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To Vaccinate or Not: Cervical Cancer
Posted by Raven on February 3rd, 2007
Parents of young girls are being asked (and told) to get their daughters vaccinated against a virus that has been associated with causing cervical cancer. Merck, the big pharma company, has recently won approval from the FDA to market their “anti-cancer” vaccine known as Gardasil.
The form of cervical cancer this vaccine claims to protect women from is caused by HPV-human papillomavirus – which has been around for a long time. Let’s look at some facts on this.
HPV is a sexually transmitted disease. It is a virus, which lives on and in the skin of infected persons. There are over 100 different forms of HPV- only 30 or 40 of these are passed around sexually. People who are infected often don’t know it because this is often a asymptomatic disease. Some people will get genital warts. The infection usually clears up within months with no side effects. Sometimes it comes back time after time though. Warts on hands and feet and around mouths are caused by HPV as well.
What about the risks for cervical cancer, the connection with HPV and other factors?
For cervical cancer, the most important risk factor is infection with HPV (human papilloma virus). HPVs are a group of more than 100 types of viruses that cause warts. Some types of HPV cause genital warts. Other types cause cancer of the cervix. These are called “high-risk” HPVs. HPV is passed from one person to another during sex. Having unprotected sex, especially at a young age, makes HPV infection more likely. Also, women who have many sexual partners (or who have sex with men who have had many partners) have a greater chance of getting HPV.
Reading further:
Even though HPV is an important risk factor for cervical cancer, most women with this infection do not get cervical cancer. Doctors believe other factors must come into play for this cancer to develop. Some of these factors are listed below.
Smoking: Women who smoke are about twice as likely as those who don�t to get cervical cancer. Tobacco smoke can produce chemicals that may damage the DNA in cells of the cervix and make cancer more likely to occur.
HIV infection (human immunodeficiency virus): HIV is the virus that causes AIDS (it is not the same as HPV). It can also be a risk factor for cancer of the cervix. Being HIV positive makes a woman’s immune system less able to fight both HPV and early cancers.
Chlamydia (cluh-mid-ee-uh) infection: This is a rather common kind of bacteria that can infect women�s sex organs. It is spread during sex. Many women do not know they have it unless samples taken at the time of their Pap test are looked at for the bacteria. Some studies suggest that women who have this infection (or have had it in the past) are at greater risk for cancer of the cervix. While further studies are needed to find out if this is true, there are good reasons to avoid this infection or to have it treated. Long-term infection can cause other serious problems.
Diet can play a part as well. Diets low in fruits and vegetables are linked to an increased risk of cervical and other cancers. Also, women who are overweight are at a higher risk.
Birth control pills: Long-term use of birth control pills increases the risk of this cancer. Some studies show a higher risk after 5 or more years of use. You should talk to your doctor about the pros and cons of birth control in your own case.Having many pregnancies: Woman who have had many full-term pregnancies have an increased risk of this cancer. No one really knows why this is, but it has been proven beyond doubt by large studies.
Low income: Poor women are at greater risk for cancer of the cervix. This may be because they cannot afford good health care, including Pap tests.
DES (diethylstilbestrol): This drug is a hormone that was used between 1940 and 1971 for some women who were in danger of miscarriages. The daughters of women who took this drug have a slightly higher risk of cancer of the vagina and cervix.
Family history: Recent studies suggest that women whose mother or sister has had cervical cancer are more likely to get the disease themselves. This could be because they are less able to fight off HPV than other women, or other factors could be involved.
So we know there are MANY risk factors associated with cervical cancer. HPV infection is one of them.
Consider this:
There are more than 70 types of human papillomavirus, and most are quite specific in the sites they can invade and the pathology they can cause. Those most strongly associated with cancer are HPV types 16, 18, 31, 45, and, to a lesser degree, half a dozen others. These are known as the “high-risk” types, not because they usually or frequently cause cancer–in fact, cervical cancer is a rare disease in the United States today, and penile cancer even more so–but because, in the infrequent event that cancer does develop, it can usually be traced back to one of these types. Even so, it bears repeating: most women with high-risk HPV on their cervix will not develop cervical cancer.
