DOCTOR IS IN: HPV vaccines, cervical cancer and you

BY KEVIN AULT, MD

  • Associate Professor of Gynecology and Obstetrics, Emory University School of Medicine and a physician at Emory Healthcare.

Human papillomaviruses (HPVs) are a group of more than 100 viruses. Some HPV types cause non-cancerous warts on the hands and feet, while other types can be sexually transmitted and cause noncancerous warts on the genitals and the cervix. A few “high-risk” HPV types are the main cause of cervical cancer.

About 6 million new genital HPV infections occur each year in the United States. Most of these don’t have any symptoms and go away without treatment over a few years. Sometimes HPV infection can linger for many years as either a benign or a cancer-causing infection.

According to the National Cancer Institute, more than 11,000 women in the United States (2007) are diagnosed with cervical cancer each year and nearly 4,000 die from it. Rates for cervical cancer in Fulton County are twice the US average. Worldwide, more than half a million women each year develop cervical cancer, which is the most common cause of cancer deaths in women. HPV infection also is a major risk factor for oropharyngeal cancer, which includes the middle part of the throat, the base of the tongue and tonsils. HPV also may contribute to cancers of the anus, vulva, vagina, and penis.

Nearly all sexually active people are going to be exposed to an HPV virus sometime during their lives. Even though for most people, it causes no complications and goes away on its own, about seven percent of the 50 to 60 million pap smears performed in the United States each year are abnormal, and we spend about three billion dollars each year to find and treat pre-cancerous stages caused by some type of HPV.

Although routine pap smears can detect early-stage cervical cancers, the only sure way to prevent HPV infection is to not have genital contact with another person. For sexually active people, a mutually monogamous relationship with an uninfected partner is the best way to prevent HPV infection, but because there aren’t always symptoms, it is hard to know whether someone is infected. Condoms may help protect against HPV infection, but don’t protect completely.

Nicole Giacopelli, 17, gets a shot of the new cervical cancer vaccine Gardasil from her pediatrician, Dr. Jill Stoller, in Woodcliff Lake, N.J., in January 2007. (AP)

Nicole Giacopelli, 17, gets a shot of the new cervical cancer vaccine Gardasil from her pediatrician, Dr. Jill Stoller, in Woodcliff Lake, N.J., in January 2007. (AP)

In 2006 the U.S. Food and Drug Administration approved an HPV vaccine named Gardasil (manufactured by Merck) for females 9 to 26 years of age. Emory researchers were part of an three-year international study in more than 24 countries that found the vaccine was 99 percent effective in preventing the two types of HPV responsible for most cases of cervical cancer – strains 16 and 18. The study, which was published in the journal Lancet, also found a high rate of protection from types 6 and 11, which cause about 90 percent of all cases of genital warts.

Gardasil is given in a series of three injections over six months. Another promising vaccine, Cervarix, is produced and is being tested by GlaxoSmithKline, but is not approved yet by the FDA. Both Gardasil and Cervarix also have been tested for safety in thousands of people in the United States and other countries, and thus far, no serious side effects have been found. The most common problem has been brief soreness at the site of injection.

Although some people have questioned giving pre-adolescent girls a vaccine for a sexually transmitted disease, young girls make strong immune responses to this vaccine, which will improve their protection. And it’s better to vaccinate against a disease before it’s needed rather than trying to time it exactly and being too late. Gardasil is proven to be effective only if given before infection with HPVs, along the vaccine may still protect against other HPV types a person hasn’t been exposed to.

The ational Advisory Committee on Immunization Practices (ACIP) has recommended that Gardasil be given routinely to girls ages 11 to 12. The recommendations also allow for vaccination beginning at age 9, and vaccination up to age 26. The ACIP is considering changes to their recommendations that also would include women over age 26 and potentially men.”

Because HPV vaccines do not give complete protection against all HPV types or prevent other sexually transmitted diseases, all women, including those who have been vaccinated, should continue to have regular pap smears to screen for cervical cancer.

