April 2007

Local women debate need for HPV vaccine

By Suzanne Strazza

LAUREL MONTANO, RN, ADMINISTERS THE HPV VACCINEIs the pharmaceutical industry trying to pull one over on us, or is the new HPV vaccine the key to preventing cervical cancer in young girls?

The Centers for Disease Control have approved a vaccine that protects women against four strains of the Human Papillomavirus virus. HPV is a sexually transmitted disease that can cause genital warts and potentially lead to cervical cancer.

HPV can also cause vulvar cancer and vaginal cancer.

According to pharmaceutical company Merck (the manufacturer of the vaccine) and the CDC, of the four strains that the vaccine addresses, two can cause genital warts and two can lead to cancer. The vaccine is administered in three doses over a period of six months, costing approximately $360.

But the issues which surround the vaccine, called Gardasil, are many and discussion surrounding them often becomes heated.

One issue is that many states are considering making the vaccination mandatory for girls entering sixth grade or 11 years old. The rationale behind this age range lies in an attempt to vaccinate girls before they become sexually active. HPV is considered to be so prevalent (and not always preventable through the use of condoms) that at least 1 in 4 persons who are sexually active is infected with the disease, often with no signs or symptoms, according to CDC statistics. The vaccine is tested and recommended for females ages 9 through 26. It has not been tested extensively in women over 26.

Kate Horle, vice president of public affairs for Planned Parenthood of the Rocky Mountains, said that number may be as high as 3 in 4. “Any self-respecting OB/GYN will tell you that if you’ve been sexually active, you’ve had HPV,” she said.

Does this mean that all women are at risk for developing cervical cancer from the virus? And are women immune if they are vaccinated?

No.

According to statistics, there are at least 40 different strains of HPV, only some of which can lead to cancer. Again, the vaccine only protects against four strains. So this vaccine does not prevent all forms of HPV, although Merck claims Gardasil “protects against the two types that cause about 70 percent of cervical cancer.” It also is said to protect against about 90 percent of genital warts and is said to be nearly 100 percent effective in preventing those strains of the virus.

Are there other factors than HPV related to the development of cervical cancer?

According to Nasha Winters, a naturopathic doctor in Durango, “Yes — smoking, an unhealthy diet, lifestyle.” She also claims that HPV and cervical cancer are “treatable through natural medicine. In states where naturopathic medicine is licensed, there is an incredible success rate in curing women with both HPV and cervical cancer.”

Another issue raised by several health practitioners interviewed for this article is the relatively small number of deaths caused by cervical cancer. That’s because cervical cancers tend to be slow-growing and, when detected early through Pap smears, are generally treatable.

According to information from both Merck and the CDC, some 10,000 women get cervical cancer every year in the United States, and 3,700 die from it. It is the sixth most commonly diagnosed cancer in women in the U.S. and the second leading cause of cancer deaths among women around the world.

Yet the actual percentage of women who die from cervical cancer is tiny, from 0.05 percent to 4 percent. According to Winters, “Four percent seems incredibly high, debatably high. Point zero five seems much more realistic.”

But, who cares, say many. If there is a way to protect your daughter or yourself from cancer, why not do it? Why not change 0.05 to 0 percent? One Durango woman, who asked not to be identified by name, tells her story of contracting the HPV virus.

“My first time going to the gynecologist, when I was 18, I had an abnormal Pap. I had progressive precancerous cell dysplasia [abnormal cells that can be a precursor to cancer].” She had laser surgery to remove the abnormal cells, which resulted in the removal of a large chunk of her cervix. She had only one recurrence of the virus in the next years and then, almost 15 years later, became pregnant.

“I told my midwife about the surgery and she insisted on an ultrasound to see how stable my cervix was. I had two and they were both read incorrectly. Everyone’s alarms went off and next thing I knew, I was headed to the Front Range for potential surgery which would have been risky for my unborn baby.”

It was then determined that there was enough scar tissue in place to hold her cervix closed while her baby grew. But when she did go into labor, the scar tissue tore and her cervix opened much more rapidly than normal, causing an extremely fast delivery.

Three years later, she became pregnant again. This time there was greater concern and another frenzied trip to the Front Range because now the doctors knew there was no remaining scar tissue. The likelihood of her cervix being able to support a baby in-utero became much more questionable.

Again, fortunately, she made it through the pregnancy and her daughter was born safely — although the fear that had surrounded both pregnancies had, at times, been overwhelming. Given that experience, how does she feel about the HPV vaccine? Will she have her daughter (now 4) immunized when she is old enough?

“My first reaction is to ask how long has the vaccine been around. I wouldn’t give my daughter anything that hasn’t been thoroughly tested. By the time my daughter is old enough to receive the vaccine, it will have been around for a few years. I’ll feel more comfortable about it then.”

