended consequences – hormone replacement therapy, Fen-phen and Vioxx are just a few examples.
Everyone wants to be remembered as the person who invented the wheel. But what about the person who invented the brake? Before we jump onto this legislative bandwagon, I suggest we slow down and let the scientists, not the politicians, do their work.
Wortman is director of the Center for Menstrual Disorders and Reproductive Choice in Rochester.
Daggett is a registered nurse and adult nurse practitioner at the center.
