Source: Reader’s Digest (www.rd.com)
Author: Julie Bain

Between the relay races and table tennis triumphs last week, there was some news coverage about the HPV vaccine. A study came out last Wednesday in the New England Journal of Medicine that looked at the economic impact of vaccinating young girls and women from the types of HPV virus that can cause cervical cancer.

Newsweek ran an informative Q and A with one of the study authors about who should get the vaccine and when. The New York Times did a big story, too, which I thought displayed a bit of bias in the disapproving tone of its headline: Researchers Question Wide Use of HPV Vaccines.

I called Maura Gillison, MD, a researcher at Johns Hopkins in Baltimore and one of the top experts on HPV, for her perspective. She said, “For those of us in the field, this study is not really new information. It is known that the HPV vaccine doesn’t have an impact on young women who have already been infected by the HPV types targeted by the vaccine (HPV6, 11, 16, and 18).”

While it was possible to measure a girl’s previous exposure to HPV in the study lab, it’s not possible in a medical clinic, she says. That’s why it’s not as cost-effective to give the vaccine to women who are already sexually active.

Still, she says, “only 4% of the 16- to 26-year-old women who were enrolled in the vaccine trials had evidence of exposure to all four HPV types targeted by the vaccine. So a young woman already infected by HPV6, for example, would still benefit from vaccination to prevent HPV infection by HPV 11, 16, and 18. But the older the woman, the higher the probability that she has been exposed to more of the virus types.”

So the bottom line, according to Dr. Gillison: “You get more bang for your buck by targeting vaccination to younger girls, before the onset of sexual behavior. It makes more sense, in terms of the overall cost and the overall impact of the vaccine for cancer prevention, to spend the health-care dollars to vaccinate a higher proportion of young women, than to extend vaccination to older women.”

The vaccine needs further study before researchers will know for sure how long immunity lasts and whether a booster shot may be needed, and when. The big question of the study was: Is the cost of vaccinating millions of girls worth the number of lives saved? Economic policy is one thing, but all any individual can answer is, “If it’s my daughter whose life is saved, the answer is yes.” By the way, Dr. Gillison has two very young daughters, and she says she plans to have them vaccinated.

But What About the Boys?

Some 20 million Americans are infected with the virus, including a high percentage of teenagers. And we know that the virus is easily spread through any kind of sexual contact, including oral sex. I’ve asked it before and I’ll ask it again: Why are we only talking about girls here?

Cervical cancer is not the only life-threatening hazard of the HPV virus. Oral cancer from the virus is on the rise, as we wrote about in A Father’s Brave Battle with Throat Cancer in the August issue.

“We don’t know yet if the vaccine protects against genital infection in boys or against oral infection in boys or girls,” Dr. Gillison says. “I’m doing all I can to see that such studies are done.” In the absence of such studies, she says, we’ll only know if the vaccine helps to prevent oral infection 20 to 30 years from now, if the rapid rise in HPV-related oral cancers switches directions and starts to decline.

I don’t want to see anyone suffer the way I saw Steve Reynolds, the subject of our story, suffer during and after his treatment. Last Wednesday, the day the vaccine study came out, Steve was in the hospital having a PET scan to see if any cancer cells have returned in the year since he completed his radiation and chemo. Then he and his wife and their 4-year-old son headed to Cape Cod for their annual vacation. He won’t have the results until he returns. Waiting and worrying means more suffering for him and his family. We need to find a way to prevent this cancer, too—in all people.