Say No to the HPV Vaccine

But say yes to regular Pap tests

by ALICIA PRIEST

If you’re a young woman, a woman who isn’t yet sexually active, or parents of a young girl, listen up.

Over the next few months, you’re going to hear a lot about a new vaccine for cervical cancer. It’s called the human papilloma virus vaccine or HPV vaccine, which was recently approved by Health Canada and the FDA under the brand name Gardasil. The information you hear will probably come either from pharmaceutical companies (Merck’s Tell Someone TV campaign is well underway) or from public-health agencies.

Cervical cancer is largely a sexually transmitted disease. Other risk factors include smoking, poor nutrition and immunodeficiency, yet almost all forms are caused by certain strains of HPV. The vaccine prevents infection from two of these strains plus two other types that cause genital warts. Public health agencies and drug companies are recommending that all females aged nine to 26 receive this vaccine as a way to prevent cervical cancer. Although that may sound straightforward, the issue is far more complex.

First, cervical cancer is relatively rare in Canada and seldom fatal. In Canada, it kills about 390 women a year, according to the Public Health Agency of Canada. Health Canada gives a slightly higher figure—400 women a year—but it still works out to .002 per cent of the female population.

The No.1 weapon against cervical cancer is the Pap smear. Widespread screening via Pap smears has dramatically lowered cervical cancer rates. In Canada, since the test’s introduction about 50 years ago, cervical cancer death rates have dropped by half, according to the Public Health Agency of Canada.

The vaccine does not eliminate the need for Pap smears, protected sex, or prudence about one’s choice and frequency of sexual partners. Women are more likely to develop cervical cancer if they have multiple sex partners or become sexually active at an early age. The vaccine could give women and girls a false sense of security about their sexual activity.

Women are being scared unnecessarily. The impression given by the Tell Someone TV ads is that a woman can go straight from getting genital warts to having cervical cancer. Not so. In many cases, when women are infected by the HPV, their body’s immune system will clear it and they will not develop any related health problems. In fact, women may become infected more than once during their lifetimes and never know it. However, women under severe stress, who are poor, or who live in an unhealthy environment seem more likely to have trouble clearing the HPV. In other words, economic inequality plays a big role in this disease.

Most women get regular Pap tests. But not all. Women who get cervical cancer are often those who do not get Pap tests or do not get them regularly. These women are often immigrants who may not speak English or French, poor women, aboriginal women, or women in remote areas without access to health care. These are the same women who may not be able to take advantage of a vaccination program. Wouldn’t it make more sense to address this inequality and fund programs to reach these women, rather than blanket everyone with a vaccine?

The vaccine does not eliminate the need for Pap tests because it protects against only the two major types of HPV that cause cervical cancer. Also, it is not effective if administered after a woman or girl’s first exposure to the virus. For most adult females, the vaccine is useless. That’s why girls aged nine to 12 are suggested as the target group. Yet teen sex is a volatile issue.

Vaccinating young girls for a sexually transmitted infection raises social, ethical, cultural, and religious concerns for many parents.

Finally, the vaccine is hugely expensive. Administration involves three injections over a six-month period at an estimated cost of about $410 per person. If taken on by the public health budget, this would be a huge burden on an already weighed-down system. Does this vaccine add true value to the fight against cervical cancer or is it just an extra cost to the system?

Given all the above, I say let’s use the tools we have, such as the Pap test, to help eradicate cervical cancer. Vaccinating everyone is a shotgun approach to a relatively rare disease as opposed to a specific, targeted planning approach that reaches the women who need it most.

Alicia Priest is a Victoria-based freelance writer and former registered nurse who will advise her teenage daughter to say no to the HPV vaccine but yes to regular Pap smears, when the time comes.

| | | | | | | |