  • National Cancer Institute: http://www.cancer.gov/cancertopics/hpv-vaccines
  • Emory Winship Cancer Institute: http://cancer.emory.edu
  • Emory Vaccine Center: http://vaccines.emory.edu
  • (Information provided by Emory on this site is intended solely for general educational purposes and is not intended or implied to be a substitute for professional medical advice. Always seek the advice of your physician or other health provider for any questions you may have regarding your health and medical condition. If you rely on any information available through this website, you do so at your own risk. You understand that you are solely responsible for any damage or loss you may incur that results from your use of or reliance on any material or information provided by Emory through this website.)
  • Get your health news, Atlanta. Feel better. Visit ajc.com/health

    19 comments Add your comment

    Annelies

    June 15th, 2009
    7:06 pm

    To start with: there are 127 strains of the HPV-virus. Gardasil and Cervarix may protect against only the dangerous strains 16 and 18 and two innocent strains. That leaves 127 minus 4 = 123 strains of the HPV-virus left. Many can cause cancer. Merk and GSK and the docters don’t tell you this.

    Next thing you need to know, is that both Gardasil and Cervarix are NOT proven vaccines!! They’re only tested for six and a half years. You’ll need to be vaccinated every 3 to 5 years with this vaccine.

    ERGO: Gardasil and Cervarix are NOT anti-cancer-vaccines.
    We’ll know at least 15 to 20 years from now, whether these vaccines are working for the strains 16 and 18.
    That means : You can still get cervical-cancer after the vaccintion with Gardasil and Cervarix.

    Annelies Witlam.
    I.C.A.P. ( International Coalition of Advocates for the People )

    nic

    June 16th, 2009
    7:47 am

    Yikes!! So I guess no sex is the best way to avoid HPV, even if you are married. That is scary.

    AnneS

    June 16th, 2009
    8:09 am

    “Nicole Giacopelli, 17, gets a shot of the new cervical cancer vaccine Gardasil from her pediatrician, Dr. Jill Stoller, in Woodcliff Lake, N.J.”

    Let’s hope she doesn’t become one of the THOUSANDS that has an adverse reaction or dies from this vaccine.

    Aquagirl

    June 16th, 2009
    9:12 am

    Let’s hope unvaccinated girls don’t become one of MILLIONS killed or maimed by HPV due to hysterical scaremongers.

    Susan

    June 16th, 2009
    9:54 am

    Let’s hope the vaccine is useful and helps prevent cervical cancer.

    Peachtree

    June 16th, 2009
    11:52 am

    Right on, Aquagirl. And to Annelies — it is true that the vaccine protects only against four strains of HPV, but you totally neglected to point out that MOST cervical cancer and warts in the U.S. are caused by those 4 types, so your risk of getting cancer is thousands of times smaller if you get vaccinated. Also, you do NOT need to get a booster shot every 3-5 years — you obviously have no idea what you’re talking about. Finally, to say these vaccines are “unproven” is just silly — they have been tested far more thoroughly than most FDA-approved drugs. Let me guess that ICAP is just an organization you made up, since you clearly don’t really know anything about HPV or vaccines or medicine or science…

    Medicine Shoppe

    June 16th, 2009
    12:33 pm

    I work for Medicine Shoppe and thus far our pharmacists recommended that girls between 11 and 12 years of age receive the Human Papillomavirus (HPV) vaccine. It’s given as a series of three shots over the course of six months. Also, it’s highly recommended for girls between 13 and 18 years old if they have not yet been vaccinated. The good news is that older adult women are also seeing benefits from the vaccine. For more information about Gardasil ask your local pharmacist.

