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Cervical cancer vaccination

I had my first Pap smear at age 19 -- 16 years ago. Back in the day, I had access to information about HIV, gonorrhea, herpes, syphillis, and other STDs. I got fairly deep into the subject, taking medical ethics courses as part of my major in philosophy, and for a time, I considered getting a Masters in Public Health. Later, I served as a volunteer counselor, then as a member of the Board of Directors, at an HIV clinic.

It's only comparatively recently, however, that a clear link has been established between sexual activity and cervical cancer, with a tie-in to HPV, which was frequently referred to as genital warts on those colorful matte pamphlets neatly categorized in the rack at the health clinic. I can tell you honestly that in my entire time in that field, I never heard much of anything about cervical cancer, much less any potential association with sexual activity as a risk factor.

While working at my first job in Atlanta, we hired a temp. She was young -- about 22 or so, maybe. She smoked, which surely didn't help her risk factors. One had the impression she'd experienced life, to euphemize a bit, but she was a pleasant individual.

She was the first person I knew to be diagnosed with cervical cancer. In her 20s. Like others in my age group, she hadn't been warned, because the link hadn't be conclusively established at that time. No, at that time, the big deal was HIV, HIV . . . use a condom. Most of us would've been a heck of a lot less surprised to hear the words "HIV positive" coming out of our Ob/Gyn's mouth than the words "cancer."

To make a long story short, we truly need this vaccine. Need. I don't use that word lightly.

The Religious Right, in the form of the Family Research Council, is already gearing up to fight it:
"Giving the HPV vaccine to young women could be potentially harmful, because they may see it as a licence to engage in premarital sex," Bridget Maher claims, though it is arguable how many young women have even heard of the virus.
Yep, even today, many health care providers are a little slow to get the word out about it to those in their care.

When this makes it to the news and the common public dialogue, as it almost surely will, please, take a minute to write your representatives. Go get pen and paper, type it up on your word processor over lunch at work, I don't care how you do it -- just please do it. You can get addresses of your representatives here.

The American Cancer Society reports that more than 12,000 women are diagnosed with cervical cancer and 4,100 women die of the disease every year in the United States.

It's not something we talk about much, but it's there.

It's past time we started talking, and taking action. In the larger view, we must allow physicians access to the appropriate tools to best serve those in their care. To do otherwise is to allow the patient-doctor relationship, and this potential vaccine specifically, to become a casualty of the current prevailing political power in this country.

In short, let the doctors do their jobs.

Comments

( 8 comments — Leave a comment )
streamweaver
May. 22nd, 2005 02:05 pm (UTC)
Oh boy I'm not sure where to begin with this because it's a hot button topic on both sides of the issue. I guess it harkens back to the fact that we have a general inability to gain perspective on risk and the role things play. Being directly involved in Healthcare Networks and specifically Health Informatics trying to get accurate information out with a healthy perspective is important to me. We're going to see a real problem with how HPV is presented however in the coming months and years. We're going to see HPV presented as the plague of the next century in the media mostly for economic reasons.

Those reasons being there is now a test that companies are going to try to sell to everyone, so they're going to take a serious health issue and try to make it out to be the black death. The 12,000/4,100 number is on the high end of the various estimates but still in the credible range so it's not a made up number like you see with some diseases. That's good. However what people don't seem to talk to talk about is that tens of millions of people in the U.S. alone are infected with the disease so only a fraction of a percent of people infected with HPV ever develop cervical cancer.

While HPV is the leading cause of cervical cancer (and you're going to hear that statement quiet a bit in the future) does not mean what they are trying to imply, that most or even many people with HPV are going to develop cervical cancer. This is a very critical difference that people need to realize because if the media hype continues we're going to end up with a Leper syndrome revolving around this disease. Pushing attitudes of this towards the kind of panic necessary to fuel a testing industry based around a disease is going to cloud the issue so much we're going to see more harm than good. As with HIV people just wont want to know, or wont talk about it.

The fact is massive number of people have and live with HPV every day of their life. The disease has a health impact that should not be dismissed but we also need to very careful not to whip everyone up into a frenzy about it and the latter is most definite what is about to happen in our country.

I'm still on my gym high right now so I'm not particularly articulate. The things I've said here are just thoughts on the topic and not in response to what you're saying just in case you were starting to think that. It's just so difficult because it's a real problem and it really pains me to see everyone from doctors to the news media hoping on board to distort the issue just to increase the sales of an HPV test.
pointedview
May. 22nd, 2005 03:30 pm (UTC)
To me, it's just really, really simple. Here is a vaccine that could prevent a health problem. This is a tool that better aids doctors and patients. You're absolutely right that it's not a hyper-deadly threat and that many people live with it every day, but there are lots of diseases that don't have a high mortality rate. That doesn't mean we don't treat them, and this should be no different, regardless of the attempts by the Right to politicize and moralize on medical care and diagnosis.

Like so many things, I think this is simply an issue between physician and patient, and empowering a good doctor with additional treatment options is not a bad thing.

(*smiles* Like you, these are just more of my thoughts on the topic.)
streamweaver
May. 22nd, 2005 06:14 pm (UTC)
On the issue of the vaccine itself and your specific comments. I actually don't think the vaccine is ready, we need a bit more study. There are ones on the horizon for HPV, a Hep B vaccine (I said C above when I meant B, just woke up and all), and one that may help with Herpies as well. Those could be significant and helpful and are definitely exciting. We have to make sure they'll actually work.