Now let’s look at some numbers:
The American Cancer Society predicts that there will be about 11,150 new cases of invasive cervical cancer in the United States in 2007. About 3,670 women will die from this disease that same year. Some researchers think that non-invasive cervical cancer is about 4 times as common as the invasive type. When found and treated early, cervical cancer often can be cured.
It’s tragic that even 3700 women will die of cervical cancer this year. What are some of the common reasons for this? Not getting a pap smear.
Cervical cancer deaths are higher in populations around the world where women do not have routine Pap tests. In fact, cervical cancer is the major cause of cancer deaths in women in many developing countries. These cases are usually diagnosed at an invasive late stage, rather than as precancers or early cancers.
Despite the benefits of Pap test screening, not all American women take advantage of it. Between 60% and 80% of American women with newly diagnosed invasive cervical cancer have not had a Pap test in the past 5 years, and many of these women have never had a Pap test. In particular, elderly, African-American, and/or low-income women are less likely to have regular Pap tests.
Now…about this vaccination- Gardasil. Is it really necessary? I don’t think so. It’s all about choices and I don’t want to get into the moral and religious arguments here. The series of shots costs over $350.00 and only a few insurances cover it; states will somehow have to pay the bill if they chose to mandate these vaccinations. The bottom line here is simple:
Roughly 15,000 women a year are DX with cervical cancer. Many will catch it in it’s early stages where it can be successfully treated. Life expectancy is high for those who take care of themselves. Remember not all these cancers are caused by HPV…and the women who are DX with this have other risk factors present.
Of the 15,000 women, 3700 will die.
The profile of these women is pretty much the same: She is in her 50’s, smokes, hasn’t had a pap smear in many years; and perhaps her Mother or a sister also has this form of cancer. Maybe she was sexually active in her youth with many different partners.
The AMC and other medical groups is recommending girls aged 9 to 13 get the series of shots to prevent this rare form of cancer.
We’re talking about millions and millions of girls here…not just a handful. And Merck is looking to make billions of dollars. One could argue that the number of girls who continue to become sexually active will increase the rate of this disease. Not true…never in history have we seen such high numbers of ALL youth being sexually active. Both boys and girls are experimenting with sex at younger ages, with more partners and with more risky behavior. All said, we’re pretty fortunate to see only 15,000 or so cases of HPV associated cervical cancer…if it could be worse, it already would be so.
Is the vaccination safe? I generally don’t get into this stuff here because it’s out of my professional venue. However, I read this a little while ago and it caused me great concern, as it should parents of girls:
The National Vaccine Information Center yesterday warned state officials to investigate the safety of a breakthrough cancer vaccine as Texas became the first state to make the vaccine mandatory for school-age girls.
Negative side effects of Gardasil, a new Merck vaccine to prevent the sexually transmitted virus that causes cervical cancer, are being reported in the District of Columbia and 20 states, including Virginia. The reactions range from loss of consciousness to seizures.
“Young girls are experiencing severe headaches, dizziness, temporary loss of vision and some girls have lost consciousness during what appear to be seizures,” said Vicky Debold, health policy analyst for the National Vaccine Information Center, a nonprofit watchdog organization that was created in the early 1980s to prevent vaccine injuries.
All vaccines have side effects. Sore arms, fever, aches and pains are common depending upon the agents used. The effects being seen here may or may NOT have anything to do with Gardasil, but it concerns me nonetheless. These are neurological side effects and this is not at all normal. I would be very weary of messing around with this stuff until more information is forthcoming.
Personally I would not have my daughters subjected to the series, at this time. It’s not worth the 1:millions chance they might get cervical cancer caused by HPV.
February 3rd, 2007 at 8:20 pm
The Facts About GARDASIL
1) GARDASIL is a vaccine for 4 strains of the human papillomavirus (HPV), two strains that are strongly associated (and probably cause) genital warts and two strains that are typically associated (and may cause) cervical cancer. About 90% of people with genital warts show exposure to one of the two HPV strains strongly suspected to cause genital warts. About 70% of women with cervical cancer show exposure to one of the other two HPV strains that the vaccine is designed to confer resistance to.
2) HPV is a sexually communicable (not an infectious) virus. When you consider all strains of HPV, over 70% of sexually active males and females have been exposed. A condom helps a lot (70% less likely to get it), but has not been shown to stop transmission in all cases (only one study of 82 college girls who self-reported about condom use has been done). For the vast majority of women, exposure to HPV strains (even the four “bad ones” protected for in GARDASIL) results in no known health complications of any kind.
