I discussed the so-called "cervical cancer vaccine," a multivalent vaccine protective against several strains of the human papilloma virus previously here. In the new issue of the New England Journal of Medicine, there's a
perspective on the vaccine, and issues surrounding it:
Genital HPV infection is common, with an estimated 6.2 million new infections each year in the United States. Although most infections are asymptomatic and transient, persistent infection with oncogenic HPV types is a serious health issue. Cervical cancer is the 11th most common cancer among women in the United States -- with an estimated 10,370 new cases and 3710 deaths in 2005. There are racial and socioeconomic disparities; more than half of all cases occur in women who have never or rarely been screened. Among women in developing countries, where effective screening programs are often lacking, cervical cancer is the second most common cancer, and a leading cause of cancer-related death.
(Continued below)
In the studies conducted so far, efficacy has been very high. There are still many unanswered questions--such as how long immunity will last, what age vaccination should begin, and of course, the cost--currently estimated at $300-$500 for the three-dose series (ouch). The middle question will be addressed shortly:
If Merck's HPV vaccine is licensed, the ACIP will probably vote at a June meeting on whether to recommend routine vaccination at 11 to 12 years of age, in an effort to confer immunity before adolescents become sexually active. HPV infection is usually acquired soon after sexual activity begins, with a cumulative incidence of about 40 percent within 16 months. According to 2003 data from the Youth Risk Behavior Surveillance System, 7.4 percent of adolescents initiate sexual activity before 13 years of age, about one third of them by ninth grade, and about two thirds by the end of high school. If people are vaccinated before they have had sex, they should benefit irrespective of when they become sexually active.
Similarly, recommendations to vaccinate only girls or both sexes need to be ironed out.
Finally, many are worried about acceptance by parents. It has been argued that his vaccine would have the effect of making teens more likely to engage in sexual activity, or more careless about it (see quotes in this article, for instance). However, even groups that were reportedly opposed to it may relent:
At the February ACIP meeting, the conservative Family Research Council, which promotes abstinence before marriage and fidelity within marriage as the best way to prevent sexually transmitted diseases, distanced itself from suggestions that it opposed HPV vaccines. Calling such reports "false," the council said it "would oppose any measures to legally require vaccination or to coerce parents into authorizing it" and that "there is no justification for any vaccination mandate as a condition of public school attendance. However, we do support the widespread distribution and use of vaccines against HPV."
The article ends with a good dose of pragmatism:
The HPV vaccine is likely to be considerably more expensive than many recommended vaccines, and its benefits will not be fully apparent for decades. It will be far easier to recommend routine vaccination than to provide the resources for its routine use, in the United States and throughout the world.
It's one thing to recommend what seems to be a safe and effective vaccine--it's another to actually have the parent get their child an expensive injection that's unlikely to show benefits for many years, especially if it comes to a choice between groceries for a few weeks or the vaccination series. I hope this will be included in insurance plans--prevention is always more cost-effective than treatment, even if the results aren't realized for many years.
Image from http://www.inca.gov.br/cancer/imagens/hpv_fig1.jpg
Comments
Tara
I have been having fits and chickens about this issue for months now. I had to be screened for cervical cancer as did a close relative. I was clear, she on the other hand was not. Thankfully they removed the cancerous cells from her cervix, and other than having to do PAP smears every three months, she is "cleared" for now.
So why have I been upset? Because just as this was happening to both of us, I started reading about the cancer vaccines and the conscientious objectors who opposed it. ARE YOU KIDDING?? I started finding out that you possibly could catch HPV from toilet seats, and other seemingly innocuous acts. That this vaccine was being potentially held up by religious objections to sex before marriage seemed ludicrous, and extremely stupid. I don't care what your beliefs are, if there is a way to protect my kids from a disease then by all means lets go and do it. Not because I am all right with them having indiscriminate sex, but because even if they don't their partner COULD be. This is a women's issue, a mens issue, a moral issue, a medical issue, and obviously a religious issue. The first four are valid, the last is irrelevant.
This reminds me of the early days of AIDS- it was seen as a scourge only for those who deserved it because of lifestyle. Well, to all the FAT self satisfied religious folks out there- and they are there because I occasionally darken the doors of a church- how would you like your medical care predicated on your choice to eat Ding Dongs or fruit? If you eat fruit and excercise you get care. If you don't- see you later..... A relative is an ICU nurse and occasionally they have to care for patients who drink til their liver is gone. Then they see the same patient a few years later with liver failure again, due to drinking. Are they allowed to withold care or judge- Umm no. Obviously the Liver Team tries their best to pick patients most likely to make the right choices and not drink, but people are people and they don't always follow through.
