The Cervical Cancer Vaccine

A new cervical cancer vaccine, Gardasil, was approved last year, and my pediatrician said my daughter could get it sometime soon (it’s FDA-approved for use in females ages 9 to 26 years). Well, we’ll see. It’s not that I don’t think it’s safe: From the studies I’ve read it seems like it has a low risk of side effects and the potential to prevent a lot of human suffering.

When Texas governor Rick Perry tried to make it mandatory for sixth graders in his state in early 2007, however, I felt a bit annoyed. I was not alone. A group of parents sued, and the Texas legislature voted to block the executive order.

People objected to the vaccine for a number of reasons—my beef is that it’s expensive, $360 for the three-shot series. And the strategy seems rushed. Going from a new approval in 2006 to mandated vaccination within a year or two? (Similar legislation has been discussed in a number of states.)

The vaccine blocks some strains of human papillomavirus (HPV), a virus that most people’s immune systems get rid of on their own. About 50% to 75% of sexually active people become infected with HPV at some point in their lives (though they may never be aware of it), but 70% of infections clear up within a year and 90% are gone within two years. Only a subset of people develop the cellular changes that can lead to cancer, and an annual pelvic exam in women can pick up those changes early, when they’re treatable.

But does the vaccine prevent the need for pelvic exams? Probably not since it targets only four strains of HPV and there are more than a hundred strains. Granted the four strains are responsible for the majority of cervical cancer cases and genital warts that occur in women, but that’s not quite enough to eliminate the need for pelvic exams.

Some public health experts are questioning the rush. The Canadian government plans to invest $300 million in programs throughout the country to vaccinate girls and women with Gardasil, but in an August commentary in the Canadian Medical Association Journal, Abby Lippman, PhD, and colleagues noted that there are many unanswered questions about the vaccine. Among them:

• The “real world” effectiveness of the vaccine is unclear.
• It’s not known if a booster is needed.
• Only about 1,200 girls ages 9 to 15 received the vaccine in clinical trials, a small number considering that this is the target group for vaccination.
• Gardasil is the most expensive childhood vaccine being proposed for mass use, but the results of cost-effectiveness analyses are still being debated.

Lippman, professor at McGill University and former chair of the Canadian Women’s Health Network, says it’s “distressing” that the questions she and her co-authors raised have been acknowledged as valid, but the programs are going ahead anyway.

“Why are we rushing?” she says. “We really need to have health decisions made by calm-thinking health experts and not with politicians breathing down their neck.”

In this case, although I’m a big supporter of vaccinations, I agree. So for now, I’m holding off on the vaccine until I see more data.