3) Cervical cancer is not a deadly nor prevalent cancer in the US or any other first world nation. Cervical cancer rates have declined sharply over the last 30 years and are still declining. Cervical cancer accounts for less than 1% of of all female cancer cases and deaths in the US. Cervical cancer is typically very treatable and the prognosis for a healthy outcome is good. The typical exceptions to this case are old women, women who are already unhealthy and women who don’t get pap smears until after the cancer has existed for many years.
4) Merck’s clinical studies for GARDASIL were problematic in several ways. Only 20,541 women were used (half got the “placebo”) and their health was followed up for only four years at maximum and typically 1-3 years only. More critically, only 1,121 of these subjects were less than 16. The younger subjects were only followed up for a maximum of 18 months. Furthermore, less than 10% of these subjects received true placebo injections. The others were given injections containing an aluminum salt adjuvant (vaccine enhancer) that is also a component of GARDASIL. This is scientifically preposterous, especially when you consider that similar alum adjuvants are suspected to be responsible for Gulf War disease and other possible vaccination related complications.
5) Both the “placebo” groups and the vaccination groups reported a myriad of short term and medium term health problems over the course of their evaluations. The majority of both groups reported minor health complications near the injection site or near the time of the injection. Among the vaccination group, reports of such complications were slightly higher. The small sample that was given a real placebo reported far fewer complications — as in less than half. Furthermore, most if not all longer term complications were written off as not being potentially vaccine caused for all subjects.
6) Because the pool of test subjects was so small and the rates of cervical cancer are so low, NOT A SINGLE CONTROL SUBJECT ACTUALLY CONTRACTED CERVICAL CANCER IN ANY WAY, SHAPE OR FORM — MUCH LESS DIED OF IT. Instead, this vaccine’s supposed efficacy is based on the fact that the vaccinated group ended up with far fewer cases (5 vs. about 200) of genital warts and “precancerous lesions” (dysplasias) than the alum injected “control” subjects.
7) Because the tests included just four years of follow up at most, the long term effects and efficacy of this vaccine are completely unknown for anyone. All but the shortest term effects are completely unknown for little girls. Considering the tiny size of youngster study, the data about the shortest terms side effects for girls are also dubious.
8) GARDASIL is the most expensive vaccine ever marketed. It requires three vaccinations at $120 a pop for a total price tag of $360. It is expected to be Merck’s biggest cash cow of this and the next decade.
These are simply the facts of the situation as presented by Merck and the FDA.
February 3rd, 2007 at 8:52 pm
Thank you Stickdog. Awesome information my readers will appreciate.
February 4th, 2007 at 8:59 am
National Vaccine Information Center? Im sure ive heard of those in an unflatting light somewhere… I will check it.
February 4th, 2007 at 9:08 am
Ah, found it – I was confusing the National Vaccine Information Center with a similar Australian organisation which has a history of poor science, misleading or just false information distributed leaflets and scare-tactics. The NVIC seems to dabble in such things itsself, but not to anywhere near the same level.
They still look suspicious though… some of the science mentioned on their site, particually with regards to vaccine-induced autism, is outdated. That particular scare was dismissed a couple of years ago after further studies – particually a very large one in Japan – concluded that there was no causal connection.
February 4th, 2007 at 9:39 am
Sorta Blogless Sunday Pinup
And a Happy Sunday to all. Not a clue who did this pinup, have hunted around, cannot find where I originally found it or anyone else that has it. Oh, well.
Funny how the UN's report on global warming which supposedly blames Man comes out duri…
February 5th, 2007 at 4:06 pm
SR- the group referred to here isn’t foreign. It’s a US group that is not run by the government, but provides the CDC with reports of reactions.
Since we don’t often have new vaccines here, I find this group’s work to be reliable and unbiased. On the RX pamphlets this is group people are asked to call if they note any side effects.
It’s pretty disturbing what’s being reported.
Merck is out to make a big buck here, based on such a small number of potential cancers that are often NOT even caused by the “bug” this vaccine claims to vaccinate against. It’s wrong.
