A Word About the HPV Vaccine

Many of my patients are asking me about this vaccine, either for themselves or for their daughters. Since Gardasil was approved by the FDA in 2006, many organizations are recommending it for females aged 9 to 26 years old.  Due to pressure from the manufacturer, Merck & Co., many states even attempted to pass legislation to require it for all girls as they enter the sixth grade. It is a very controversial topic and I feel that the decision should be made on an individual basis. The vaccine only protects against 2 out of 13 of the strains known to be a high risk for causing cancer, but it does so effectively and may be worthwhile in certain populations. It does also protect against 2 of the strains that commonly cause genital warts, a contagious sexually transmitted infection. Though the vaccine is an impressive breakthrough in medicine and will certainly save lives, I question the necessity and safety of mandating it for all girls.

Women who get regular Paps, do not smoke, have strong immune systems, use condoms, have only a few sexual partners and have a healthy diet are generally at low risk for cervical cancer. As long as a woman is getting regular Paps and doing appropriate follow up and treatments, she can identify and manage any problems before cancer develops. Even for women who are diagnosed with cervical cancer, if it is detected in early stages, it is rarely fatal. Since the introduction of Pap smears in the 1950s, early detection and prompt treatments have caused cervical cancer rates to decrease by 75%. The rates of cervical cancer continue to decline, even though HPV infection rates are high. According to the CDC, approximately 20 million Americans are currently infected with HPV, yet the American Cancer Society estimates that only 11,070 women will be diagnosed with cervical cancer in 2008. These women likely wish the vaccine had been available for them, but not all of these cases would have been prevented.

One of my concerns is that vaccinated women could have a false sense of security and may not get their regular Paps. Because the vaccine only protects against strains 16 and 18 (which cause 70% of cervical cancer), these women are putting themselves at risk of late detection of advanced cancer (caused by the other high-risk strains). Another concern is that the vaccine contains aluminum as an additive, and some women have adverse reactions to the vaccine itself. Also, Gardasil is new enough that there are no long-term studies to show its safety and efficacy, especially for young adolescents. I admit that I am also skeptical of the financial motivations of the manufacturer, since this is one of the most expensive vaccines, and it is very heavily marketed to the public. If you are trying to decide whether the vaccine is appropriate for you, please discuss this with your doctor.

published 2 years ago

senthilkumaran

518 points