Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
27 June 2007

THE VACCINE AGAINST CERVICAL CANCER

            The May 10^th issue of the New England Journal of Medicine had nine separate articles devoted to cancer caused by Human Papilloma Virus.  This virus is known to have at least 38 different serological types only some of which are known to cause cancer in humans.  However, it is known from international studies that about 70% of all cervical cancer in humans is caused by human papilloma virus strain 16 and strain 18. 

            Trying to get a vaccine that will immunize against all 38 strains of human papilloma virus has not been successful.  The human immune system is unlikely to pay attention to 38 different viral strains although it can pay attention to four at a time.  Thus, a vaccine has been developed to strains 6, 11, 16, and 18 serological types of human papilloma virus. Since strain 16 and 18 cause 70% of all human cancer of the cervix, this vaccine would be expected to have a major impact on the incidence of this disease.  Initial studies have supported the expectation generated by this vaccine. 

            So what is the problem?   The biggest problem is the observation that the vaccine protects very little, if at all, in individuals vaccinated after they have been infected with human papilloma virus.  The major route of papilloma virus infection is sexual activity.  By age 15, 13% of American young women are already sexually active.  By age 19, 70% of American young women are sexually active.  Thus, introducing the vaccine to the 13-19 year-old population after they have become sexually active has a reduced protective effect.

            So where should the vaccine be used?  The answer is we should start vaccinating 12-year old girls before they become sexually active.  A host of objections have been raised by the moralistic group in our population suggesting that this will encourage premarital sexual activity.  In my opinion this moralist group is naïve beyond description to think that not vaccinating teenage girls against a disease that may not come for 20 years will have any impact on their teenage sexual activity. 

            But then comes the second problem.  A group of very enthusiastic healthcare professionals have pushed legislation that would mandate that all 12-year old girls be vaccinated with this vaccine or not allow school attendance.  One of the most basic properties of normal American behavior is resistance to being told what a person has to do.  As a group, Americans resist mandates and laws requiring certain behaviors.  Witness the continued resistance to the use of helmets for motorcycle riders and seat belts for our automobile drivers; both of these practices would save countless lives and are still bitterly fought over.  Thus being told that your 12- year old daughter has to have a vaccine to prevent cervical cancer in order to go to school has met with very organized resistance.

            So what is the right answer?  In my opinion, I would have my 12-year old daughter receive this vaccine.  But I would not mandate a law that this vaccine be provided for every 12- year old young lady in order for her to be allowed to attend school. I still think that there is a freedom the individual has a right to exercise as long as that freedom does not endanger others.  While a person’s right to smoke cigarettes wherever they want has been impeded, their ability to smoke at all has not been forbidden and certainly smoking is the most detrimental health habit any citizen of the United States can engage in.  Mandating that this vaccination should be provided to all our 12-year olds as a life-saving step is a drop in the bucket compared to cigarette discontinuation. 

            But the anti-cervical cancer vaccination can be a very important thing for the individual who receives it and is prevented from being infected with the human papilloma virus.  In my opinion, that vaccination should be a privilege, not legally required for school attendance.

            At this time, the vaccination is paid for by the state health department for girls age 12 to 19 so cost is not an individual issue.