As the poster points out below allergic reaction could be a very serious problem. When we're dealing with the numbers we're talking about with HPV an understand of how dangerous it is very important. I suppose that is why I commented as I did, people don't understand that while it is unfortunate there are relatively few cases of cervical cancer overall. We know that about 4 thousand die of cervical cancer, but the thing about talking about HPV is not all 4 thousand of those were caused by HPV. So some fraction of that will be prevented with this vaccine we think. Even if all 4000 were prevented however we're talking about vaccinating perhaps a hundred million people or more. Even with a modest reaction rate we could be killing as many or MORE people with that vaccine than die of cancer from it.

So going back to my original statement, perspective on just how big the scope of the problem is very important. Few people want to admit that HPV, while a serious problem, is not a dramatic health problem. We're dealing with numbers small enough that very small mistakes over such a large population could be worse than the solution. Unfortunately we're about to lose all perspective on the issue as a nation, as drug companies are about to begin a massive advertising campaign for it's HPV test coupled with releasing all kinds of funded studies to show up how it's the next plague. All kinds of media outlets will coincidentally begin running specials on this "hidden" disease. So it's going to be harder to forge ahead with an effective discussion on the topic as that occurs. It's just unfortunate.
goodjoan
May. 22nd, 2005 05:31 pm (UTC)
Vaccinations pose a health risk themselves, even death due to allergic reactions so I'd think the real discussion needs to be if the benefits of the vaccine outweight the risks of the shot itself. This argument was had before with the Hep B vaccine. At first it was just for medical personel who might be exposed to infected people in a hospital setting, now it's manditory in GA for admission to school! At what point did we stop arguing about HOW you get it and settle on the simple fact that we can simply avoid it. Not only did we decide it was ok to vaccinate high risk people, we decided to skip the morality argument and vaccinate babies at birth!

I'd bet that in time, this vaccine will be available to all babies like the chicken pox vaccine. I know that if it is deemed safe, I'd make sure all my kids had it before going off to college! (if not sooner!)
pointedview
May. 22nd, 2005 08:27 pm (UTC)
Now, see, I agree about the allergic reaction bit on the vaccination -- that's a very valid point. I mean, I don't think it's something that should necessarily be given out willy-nilly. I'm more a proponent of it existing as an option for medical care to be used by responsible doctors in diagnosis, and don't want to see a political agenda tying physicians' hands.
goodjoan
May. 22nd, 2005 10:50 pm (UTC)
In the end, I think the drug companies hold more sway over the FDA than the religious PACs. It'll be made and tested and released and the fanatics can wail all about it to the evening news. For a while, some doctors may hold an ethical opinion about it, but eventually it'll be someting routine and easy to find. The religious folks are just trying to force their views on others, the drug companies are looking to turn a profit. I know where I'd put my money!

In the late 1960's after having 5 kids, my mom asked her OB/GYN about this new "birth control pill" that was all over the news. He told her that since she was catholic, she couldn't have it! No other reasons! (Just as well for me since I was born a few years later) Times have changed enough that I would be not only shocked if my dr said something like that, but probably sueing him for malpractice!
organfailure
May. 22nd, 2005 07:46 pm (UTC)
That really hits home for me with my cousin who just was diagnosed with cervical cancer.

It makes no sense to prevent such a thing because it might give free liscense to engage in pre-marital sex. What's next? Take away all birth conotrol because it too gives you 'free reign' for pre-marital sex?

i don't understand organized religion sometimes, especially self-righteous ones.

UUGGHhh....

It really makes me fear for the immediate future unless there IS a big change :/
quandry
May. 23rd, 2005 09:24 am (UTC)
Honestly, I wouldn't worry. FRC is, yes, a religious right organization, but there are a heck of a lot of policy initiatives they back that have not seen, and never will see, actual implementation.

They don't have a chance in hell of preventing people from getting the vaccine. There are religious right groups out there demanding that oral contraceptives be made illegal, but that's not going to happen either.

http://www.cdc.gov/std/HPV/STDFact-HPV.htm

1) Too many people have it. In fact, if you and I don't actually have it (or had it at one time), half our friends do.

"Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year." (emphasis added)

2) Some strains of HPV cause problems (genital warts) that are not nearly as serious, but ARE much more immediately annoying. People don't necessarily respond to some vague and remote threat to their lives, true. But they do respond to an immediate and revolting and common threat to their privates. If there were a herpes vaccine, single people would be beating down clinic doors to get it, and no religious right organization would be able to stop it. It will be the same with this one. Sad to say, but people are motivated if the alternative is "gross" or "icky". It is likely that vaccines against most strains of HPV will be bundled together, so people will get the cancer vaccine while getting the anti-icky vaccine.

The research is moving forward on the vaccine. I'm pretty confident it will be used.

I'll add one more thing: people and kids die all the time because of diseases that could have been prevented with a vaccine. This definitely includes modern, affluent, Western countries as well as places like Nigeria where there is a resurgence of polio because of fear of the vaccine.

Also, when you don't get a vaccine, you are a free rider: your safety depends on the people around you not getting sick, and that means your safety depends on them having the vaccine. If you haven't gotten a vaccine, what does the safety of the people around you depend on? No vaccine is perfect: even people that have had a vaccine sometimes get sick. You are MUCH more likely to get sick, and yes, to pass the disease on to others if you have not had a vaccine.

Unreasoned fear of vaccines kills. An example is measles, which can be deadly, and is occuring more often because parents fear the MMR vaccine.

http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&node=&contentId=A44227-2003Sep21¬Found=true

Kids are safer if the get the vaccine than if they don't, and kids are also safer for everyone around them, including other children, if they get a vaccine. It's true that there are occasional reactions to vaccines. But, things like this need to be weighed in the balance of the alternative.

( 8 comments — Leave a comment )

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