HPV Vaccinations the Surest Way to Fight Cervical Cancer

Posted on October 11, 2008. Filed under: Cancer, HPV | Tags: , , |

With all of the controversy over mandating vaccinations for the human papilloma virus (HPV) for female immigrants to the U.S. and sixth-grade girls throughout Texas, we shouldn’t lose sight of one key fact: This vaccination saves lives. Period.

As a family physician, I advocate both testing and vaccination for HPV in all of my female patients. Offering vaccinations to 11- and 12-year-old girls is a reasonable and easy way to eradicate deadly cervical cancer.

Every woman should know her HPV status, regardless of her age. HPV is, indeed, sexually transmitted. The virus has many subtypes; some are harmless but others are the likely causes of cervical cancer. The virus can lie dormant for many years before causing infections or cancer. The HPV assay is a highly accurate test that examines the DNA “footprint” of the cells and detects subtypes that are most likely to cause cervical cancer. The test can be performed on a simple pap smear specimen and retails for around $200. Gardasil, the new vaccine developed by Merck, targets high-risk HPV subtypes that cause 70 percent of cervical cancer. The vaccine is administered in three doses, which cost anywhere from $120 to $200 per shot (or $360 to $600 total), and the vaccine may require boosters every six years or so. Other pharmaceutical companies are developing HPV vaccines, and over time, the vaccines will address other cancer-causing subtypes.

If the woman’s HPV test is negative, her chances of developing cervical cancer are nil, and the vaccine is clearly indicated. If her test comes back HPV positive, the doctor should conduct appropriate further screening. Evidence suggests that even when the test detects the high-risk HPV subtypes, the vaccine can still be effective in halting the progression of cancer if administered early enough.

Many doctors do not perform HPV tests unless the pap smear is abnormal. That is exactly wrong, as it is HPV that renders the abnormality in the first place; by the time an abnormal smear is detected, the patient could have developed cervical cancer. Other physicians are reticent to perform the test because of costs. Yet the Texas Legislature mandated coverage for HPV testing in 2005, leaving no excuse. Lawsuits alleging malpractice have been won by women who developed cervical cancer even after being seen by their physicians annually. The science is so exact that those doctors were held liable because they did not test for HPV.

Early detection of abnormal precancerous cells is always the best prevention. Better still would be to ward off abnormal cells in the first place. This can be done by vaccinating girls at 11 or 12 years of age, long before the need for HPV testing ever arises. Every young girl’s parents should be begging for this vaccination. This movement could lead to total eradication of this deadly disease.

Think about it: Requiring HPV vaccinations is really no different than requiring vaccination for hepatitis B among newborns. No newborn can leave the hospital without that vaccination. Yet no one is kicking up a fuss about vaccinating infants or arguing that because children have been immunized against hepatitis B, they will grow up to become intravenous drug users.

The easiest way to conduct HPV vaccinations would be to set up programs at schools. Baby boomers will recall being vaccinated for polio, smallpox, tetanus, and measles and being tested for tuberculosis in grade school, and an HPV vaccination program could follow that model.

As for the cost, compensation for such a program should come from all factions, beginning with discounts from Merck and other manufacturers that are developing their own HPV vaccines. The state should subsidize the program, just as it did for vaccinations during the 1950s and 1960s, and ensure that girls from families without insurance have access to the vaccine. Insurance companies should include the HPV vaccine in the list of inoculations they cover. Families of individuals receiving vaccines could also contribute. This is the best possible compromise, and the potential benefits are well worth it.

Protecting our girls against cervical cancer is possible. Let’s take the politics out of it, and save their lives.

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