WORTH A SHOT?
The truth about young women and the HPV vaccine.
The Gardasil vaccine has garnered much attention for its claims to prevent certain types of the human papilloma virus (HPV) infection, a virus strongly linked to cervical cancer. By preventing HPV, the vaccine strives to provide the basis for cervical cancer prevention. But as with all treatments, several questions do arise like, “Does every woman need this vaccine?” and “Who would benefit most from this treatment?” An explanation of the risks and benefits can help target those who should look into this method.
In the United States, nearly 12,000 women are diagnosed with cervical cancer each year, with over 3,800 deaths [1]. As mentioned, HPV is strongly linked to the origins of cervical cancer. But it's not as simple as saying that if a woman has the virus that she will get cancer. There are several subtypes of the virus, up to 100, some of which are more strongly considered cancer-causing [2]. In fact, some research suggests that up to 6 million women are infected with some type of HPV each year [3]. Fortunately, among those several million, only about 0.2 percent develop cervical cancer, with only a quarter of that group succumbing to the disease. This of course is still too many, but it does mean that there are factors beyond HPV that effect how well the body maintains the health of the cervix.
The advent of this vaccine has led to a mass marketing concept appealing to concerned parents who may have had no previous knowledge of HPV. Education is very important here. Aside from the potential problems from the viral infection, perhaps the two greatest risk factors for cervical cancer are smoking and unprotected intercourse with multiple partners. The vaccine is approved for females ages 9-26, which can put the decision in the parents' hands. Unfortunately, some parents are fearful they are letting the system down if they don't choose the vaccine. In truth, the vaccine will benefit some patients more than others. Girls who continue to smoke will put themselves at higher risk for cervical changes. Also, patients who practice unprotected intercourse with many partners can also be at higher risk as the probability of contracting multiple types of HPV rises.
The pros and cons of this vaccine need to be weighed. For example, the shot is recommended for children as young as age 9. The goal of course is to protect young girls before they would actually become sexually active. However, it is really unknown at this point how long the vaccine lasts in the body. A child vaccinated too early may need to be revaccinated at 15. This means the protection may wane before the timeframe when the child is actually at risk. The HPV vaccine is not without side effects. From the time it was introduced in 2006 to the end of June 2008, 9,749 adverse events were reported [6]. These accounts included 21 reports of death and 44 reports of Guillain-Barre syndrome (a form of paralysis). Most likely the vaccine is not fully responsible, though it does mean that caution and better judgment need to be used before a blanket statement to vaccinate every 9-year-old girl is issued. Even with the vaccine, patients will remain unprotected against the other 90-plus types of HPV they're exposed to without the use of condoms.
All women of childbearing age need to be aware of the importance of folic acid to prevent a certain type of birth defect in developing babies. Folic acid is most helpful if it is taken before the actual pregnancy takes place. Fortunately, folic acid also seems to show significant benefit in protecting the body against cervical cancer [4,5]. Folic acid is very easy to supplement, well tolerated, and can be taken at 400-800 micrograms daily.
Another way of preventing the onset of cervical cancer is the Pap smear. This test takes cells from the cervix for microscopic evaluation. Since the Pap smear's inception, cervical cancer has gone from the number 1 killer of women to number 15. Testing should begin 3 years after first intercourse or at age 21, whichever occurs first. Now, technology has allowed the testing of specimen for high-risk types of HPV to help focus on those at the highest risk of cancer.
When deciding whether to pursue the vaccine, patients and parents need to have an open discussion about risks, benefits and lifestyle choices that may effect cervical cancer risk. The vaccine is not without risks itself and does not protect against all types of HPV. Education, not fear, should lead this decision along with open, receptive communication between the parents, doctor and patient.
References:
1. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2004 Incidence and Mortality. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2007. From the CDC Web site: http://www.cdc.gov/cancer/cervical/
2. Erb, T. (2008). Update on infectious diseases in adolescent gynecology. J Pediatr Adolesc Gynecol. 21(3): 135-43.
3. Cates, W. (1999). Estimates on the incidence and prevalence of sexually transmitted diseases in the United States. American Social Health Association panel. Sex Transm Dis 26. (4 suppl):S2.
4. Piyathilake, CJ. (2008). Mandatory fortification with folic acid in the United States is associated with increased expression of DNA methyltransferase-1 in the cervix. Nutrition, 24(1):94-9.
5. Hernandez, BY. (2003). Diet and premalignant lesions of the cervix: evidence of a protective role for folate, riboflavin, thiamin, and vitamin B12. Cancer Causes Control, 14(9):859-70.
6. http://www.cdc.gov/vaccinesafety/vaers/gardasil.htm
Other Trusted Sources:
Centers for Disease Control and Prevention
National Cancer Institute