February 5th, 2007 at 4:38 pm
Thank you for addressing this issue. I have been writing about this vaccine (wrongly called a “cervical cancer” vaccine) for some time. I’ll be doing a round-up of blogs posting about this controversy next weekend.
February 5th, 2007 at 4:54 pm
Note that nowhere are we discussing actual incidences of cervical cancer because there is no clinical evidence whatsoever that GARDASIL reduces cervical cancer rates, and even if we place our hope in the the fact that it might, cervical cancer is simply not a meaningful health risk for any girl in the target vaccination population who is getting an annual pap smear.
While it is a widely accepted medical theory that HPV “causes” cervical cancer, it’s not close to being a fact. Although the vast majority do, many cases of cervical cancer don’t show any association with HPV. It’s a very good guess that certain strains of HPV are necessary co-factors for certain highly prevalent types of cervical cancer to emerge. The two really bad strains protected for in GARDASIL go hand in hand with 70% of CURRENT cervical cancer cases. My point is that there are 36 nasty strains of HPV screened for currently, and the human body is an ecology. We have no idea how protection against the two strains of HPV that are CURRENTLY most prevalently associated with cervical cancer (typically decades after initial exposure) will affect overall cervical cancer rates far in the future.
What we instead DO know is that current practices of annual pap smears and screening for ALL bad strains of HPV continue to reduce rates of cervical cancer among the US population annually. If all US women received a pap smear every year and were then promptly treated for any abnormal growths encountered, both the cervical cancer contraction and mortality rates would plummet even further to the point where HPV-associated cervical cancer would kill no more than a handful of US women a year. Yes, that is a guess as well, but it’s a far better guess than assuming that conferring protection against four of the myriad of current and future strains of harmful HPV will somehow do the trick.
Certainly GARDASIL’s benefit data against the four strains of HPV it targets are compelling. HOWEVER, the benefit data against ALL forms of HPV are not published by Merck and estimated by OP-GYNs to be a mixed bag. The benefit data against cervical cancer itself are nonexistent. The long term risk data for any population are nonexistent. There are almost no risk data at all for pre-teens. The fact that the “placebo control” was a shot of alum that was recently shown to cause neural death in mice is particularly problematic in terms of interpreting the small amount of risk data that were gathered.
Studies of the long-term benefits of a new drug or vaccine take a long time. It would take several decades to prove conclusively that this vaccine prevents cervical cancer deaths. So why the rush to make these three injections COMPULSORY for preteens?
Perhaps this would be excusable if GARDASIL conferred protection against HPV generally, but it does not. We have absolutely no way of even guessing how conferring protection against four strains of HPV will affect cervical cancer rates decades down the line. If you do, please quantify the expected benefits in terms of the expected reduction of cervical cancer contraction and mortality rates for the population of US women who get annual pap smears. The only thing you can say about these number are that they are unknown and tiny.
I am not trying to stop anyone from signing up themselves or their kids for this. If you want to pay $360 to make your little girl one of Merck’s test subjects, please do. As I said, the vaccine shows promise. It may be a life saver for a small segment of the population (especially those too poor or uninformed to get annual pap smears), and it offers protection against most genital warts and a good percentage of HPV dysplasias. The procedures to remove these warts and dysplasias are very painful, so these benefits are compelling. However, the risk and cost vs. benefit profile of this vaccine is not such that it is good public policy to mandate it — especially not for a pre-teen population on which it has never been sufficiently tested — even with an “opt out” clause. If Merck wants to make sure that women and parents who want it and can’t afford it can get it, they should offer it to low income individuals and families on a sliding scale rather than lobbying state and federal governments to pony up the billions.
February 6th, 2007 at 8:41 am
It’s simply irresponsible to claim this vaccine is to vaccinate against cancer — and that’s how it’s being sold. Completely dishonest.
February 6th, 2007 at 8:36 pm
You’re right Ogre.
They should have marketed it for what it is…a vaccine against Herpes and HPV.
February 23rd, 2007 at 10:39 am
Raven, I’ve been trying to find out if cervical cancer is something that was unknown say, 60 or 70 years ago. And if so, why? Has there been a huge proliferation of cases worldwide?
I’m forwarding your page to friends who are determined their daughters will get this vaccine.
March 12th, 2009 at 7:57 pm
[...] Raven discusses a serious subject: vaccination and cervical cancer [...]