The commercials are persuasive: "Each year in the US, thousands of women learn they have cervical cancer," says the confident girl holding the skateboard. "I could be one less. One less statistic." She's edgy and cool, posed at the top of the half pipe, but getting cervical cancer isn't a risk she's willing to take.
But what if there's not that much of a risk to begin with?
Cervical cancer is caused by the same virus that causes genital warts -- the Human Papilloma Virus, or HPV. It's spread by skin-to-skin and sexual contact, and while there are more than 100 types of HPV out there, only 15 or so cause caner and, in most women, almost all HPV infections are cleared by the immune system naturally. "Even if persistently infected with HPV, a woman most likely will not develop cancer if she is regularly screened," Dr. Charlotte Haug writes in an editorial in the Aug. 2009 issue of The Journal of the American Medical Association. Dr. Haug also points out that while HPV is the most prevalent sexually transmitted infection today, "the relationship between infection at a young age and development of cancer 20 to 40 years later is not known" and "the true effect of the vaccine can be determined only through clinical trials and long-term follow-up." (The entire article is an eye-opening read; you can find it here.)
Unlike with diseases like the measles or the mumps, herd immunity isn't at risk here -- the number of cases of cervical cancer aren't going to skyrocket if our daughters aren't immunized. And last year, a government study linked one of the HPV vaccines, Gardasil, to 32 unconfirmed deaths and other serious but rare side effects.
"The rate of serious adverse events [with Gardasil] is greater than the incidence rate of cervical cancer," Dr. Diane Harper, director of the Gynecologic Cancer Prevention Research Group at the University of Missouri and the lead developer of the HPV vaccine, said at a vaccine conference last year. [Edited paragraph to clarify the source of this quote -- LMA]
Catherine Ruhl, a certified nurse-midwife who is Director of Women's Health Programs at The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), recommends the vaccine but acknowledges that the chances of getting cervical cancer are low for girls in the targeted age group. (The US Centers for Disease Control and Prevention recommends that all girls and women age 9 to 26 get the three-shot series, and girls age 11 and 12 are especially encouraged to do so). "Cervical cancer grows very slowly from HPV changes," she says. "It's extremely rare in the 15 to 19 year age group. But HPV is very common once teens start to have sex, though."
Which is why the CDC wants girls to get vaccinated before they become sexually active. There are no easily recognizable signs of infection, since it affects the cervix, but some strains of the virus also cause genital warts in both men and women. According to Health4Women.org, the vaccine has recently been cleared for (though is not yet officially recommended for) men ages 9 to 26, who may be carriers of strain of HPV that causes cervical cancer in women.
Since HPV is transmitted by skin-to-skin contact, the best way to avoid it is by not engaging in any sort of sexual activity.
"There are four things that I would recommend," says Ruhl. "The first is that they should delay the start of having sex, because there's some evidence that the younger you start, the more vulnerable your cervix may be to the HPV." She also says that being in a monogamous relationship and having regular pap screenings starting at age 21 can also decrease the risk of contracting cervical cancer, as can not smoking.
"Cigarette smoking is associated with accelerating the changes caused by HPV on the cervix," she says. Quitting smoking, or not smoking at all, "doesn't prevent HPV, but is associated with a decreased risk of cervical cancer."
Of course no one wants their daughter to become a statistic. But I'm not convinced that the benefits outweigh the risks in this case. Our oldest daughters are 16 and 14, and I'm thinking that the best thing the HPV vaccine may offer our family is a chance to talk frankly about sexual health, sexual activity, and our family's values, sticking to the facts and avoiding the hype.
"Providing factual information is always the best choice," Ruhl says. "I think the best choice is giving knowledge to your children, and making sure that they understand about health and safe choices and options, and where they go with that is going to be, especially as they get older, their decision."
Parents, are you considering vaccinating your kids against HPV? Why or why not?
Lylah M. Alphonse is a Globe staff member and mom and stepmom to five kids. She writes about juggling career and parenthood at The 36-Hour Day and blogs at Write. Edit. Repeat. E-mail her at firstname.lastname@example.org.
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