HPV Is Not as Big a Threat as Some People Think
Some General Background. On June 8th, 2006, the Food and Drug Administration (FDA), after an expedited approval process, licensed the pharmaceutical company Merck to sell Gardasil. Gardasil was an amazing breakthrough, a vaccine against four types of human papillomavirus (HPV) for use in girls and women between the ages of 9 and 26. It promised 90 percent effectiveness against two types of viruses that cause 70 percent of all cervical cancers as well as protection against two other viruses known to cause genital warts. Gardasil was, in effect, the first anti-cancer vaccine.
The excitement over Gardasil was almost palpable, yet parents had reservations. Despite Merck’s extensive ad campaign, convincing parents to do the “right thing” for their daughters proved harder than expected. Policymakers were baffled. Why were so many people hesitant to give their children this remarkable new vaccine?
In less than 12 months, more than two dozen states considered mandating HPV vaccination. As of September 2008, only Virginia and the District of Columbia require inoculation for school enrollment, but other states are still considering the policy. In addition, 22 states have instituted public health education programs or financial programs to encourage HPV vaccination.
Just last week, the FDA added the prevention of vulvar and vaginal cancers to the list of potential benefits for Gardasil. This conclusion was based on data from 15,000 women who participated in Merck’s earlier cervical cancer studies. Of the women who were vaccinated with Gardasil, none developed precancerous cells in the vagina or vulva, compared to 10 who received a placebo vaccine and did develop precancerous cells.
The Prevalence of HPV and the Threat It Poses. Cervical cancer is the world's second–deadliest cancer for women, but only because women in developing countries don't have easy access to regular Pap tests. Eighty–three percent of the world's new cases and 85 percent of cervical–cancer deaths occur in developing countries.
The Journal of the American Medical Association reports that among U.S. women aged 14 to 24, the combined rate of infection for all 37 types of sexually transmitted HPV is 33.8 percent -- much lower than the 50 percent cited on Merck's website. More importantly, the rate of infection for HPV 16 and 18 -- the two types of cancer-causing HPV against which Gardasil protects -- are astronomically lower: only 1.5 percent and 0.8 percent, respectively. So even if every U.S. woman between 14 and 24 were vaccinated with Gardasil before being exposed to HPV, the vaccine would only protect 2.3 percent of all U.S. women or around 1 percent of the U.S. population.
Most HPV infections, including the carcinogenic ones, resolve themselves without treatment. The American Cancer Society’s HPV guidelines for physicians explain that approximately 75 percent of all types of HPV infections in adults and 90 percent of those in adolescents disappear on their own. (In my early 40s, I had an HPV infection that turned precancerous, but over a two-year period the infection resolved itself without any treatment whatsoever.)
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I agree with much of your article but disagree that cervical cancer is higher in the third world because they don't have pap tests. This is an argument used by doctors and Governments to get women to test, a scare campaign. In fact, these women would always have higher rates than us, screening or no screening - they have unique risk factors (very early sexual initiation, lack of condoms, poor sanitation, more STD infection, poor nutrition and compromised immune systems, lack of sanitary protection - use of mud caps, old newspapers and other contaminated items during menstruation, multiple pregnancies etc) that increase the risk of cancer. You cannot compare the third world to a developed nation.
Also, be careful with pap tests, most women are unaware of the facts.
99.35% of women derive no benefit from smears, including the 0.35% who get false negatives - that means 0.65% benefit from smears. This is a rare cancer, always was and was in decline before screening started, it occurred at the same frequency as mouth cancer. It occurs only slightly more often than testicular cancer. One third to one half of women who get this cancer have had a recent normal pap test or s series of them. All women should watch for symptoms and focus on risk prevention rather than rely on the pap test - it's intrinsically unreliable.
The biggest risk - false positives and over-treatment. This test produces heaps - less is more with pap tests. Finland has the lowest rates of cc in the world and sends the fewest women for biopsies/fewer false positives - they offer 5 to 7 tests over your lifetime - 5 yearly from age 30.
Screening does not affect the tiny death rate in women under 25...
but causes huge rates of over-detection and over-treatment. Cancer is incredibly rare in young women.
Cervical damage can lead to infertility, miscarriages, high risk pregnancy, more c-sections, premature babies and psych issues.
Almost all referrals are for false positives - the cancer simply does not occur that often.
If you get an "abnormal" result, you have less than a 1% chance it's cancer or would be cancer without treatment.
Condoms offer at least 70% protection from HPV infection - perfect use, maybe higher.
As a low risk woman I have always declined pap testing - I made an informed decision over 20 years ago.
The facts are available, but not from your Dr or the Govt - go to Dr Joel Sherman's medical privacy forum and under women's privacy issues you'll find my references. I recommend research by Angela Raffle, UK expert and Richard DeMay, American pathologist.
The Raffles research released in the UK in 2003 shook the medical world and women, who've been kept in the dark - "1000 women need regular smears for 35 years to save ONE woman from cc"...hardly an epidemic
Beware with mammograms as well - see the paper by the Nordic Cochrane Institute, "The risks and benefits of mammograms".
The well-woman exam is not evidence based and is more likely to harm you - our doctors do not recommend them, ever, at any age, in asymptomatic women. These issues are also covered at Dr Sherman's site.
Gardasil - do your own research, there are lots of vested interests in cancer screening. I read recently that doctors omitted to mention that vaccinating a woman already infected with HPV increases by 44% her chance of getting pre-cancerous lesions. Most lesions are harmless, even 80% of high grade lesions regress spontaneously, but still something that should have been mentioned to girls and their parents and to young women.
The paternalistic attitudes that still exist in medicine need to be addressed and broken down, doctors and govts do not have the right to gamble with our health, to mislead us and accept risk on our behalf. It is our right to have the facts and make informed decisions and that may mean, no screening at all.
"So even if every U.S. woman between 14 and 24 were vaccinated with Gardasil before being exposed to HPV, the vaccine would only protect 2.3 percent of all U.S. women or around 1 percent of the U.S. population."
So the vaccine could perhaps help 3 million women avoid cervical cancer? Oh but it won't kill them, they'll just have to go through a horrible cancer treatment process ruining their lives in a number of other ways? What's your point here?
You are correct, the vaccine doesn't cover all types of HPV, and isn't as far-ranging as people assume due to misinformation. However, it also seems like you need some perspective on what 1% translates into -- a lot of unnecessary pain and misery.