Risks of HPV Vaccine for your Pre-Teen and Risks of Cervical Cancer:
by Barbara Lock, MD and Robert Latkany, MDJuly 05, 2009
HPV Vaccine Associated Deaths
A fourteen year old girl died on Monday shortly after being given the HPV vaccine through a school program in the UK, according to AOL/wire services. Three other girls suffered less serious side effects.
As of June 1, 2009, there have been 43 deaths in young women and girls associated with the HPV vaccine in the US, of which 26 have been confirmed as having occurred, although in no causal association was found.
While deaths among elderly persons that appear to be associated with vaccines are very likely to just be coincidence, because elderly people are more likley to die in general, the idea that the sudden death of a previously healthy young woman or girl shortly after getting an HPV vaccine is coincidence defies logic.
Rationale for HPV Vaccine
The Centers for Disease Control recommends that 11 and 12 year old girls be vaccinated with the Human Papilloma Virus (HPV) vaccine with three intramuscular injections over a period of 6 months. The vaccination helps prevent chronic HPV infection, and should therefore reduce the likelihood that immunized girls will develop cervical, vaginal, and vulvar cancer caused by the HPV subtypes 6, 11, 16, 18 (70% of cervical cancers) in those not already infected with these virus subtypes. Girls must be vaccinated before they have been exposed to HPV through sexual contact for the vaccine to work, so it is important to vaccinate girls when they are in early adolescence.
Smoking, Sexual Intercourse before Full Development, Poor Access to Health Care Raise Risk of Cervical Cencer
Among sexually active college aged women who rarely use condoms, nearly 90% are infected with HPV.
But the vast majority of women and girls who get infected with HPV will not develop cervical cancer. In fact, more than nine out of ten adolscent girls who get infected with the HPV virus will clear the infection on their own within 9 to 12 months. Those who do go on to develop pre-cancerous lesions are more likely to be smokers and to have had first sexual intercourse at a young age than those who do not, according to studies by Girianelli et al and Deacon et al.
Girls who are sexually active before they have fully developed appear to be more at risk for HPV infection than older women because the epithelium, or top layer of cells, that covers the cervix has not yet transformed to its mature state.
Cervical cancer is also detected through Papanicolaou testing, otherwise known as pap smears. Cervical cancer is the leading cause of cancer mortality among women in the developing world. Of the almost four thousand women who die in the US each year from cervical cancer, about half had poor access to health care.
If You're Going to Have Your Daughter Vaccinated, Do it Early
Because girls in early adolescence are more likely to contract HPV if exposed than fully mature women, and because the vaccine must be given before exposure to work, the vaccine is recommended for pre-teens. Many parents, even health care professionals, do not know that HPV can cause cervical cancer, or don't understand the need for vaccination in pre-teen girls. Over 7 thousand mothers who are nurses were asked when they should bring their daughters in for vaccination by Kahn et al. 48% said between 9 and 12 years of age, 68% between 13 and 15, and 86% between 16 and 18. Dursun et al provided questionnaires for 1434 Turkish women and found that 55% of them did not know what HPV was or that it is sexually transmitted and can cause cancer.
Is your daughter a 22 year-old sexually active nonsmoker with an excellent diet?
Some people resist the idea of endless vaccinations. The HPV vaccine makes less sense for women who are older, women who are already sexually active, and women who do not smoke. There is also some weak evidence that women who have higher levels of antioxidants clear HPV infections quicker than those with lower levels of antioxidants, and that women who have higher levels of the anti-viral dietary factor all-trans retinoic acid (ATRA) have a reduced risk of developing invasive cervical cancer. ATRA is the acid form of vitamin A, and is found in animal sources of vitamin A such as liver. Vitamin A, a fat soluable vitamin, can be toxic in overdose.
Pap smears will still be needed.
In 2006, Kelly et al discovered there were 321 stories about the HPV vaccine in the media (newspaper and television), 23% did not mention the sexually transmitted nature of the disease, and 80% failed to mention the importance of continued cervical cancer screening with pap smears.
Addendum October 1 2009: Cancer Vaccine is a Mass Experiment
On October 1, 2009, the Daily Mail reported that HPV vaccine developer Dr. Diane Harper said of the immunization drive: "It is a public health experiment. No one knows if this vaccine will protect women into their 20s and 30s."
This statement sums up problem with evaluating the risks and benefits of the vaccine for your child. We know that the vaccine protects girls from HPV infection in the short run, but we do not know whether it protects them from HPV in the long run, nor do we have any proof that it will reduce the rate of cervical cancer years down the road. It would take years and years to prove that outcome. And since about half of women who develop invasive cervical cancer already have poor access to the health care system, immunizing girls (who by definition have access to the health care system) might reduce cervical cancer by far less than would otherwise be projected if it affected women from all strata equally.
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