    tsmeg

    June 16th, 2009
    1:10 pm

    They actually do recommend getting a “booster shot” every five years, after receiving the first initial shots because the vaccine is only effective for four and a half years. The ingredients in the vaccine contain aluminum (which has been associated with Alzheimer’s and CANCER), and sodium borate, a boric acid, which is an insecticide and anti-fugal that’s been banned in the U.S. as a food additive because it is toxic to all the human cells, and those are just a few to name. The Journal of the American Medical Association reported that the vaccine is basically useless, “No significant evidence of a vaccine therapeutic effect was observed… it is unlikely that vaccination could have a significant beneficial impact on rate of lesion progression. There is little, if any, therapeutic benefit from the vaccine in the population we studied.” Diane M. Harper, M.D., a chief developer of Gardasil says that mandating the vaccine for young girls is ” a great big public health experiment,” and that ” the vaccine has not been out long enough for us to understand what all the potential side effects are going to be.” And she helped develop the vaccine! Some of the potential side effects are: genital warts, paralysis, blood clots, Bell’s Palsy, Guillain-Barre Syndrome, seizures, fever, nausea, vomiting, diarrhea, muscle pain, gastroenteritis, appendicitis, pelvic inflammatory disease, asthma, juvenile arthritis, rheumatoid arthritis, lupus, reproductive system complications ( 33 out of 70 pregnant women who received Gardasil experienced spontaneous abortion and fetal abnormalities) and vaginal warts. Young women need to be informed of all the information, good and bad, before the make an informed decision.

    Cancer Survivor

    June 16th, 2009
    2:32 pm

    I agree with Annelies. This is all true. But here’s the bigger thing they aren’t telling you. THE VACCINE IS EFFECTIVE IN THE MALE POPULATION, that spreads the vaccine. IF all the males were vaccinated, there would be no need to vaccinate young girls, but according to a recent paper it isn’t “cost effective” to vaccinate the males. The reality is that when your daughter reaches out for birthcontrol they want to give her the shot first. I know first hand that cervical cancer is a killer. I had ONE sex partner and contracted the disease thanks to an unfaithful husband. As a result it was a complete hysterectomy for me. You would think I would be cheering the HPV vaccine, but I am not! And yes, you have to get a booster shot FOREVER. Translation: you aren’t totally covered and there is no “cure.” like they want to announce. Young girls have no idea that sex with multiple partners literally destroys your body. Years from now when they want children of their own, I fear it shall be too late for them to learn this valuable lesson.

    Annon

    June 16th, 2009
    3:27 pm

    The Journal of the American Medical Association (JAMA, June 16th 2009) has very favorably reviewed a book on “The HPV Vaccine Controversy: Sex, Cancer, God and Politics” authored by Shobha S. Krishnan, M.D, Barnard college, Columbia University. The book is to educate both professionals and the public about HPV infections, the diseases they cause and the role/ controversies surrounding the new vaccines. The book is written without the influence of any pharmaceutical companies or special interest groups and is available at amazon.com and Barnes and Noble .com. Link to the book: http://www.greenwood.com/catalog/C35011.aspx

    Aquagirl

    June 16th, 2009
    4:46 pm

    Hey, tsmeg, nice spin. That quote about Gardasil being useless was in a study of women who ALREADY HAD BEEN INFECTED. It didn’t help them clear the virus quicker. Quote mining is a tactic of propagandists like the quack who wrote that article. It’s deliberate misinformation. And you spread it around like it’s okay to LIE.

    I completely agree anyone who has a vaccine (or parents who give permission) should be fully informed. Your cut-and-paste lies are the problem….people read that crap and think it’s valid information because its on the internets tubes. People who read unbiased information and think rationally are the ones overwhelmingly in favor of vaccinations.

    You should be ashamed of yourself.

    RA

    June 17th, 2009
    11:43 am

    If you believe in informed consent then why didn’t you criticize the good doctor’s letter for not disclosing the other side of the coin: side effects.

    This is 30 girls have died. Many cases of paralysis and neurological side effects have occured. And there is no proof that this vaccine prevents cancer. It takes years to prove show that inference. That study wasn’t done. All that has been proven is it seem to prevent HPV (4 strains). Time will only show if the cases of cervical cancer rapidly and dramatically decrease. Which they won’t.

