Noelle Swan

HPV Vaccine Holds Promise

Several years ago, I found myself sitting alone in the Planned Parenthood waiting room, anxiously awaiting a follow up appointment to a routine gynecological exam. I had never been summoned for a follow-up before and was unsure of why the nurse had called me to return to the clinic. She had been reluctant to speak over the phone and simply asked that I return the following morning.

By the time I was brought back to the small and stark exam room, I was more than a little bit nervous. A doctor entered with some paperwork and informed me that my pap smear had indicated atypical cells with undetermined significance (ASCUS). She explained that while this did not necessarily indicate any problems, there was a possibility that it was an indicator of cervical cancer caused by the human papillomavirus (HPV). As I heard the news, I could feel a desperate sense of dread. The doctors and nurses provided me with information and answered my questions, but all I could focus on was my swimming thoughts. “I have cancer“…“HPV, that’s only one letter off from HIV“…“how am I going to tell my boyfriend.”

After the initial shock set in, I was finally able to listen to the answers of my many questions. One nurse assured me that at least 10 percent of people have HPV; she had even seen a nun with it. While most people with cervical cancer have HPV, most people with HPV do not have cervical cancer. After several visits to the doctor, the abnormal cells were removed and I was told that they were benign. The relief that I felt at that moment was well worth the painful procedure, the risk of HPV seemed dimmed and retreated to recesses of my mind.

Awareness of sexually transmitted diseases has grown tremendously over the past several decades. Sexual education courses have become a routine segment of both public and private school curricula. Movies such as Philadelphia and Forest Gump have personified the risks of AIDS and helped to increase public awareness of this one particular sexually transmitted disease. The images portrayed in each of these movies of once vibrant individuals reduced to frail shells of themselves shrouded the very word with a sense of dread. Yet the fear fueled by awareness and dread is tempered by a sense of control, as individuals can make choices to reduce their exposure to the risk of AIDS.

Cancer has likewise become more prevalent in the pubic eye as it has been personified by countless celebrities and politicians that have brought their personal struggles to the public forum. Cancer rates are high enough that nearly every individual knows someone that has been diagnosed with cancer of one form or another. The very word cancer when used as a general term conjures a sense of dread surrounding an indiscriminant killer. When the topic is broken down into specific types of cancer, certain levels of control become apparent and help to mitigate our fears. With the release of Gardasil, a vaccine for the human papillomavirus, it seems now that there may be another level of control over our exposure to cancer.

Merck’s website, http://www.gardasil.com touts that “Gardasil is the only vaccine that may help guard against diseases that are caused by human papillomavirus (HPV) Types 6, 11, 16 and 18.” Merck cites that these particular types cause 70% of cervical cancer cases and 90% of genital warts cases. In an aggressive advertising and public information campaign, Merck has brought the topic of HPV to dinner tables across the United States. Although there are over 100 types of this virus and it has been widely known to doctors for many years, until this past year, it remained largely unknown to the public. Women most often learned of HPV in a similar situation to mine. While in the midst of a personal health scare, it can be difficult to process the information. By sparking public discourse and education, Merck’s campaign has helped to inform millions of women of the questions to ask their doctor in understanding their own risk for cervical cancer.

HPV awareness is a side effect of a much more profound potential for the health of future generations of women. Those of us over the age of 26 likely to have already been exposed to at least one strain of HPV. Young girls that are not yet sexually active are the prime beneficiaries of this new medical breakthrough. To many policy makers, the potential is so great that several states are considering mandating vaccination for pre-teen girls. Vaccination requirements have been in place for years. Prior to entry in school, families must provide proof that their children have been vaccinated for a variety of diseases such as chicken pox, measles, mumps and polio. Since their introductions, these vaccines have drastically lowered the incidents of these diseases.

The issue of mandated HPV vaccination has stirred up several opponents. Dr. James Colgrove of the Center for the History and Ethics of Public Health at Columbia University discusses several constituencies that are opposed to mandated vaccinations in his December 7, 2006 article “The Ethics and Politics of Compulsory HPV Vaccination” published in The New England Journal of Medicine. Religious conservatives have spoken out against the vaccine as it conflicts with their abstinence-only message. Others are wary of the unknown dangers of long-term side effects. Colgrove attributes these concerns to “unproven theories alleging connections between vaccines and illnesses including autism, diabetes, and multiple sclerosis.” Colgrove further challenges this position with the adamant statement that “Minors have a right to be protected against vaccine-preventable illness, and society has an interest in safeguarding the welfare of children who may be harmed by the choices of their parents or guardians.” Without such exemption, there is greater potential for vaccination of the herd and possible eradication of these particular strains of HPV.

The protections that the vaccine now affords young girls will also translate into a societal economic gain. The 6 month round of three shots required per vaccination costs $360. Colgrove estimates that 10,000 new cervical cancer cases are diagnosed each year in the United States. The costs of caring for a patient with cervical can reach $30,000 (cost pegged to 2004 US$) according to Anthony T. Newall’s article, “Cost-effectiveness analyses of human papillomavirus vaccination” published in the April 2007 issue of The Lancet: Infections Diseases. Newall cites predictions that vaccination will reduce likelihood of cervical cancer between 40% and 60% resulting in dramatic annual health care savings.

For me the financial benefits are but icing on the cake. I cannot help but remember the fear that I felt when I learned that I could have cancer at 19 years old and the shame that it could be the result of a sexually transmitted disease. The idea that a few rounds of inoculations could so drastically reduce this risk for future generations of girls and women is miraculous.

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