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Cervical Cancer Vaccine

Posted by MDViews on October 6, 2005

Gardasil.

That’s the name of the new HPV vaccine seeking FDA approval. It is expected to be approved as early as June 8. It’s a vaccine made by Merck and gives immunity to the two most virulent Human Papilloma Virus strains, 16 and 18. By virulent, I means capable of transforming the cells on a woman’s cervix into pre-cancer–and ultimately cervical cancer–if not detected and treated. That’s what the “Pap” or cervical smear is for. Detecting these abnormal cells early so they can be destroyed in the benign pre-cancer stage before they cause a life-threatening problem.

Merck hopes that the vaccine will be administered to pre-pubescent boys and girls to provide them this immunity. Merck touts this vaccine as the first cervical cancer vaccine to hit the market.

Hold it. What? Boys too? I thought you said this was to prevent cervical cancer in women?

Well, I did. But it’s not as straight-forward as that. The vaccine does not target cervical cancer, and in fact, if I read the news report correctly, it is not intended to. Instead, it targets the HPV virus and provides immunity to it. By extrapolation, then, it should help prevent cervical cancer, since HPV is the agent that causes the most common type of cervical cancer.

So why vaccinate boys? Because HPV is a sexually transmitted disease which is harbored by 50% of sexually active teens and young adults. One cannot get HPV unless one has sex with an infected partner. And sex means boys and girls–so, vaccinate the vector as well as the victim.

This vaccine opens the same can of worms as the Hepatitis B vaccine. Hepatitis B is a liver infection that one can only get by exchanging bodily fluids with an infected person (the same as HIV), ie., blood products, IV drug users sharing needles, inadvertent needle sticks to doctors and nurses (health care workers) or sexual activity. So, does everyone need Hepatitis B vaccine? Sure–if you do IV drugs, plan on getting an infected blood transfusion (very rare), plan to be a doctor or nurse or if you have sex with multiple partners and one is infected.

Does that sound like you? Does that sound like the person you want your child to become? Hepatitis B vaccine can be given to adults if they enter health care and it works just fine. Our blood supply is safe–very safe. Testing continues to improve. So that leaves IV drug use and promiscuous sex as the reasons to vaccinate your child.

Along comes Gardasil. Your child receives the vaccine, maybe at age 10 or 11 and is protected from the consequences of promiscuous sex–at least one of them, the HPV virus that causes cervical cancer.

No woman wants cervical cancer. And no man would want to spread the virus to women, I presume.

So where does that leave the wait-until-marriage-and-have-one-partner-for-life argument? Weakened, that’s where.

Obviously, some parents will not want their children vaccinated against a sexually transmitted disease for moral reasons. But no parent would deny his children protection against cancer. Doctors do not want their patients to get cervical cancer. Doctors will not want the parents of a 10 year old girl or boy to say, “No thanks. We’ll pass.” So if the doctor says, “This is a vaccine against cancer,” –and stops there, parents of boys and girls will likely say ‘yes’. But, if the doctor says, “This is a vaccine against an STD. By stopping the STD, your child is protected from cancer,” –some parents will decline.

What to do, what to do.

I presented this at a hospital meeting last week in the context of being “culturally sensitive” to those who may object, and to lobby for honesty when presenting the purpose of the vaccine.

Oh, my. Did I get a response.

Anger. Indignation. Loud voices. It appears “cultural sensitivity” does not apply if the group likely to object is Christian conservatives. One doctor flat out said it should be presented as a cancer vaccine, not an STD vaccine. Otherwise, we would have to tell patients that cervix cancer is an STD. To which I replied, “You don’t? I do. We have always known that as gynecologists and have not hesitated to inform patients of that. I do it every day.” He was surprised, I think, but remained adamant that this should be presented as a cancer vaccine and that no one should be allowed to refuse the vaccine. Another doctor said that the cancer part needed to be emphasized and the STD part minimized. No one in the meeting backed me. I was alone in my view.

So, what do you think, dear reader? Will you vaccinate your little ones?

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