    People are believing in a vaccine that

    RA

    June 17th, 2009
    6:24 pm

    “Let’s hope unvaccinated girls don’t become one of MILLIONS killed or maimed by HPV due to hysterical scaremongers.” – aquagirl

    Millions killed by what? 11,000 women get cervical cancer in the U.S. 3500 die from cervical cancer. Not all cervical cancer is caused by HPV. Not all HPV cervical cancer is caused by the 4 strains covered by gardasil. Not once single study has shown that gardasil prevents cancer.

    Who’s the one being irrational and a fearmonger?

    itamazesme

    June 19th, 2009
    10:01 am

    my daughter is going through the series of shots right now. I say everyone should get the shots. I am having my teen vaccinated not because she is sexually active but because i was diagnosed with cervical cancer in november of last year.

    Great Article – I would rather risk my child having a slim chance of an adverse affect then to have her endure what i have to

    itamazesme

    June 19th, 2009
    10:03 am

    RA – I am living it – it is better to hope in something than to have NO HOPE at all.

    RA

    June 21st, 2009
    9:35 pm

    You are so very true. It is better to have hope. No hope at all is not a good situation. This is exactly what a lot of oncologists are wary of. They (and I’m generalizing here) believe that the worst thing you can give a patient is false hope. But the worst situation is hopelessness. I just hope that people aren’t misplacing there hope and putting it into a vaccine.

    I hope that I said “hope” enough to let you know that I believe in hope. And the vaccine is not the answer.

    J

    July 26th, 2009
    11:39 pm

    RA — it is quite obvious how you feel. I’m not going to put my opinion down about this topic, and I’m not disagreeing or agreeing with you about the vaccine. However, I think that once your opinion has been stated, it is often a good idea not to beat everyone over the head with your opinion. We get it. It has been said. Now please move over so that others can comment. This is a comment section, not a message board. And so I don’t act hypocritical, this is the only message I’m leaving on this health topic.

    [...] DOCTOR IS IN: HPV vaccines, cervical cancer and you [...]

    Annelies

    September 28th, 2009
    9:57 pm

    http://www.dailymail.co.uk/news/article-1216714/Schoolgirl-14-dies-given-cervical-cancer-jab.html#ixzz0SQZIbILK

    I have contact with, several parents in America, who’s daughters died after getting Gardasil, the American Cervarix. The product is the same.I also have contacts with many, many parents around the wolrd who’s daughters are very, very sick due to either Cervarix or Gardasil. P.e.: Asleigh Cave, a 14 yesr old Englisch girl, paralysed due to Cervarix.

    The most shocking facts are, that her mother Cheryl is beiing acused of Munchaussen by Proxy, because she kept saying Asleigh is paralised due to Cervarix. Ashleigh is still in the hospital for nearly a year now and placed in custody of the gouverment.

    What does this mean?

    The gouverment does’nt want to be acused of giving dangerous vaccine’s to young girls ? Apperently so. But they do !!

    The most extreme information I got the past few month’s, about Gardasil, Cervarix and the up-comming Mex.flu vaccine: Farmaceutical company’s are no longer responsible for, adverse reactions or death due to the vaccine. I beg you’re pardon?

    This means, that when you’re little girl becomes sick, paralysed or even end’s up death, nobody is responsible.

    In the Netherlands our Min. of Health is completly silent about the absolute adverse reactions of Cervarix.
    We have sued our Min. of Health last Friday on the up-comming very , very dangerous Mex.flu vaccine. Belgium and France did so too.
    The Cervarix-programme is expelled for now. ( That gives us more time to spread the information).

    We are working international about Gardasil, Cervarix and now the very, very dangerous Mex.flu vaccine. Google: Thimerosal, polysorbate 80, Triton X100, and most of all MF59, and search for a Nano-supplement as named in both Baxter and Novartis patent-applications for their Mex. Flu vaccine.
    I won’t tell you because I want you to learn for yourself. People only believe what they see for themselve’s ; I gave you the clue’s.