In June of 2006 the FDA announced that they had approved the first HPV vaccine. Although Gardasil is being called the "cervical cancer vaccine", that is slightly misleading. The vaccine protects against the two strains of HPV that cause most cases of cervical cancer, but there are 11 other strains that are also potentially cancer causing which the vaccine does not address. Therefore, even if the vaccine is 100% effective, women who receive it will still be at risk of cervical cancer and still need to get regular Pap smears to prevent the consequences of the disease.
HPV is an extremely common sexually transmitted virus. Most sexually active people will be exposed to one or more strains of the virus at some point in their lives, and up to a quarter of people in any particular age group are infected at any one time. The virus is so common that exposure is essentially a given. If you are sexually active, you will be exposed to the virus. Even consistent condom use is no guarantee of protection, since the virus is transmitted skin to skin, and condoms only protect the areas of skin that they cover.
What you may not know from the advertisements is that Gardasil actually protects against 4 strains of HPV. Only two are associated with cervical cancer. The other two are associated with genital warts. The manufacturer is playing down this benefit of the vaccine, because of fears that it will discourage parents from getting the vaccine for their daughters. Protecting your daughter from cancer is clearly a good thing, but when genital warts come into the picture all of a sudden the conversation becomes about sex.
A vaccine that prevents cancer is an easy sell. A vaccine that prevents a sexually transmitted disease, however, can raise parental flags. Parents say
"My daughter isn’t having sex, she doesn’t need this vaccine."and all of a sudden the vaccine is no longer about preventing a serious and common disease, but about teenage promiscuity and sexual politics. This is why some politicians and health professionals want to mandate the vaccine. Mandating the vaccine takes sex off the table, and focuses people on the long-term benefits to their children’s health. Because, eventually, everyone will have sex, and when that day comes it would be nice if that sex were as safe as possible.
or
“If I give my daughter this vaccine it will make her decide to have sex”
Cervical cancer is both preventable and deadly. Regular Pap smears can prevent the serious consequences of HPV infection, but only if people get them. However, people don’t have uniform access to Pap smears. Although, in theory, they are available from affordable clinics, not everyone knows where those clinics are. Other people don’t know they need a Pap smear ever year, or may think they are not at risk because of age or other demographic factors. They are wrong. Cervical cancer kills people because not everyone is reliable about prevention. Older women stop getting Pap smears when they no longer need birth control pills, and doctors don’t see the early pathological changes affecting their cervix. Younger women may not consider themselves at risk for cancer, or not have access to health care, and therefore wait too long to start getting screened.
A 1999 study of over 10,000 Pap smears from girls aged 10 to 19 found that more than 14% of the samples showed potentially pre-cancerous changes. This was in a population that most people would consider low-risk: predominantly White girls from urban and rural areas of Maine, New Hampshire, and Vermont who are health care consumers. This is a higher rate of problems than seen in 20-24 year olds, or in older women, which both reflects the fact that adolescent girls are sexually active and that they may be more biologically susceptible to infection.
But why, a very sensible friend of mine asked, mandate and not recommend? To which, I answer, because people ignore recommendations. If every woman followed the recommendation to get an annual Pap smear, almost no one would ever die of cervical cancer. Which would serve much of the stated purpose as the vaccine. Although it's much better to stop someone from getting a virus than it is to have to continually treat it.