The same with sex. People do do stupid things, or sleep with people who have made foolish choices in the past. You can never know where that penis or vagina have really been on your new love. Sometimes you take people at their word, only to find out that they are liars and their choice has given you one of a host of sexually transmitted diseases. Sometimes the decision to use a public toilet could be the wrong one. Sometimes stuff just happens.
But because we as a society are so judgemental when it comes to sexuality, and are so stupid to assume that sexually educating and vaccinating children might be more dangerous than ignoring what people actually DO- we have a whole bunch of idiots getting publicity who figure the world should run according to their vision only. Unbelievable.
Hep B is a vaccine my kids have had that protects them against a terrible bunch of complications. This can be sexually transmitted, or passed on by needles. Does that make it morally wrong to vaccinate them against it, because these are bad things. No, because it can also be transmitted in more ordinary ways. I have no qualms with this vaccine being given if in fact it helps my kid make it through life without having to worry about something, great- There is enough to worry about.
Sorry I am ranting, but it insults me that something good can be made into something bad because some right wing religious nut bar has a moral and religious objection to it.
And my next question is- Will the price of the vaccine come down as its use becomes more ubiquitous? I hope so, because it seems ridiculous that in the richest nation on earth one should have to choose between groceries and health. That is a whole other tantrum, but I will write about that on my own space.
Posted by: impatientpatient | March 18, 2006 4:28 PM
Do we know that the vaccine is not going to be effective after infection has occurred?
Posted by: JohnnieCanuck | March 18, 2006 4:58 PM
Unfortunately, this is the type of thiing that insurance is unllikely to pay for because, though it's cost effective overall, it may not be cost effective for a given insurance company. The potential savings will go to the company insuring the woman later in her life, which is quite likely not to be the company insuring her at age 12. This is a problem with preventive measures in general. Twisted, isn't it?
Posted by: janet | March 18, 2006 7:49 PM
Janet
And that right there is stupid economic theory. Though it is reality. It is why we feed cows to other cows, and end up with mad cow and its financial foul ups , it is why we pollute the earth and damn the consequences, it is why we stopped making or looking for nth generation antibiotics and it is why we don't seriously look for alternatives to our dependance on oil. Because somebody else can worry about it, as it costs too much to plan for the future.
Annoyed AND Impatient
Posted by: impatientpatient | March 18, 2006 9:28 PM
I.P.,
Well said on both counts.
Posted by: Lou FCD | March 19, 2006 7:52 AM
Frustrating on many levels, isn't it? Resistance by some parents to vaccinate their children and resistance by insurance companies to pay for it. I'm glad I have several years yet before my kiddos are of age to worry about it.
Posted by: Tara | March 19, 2006 3:44 PM
In Australia we've had some ministers expressing concern that vaccinating teenage girls against HPV will encourage them to become promiscuous.
The implicit assertion behind this is that at present there exists a sizeable number of teenage girls that are abstaining from sex because they are concerned about a small (but significant) increased risk of getting cervical cancer some 20-30 years in the future. The whole thing is implausible. I think this is the last thing on their minds.
How many teenage girls new about HPV before the "debate" about vaccination started to gain media attention. How many know about it now?
Posted by: Chris Noble | March 19, 2006 6:42 PM
The implicit assertion behind this is that at present there exists a sizeable number of teenage girls that are abstaining from sex because they are concerned about a small (but significant) increased risk of getting cervical cancer some 20-30 years in the future. The whole thing is implausible
Dear Chris
Exactly and much better said than I could have. What adults calculate risks and benefits before they engage in activities that could pose any danger? Stuff like driving poorly, eating badly, drinking and driving.....after just one of course. And yet we are assigning more intelligence and forethought to teenagers than we do ourselves. Whatever!
This is why religion and politics and science and business should not be tossed into the same pool and mixed. Otherwise it all turns to crap.
Posted by: impatientpatient | March 20, 2006 7:07 PM
While I don't think that kids can make the connection, the simple solution is: Don't tell them. Simply say that this is a vaccine for HPV, which will keep them from getting something worse in the future.
Posted by: KeithB | March 21, 2006 5:19 PM
Old post I know, but I am wondering- should males be vaccinated for HPV as well. I have both kinds of teens at my house, and I would be the first to line up the boy child if I knew it would help protect him or someone else.
Posted by: impatientpatient | August 4, 2006 2:34 PM
Tata,
I am doing a research paper on the Human Papillomavirus and wandering if you could tell me or lead me in finding out the history of this virus and what attempts have been made in the past t rectify the issue.
Thank you!
Carylon
Posted by: Carylon | November 18, 2007 9:29 PM