By Helen Furr, M.D.
Mothers, what would you say if someone told you that your little girl could get immunization against a virus that can eventually lead to cervical cancer? What if they then told you that the virus is most commonly transmitted through sexual intercourse? How would you feel about a physician asking if you wanted your nine-year-old to receive a series of three injections to prevent genital warts, certain vaginal, vulvar and cervical cancers, and the Human Papilloma Virus (HPV)?
On June 8, the Food and Drug Administration approved a vaccine to potentially lower women's risk of developing cervical cancer. The vaccine, called Gardasil, protects against the two strains of HPV that cause 70 percent of all cervical cancers, and two strains that cause genital warts. Currently, the vaccine is approved for use in girls and women ages 9 to 26.The vaccine is comprised of a series of 3 injections given over a six-month period.
Nearly 75 % of all U.S. adults and 25 % of people ages 15-24 have been exposed to the human papillomavirus. In the majority of these people, the body naturally clears the infection without progressing into active disease, however in some the virus can cause various changes including affecting the lining of the cervix or vaginal mucus which can potentially progress to cancer. There are about 30 known strains of HPV, some of which are risk factors for pre-invasive and invasive cervical cancer. Gardasil immunizes only 4 of the HPV strains.
Statistics show that about 50% of teenagers in the United States have sexual intercourse before the age of 18 and it is for this reason that health officials are recommending the vaccine be given at a young age, perhaps teenagers, prior to exposure and initiation of sexual activity.
Unfortunately, for teens and women in their early 20's who may have already been exposed to HPV, it is not clear if the vaccine is helpful, especially since studies show that once girls or women become sexually active they often soon thereafter become infected. Moreover, the studies on Gardasil were conducted in girls and women ages 9 to 26 so it is not clear whether it gives any immunity to women older than 26- that is especially if they have already been exposed to HPV.
Now you ask, ?How would one know if they have the virus, and how can you find out what type it is to figure out if the vaccine is needed?? Although the vaccine doesn't cure HPV, it may help those that have one type of HPV from being infected with other strains. If a person has an abnormal pap smear, HPV typing can be done to determine the virus strain. Your doctor should be able to explain more to you about this kind of testing.
A word of advice:
The vaccine will not, and does not replace pap smears. Pap smears remains a screening tool which looks for cell changes caused by HPV, which if untreated, can lead to cervical cancer. Girls and women who do receive Gardasil will still need to have pap smears, since the vaccine only immunizes against 4 of the 30 known strains of HPV, and there will still be 30 % of the strains that cause cervical cancer which the vaccine does not protect against.
I anticipate many challenges with the introduction of the vaccine on moral, religious or social beliefs. One can take the perspective that if the government were to support this, are they advocating and funding safe sex? Or are they helping the public in the long run? Since boys can transmit the virus to girls, isn't it only fair that they be immunized too?
I would like for people to look at this vaccine as somewhat similar to the Hepatitis B vaccine series. It has been shown that chronic infection with Hepatitis B can predispose one to develop hepatocellualr carcinoma as well as cirrhosis, which may be fatal. Although Hepatitis C runs similar risks, there is no vaccine for it. And yet many people, especially healthcare workers, who may be exposed to the hepatitis are being immunized against Hepatitis B. Similarly, Gardasil immunizes against some of the strains which may lead to cervical and vaginal cancer. Wouldn't you want to have as much protection as possible in this day and age? After all, some protection is better than no protection at all.
Helen Furr, MD specializes in Family Practice. She received her medical degree from Ross University and did her residency at Cook County-Loyola University in Chicago. She is a member of the Chattanooga & Hamilton County Medical Society since 2006. She currently practices at Lookout Valley Medical Center, 3309 A Cummings Highway, (423) 648-4800.