She added, “Would I like to avoid my daughter going through what I have been through? Yes. Would I like to do anything that I can to ensure that my daughter can have children? Yes, since there was a time there when I thought I might not be able to.”

She looks at the vaccine in another light. “If this was a vaccine that wasn’t related to an STD or if this was a vaccine for breast cancer, we would all do it.”

So should it be mandatory for young girls? Many states (Texas and Florida being the first), organizations and of course, Merck, say yes. According to an Associated Press article, Richard M. Haupt, Merck’s medical director for vaccines, stated, “Our goal is about cervical cancer prevention, and we want to reach as many females as possible with Gardasil.”

Merck began lobbying state legislatures to make the vaccine mandatory. Their aggressive marketing campaign involves a two-page ad in national magazins with headlines such as “GET YOUR DAUGHTER VACCINATED AS A GIRL. HELP PREVENT HER FROM GETTING CERVICAL CANCER AS A WOMAN.”

This seems like an easy choice: get shot, no cancer. Then why are so many people against the vaccine?

One group fighting the mandate is the religious right. Many believe that giving the vaccine will encourage young girls to have premarital sex. Before the vaccine, having multiple partners and/or having intercourse before 18 was a risk factor for cervical cancer, but the vaccine would change all that.

Of course, girls can contract the virus through rape, not just voluntary sexual activity.

Other parents’ rights groups believe that the mandate for vaccination interferes with their control over their children.

Many parents choose not to immunize their children or only partially immunize them when it comes to “routine” vaccinations such as the measules- mumps-rubella, pertussis and polio shots. In Colorado and about 20 other states there is an “opt-out” option, which means that parents can bypass mandatory immunization requirements in places such as public schools on grounds of personal health or religious beliefs.

This opt-out option would also apply to the HPV vaccine in Texas and other places where it is being considered.

One advantage to having the vaccine mandatory is cost-related. If getting the shot is required, then it would have to be made easily available, both in quantity and in price. Also, many insurance companies would be forced to cover the cost. The Montezuma Health Department currently offers the vaccine through its Vaccines For Children program at the incredibly low price of $15. They have only had it available for a month now, but so far, according to Opal Stalker, RN, there have many inquiries but only a small number of vaccines given to local girls.

Stalker is very optimistic about the vaccine and its ability to reduce the occurrence of cervical cancer. “It should be treated as any other vaccine,” she said.

The San Juan Basin Health Department in Durango also offers the vaccination.

Planned Parenthood of the Rocky Mountains backs the use of Gardasil. Horle explains that testing for HPV is not a routine part of a regular gynecological exam and a woman often does not know she is infected unless she has symptoms or an abnormal Pap.

Horle believes that “with the vaccine, more than 99 percent of the yearly 10,000 cases of cervical cancer will be eradicated.” And although there are other ways to help prevent cervical cancer, such as not smoking and getting adequate folic acid in the diet, “this is a major breakthrough for women’s health. Anything that we can do to prevent cancer should be taken seriously.”

She added, “The price for having sex should not be your life… If I had a daughter, we’d be there!”

But skeptics question the timing. Only recently, Merck came under attack due to the Vioxx controversy, in which the popular painkiller was pulled because it could cause or exacerbate heart problems.

According to one pharmaceutical watchdog, Health Truth Revealed (healthtruthrevealed.com), “Merck needs cash badly.” The web site argues that Merck has “spent millions buying the favors of members of the state legislatures” to get Gardasil approved.

But according to the Associated Press, Merck has suspended lobbying for the vaccine “after bowing to pressure from medical groups, politicians and parents.”

There are also questions regarding the thoroughness of the testing of Gardasil. Gardasil was approved just 8 months ago, causing many to question making something so new “mandatory.”

Winters sees the rush as a reaction to fear. “Everyone freaks out when they hear the C-word. But people need to not do so. Preventing HPV is a lifestyle choice… if we are conscious of our sexuality and take more personal responsibility …that goes a long way.”

Having multiple partners introduces varying organisms into your body, which can cause more infections, she said. One of her concerns is that a vaccine will “take away that personal responsibility by creating a false sense of security.”

The vaccine does not prevent any disease in a woman who has already been infected, so women already sexually active may get no benefit from the shot. Also, Gardasil has not been tested on women over the age of 26.

The drug has not been approved for use in men, but at some point there will probably be testing, as males are often asymptomatic carriers of HPV.

One thing everyone agrees upon is the need for people to educate themselves; ask questions, contact their health-care provider, look on the internet. Whatever a person’s choice is in the matter, make sure that it is an informed one.