Shame On Us: Poor Uptake of Cervical Cancer Vaccine by American Women

MIAMI, FL - SEPTEMBER 21:  University of Miami pediatrician, Judith L. Schaechter, M.D., gives an HPV vaccination to a 13-yea
MIAMI, FL - SEPTEMBER 21: University of Miami pediatrician, Judith L. Schaechter, M.D., gives an HPV vaccination to a 13-year-old girl in her office at the Miller School of Medicine on September 21, 2011 in Miami, Florida. The vaccine for human papillomavirus, or HPV, is given to prevent a sexually transmitted infection that can cause cancer. Recently the issue of the vaccination came up during the Republican race for president when Rep. Michele Bachmann (R-MN) called the vaccine to prevent cervical cancer 'dangerous' and said that it may cause mental retardation, but expert opinion in the medical field contradicts her claim. Texas Gov. Rick Perry, also a presidential contender, has taken heat from some within his party for presiding over a vaccination program in his home state. (Photo by Joe Raedle/Getty Images)

Many people complain about the lack of cures for cancer but when a preventative vaccine for a type of cancer is within our reach, too few reach out for it. Even worse, we are neglecting to protect our daughters.

It was not too long ago, as late as the 1940s, that cervical cancer was a major killer of women of childbearing years in the U.S. Fortunately in the U.S., the introduction of cervical cancer screening by the Pap test led to a 74 percent decrease in the incidence of cervical cancer from 1955 to 1992. More recently we have a new target against it. Scientists have identified that 100 percent of cervical cancers are caused by the human papillomavirus (HPV).

John Schiller, Senior Investigator at the National Cancer Institute, said "Discovering that a virus is the central cause of a cancer provides an exceptional opportunity to prevent cancer by preventing the initiating virus infection. It is certainly good news that a simple series of vaccinations now available will likely reduce a young women's risk of developing the second most frequent cause of cancer deaths in women by at least 70 percent." John Schiller, together with Douglas Lowry and colleagues, pioneered the development of the vaccine.

HPV is one of the most common types of sexually transmitted viral infections. More than 50 percent of men and women who are sexually active acquire HPV infection during their lifetimes. Usually the infection is cleared by our immune system but some women do not clear it and develop long-term (chronic) infection. Chronic HPV infection is the central risk factor for cervical cancer. Not all HPV infections lead to cancer -- of the 130 different types of HPV, two types (HPV16 and 18) account for about 70 percent of all cervical cancers. Two FDA-approved vaccines against HPV16 and 18, Gardasil (Merck) and Cervarix (GlaxoSmithKline), are available. Note that Pap testing is still necessary to protect against the other 30 percent of cervical cancers.

According to the National Health Interview Survey (2010) only about 20 percent of 13-17 year olds in the U.S. received the three recommended doses of HPV vaccine. In contrast, by 2009, 70 percent of 12-13 year olds in the U.K. were fully vaccinated. Canada's uptake is somewhere in between the two.

Why is the uptake so poor in the U.S., a country that leads the world in medical innovation?
The only acceptable excuse is lack of education. Foremost is the question of safety. The HPV vaccine is safe. Vaccines in general are safe medical interventions which are exceptionally effective. We have eradicated smallpox and cut the incidence of mumps, measles, and polio to name a few. The public scare regarding a supposed link between the MMR vaccine and autism was unfounded and caused great damage.

Because the HPV vaccine uses virus-like particles, it is even safer than some other vaccines that use intact viruses. These virus-like particles act as the shell of a virus without any life within. The body generates antibodies against this shell. In the future, these antibodies will recognize and bind to an invading virus and stop it from infecting cells.

The vaccine is preventative and NOT therapeutic which means that it must be given before exposure to the virus so that the body has time to trigger an immune response. The vaccine is recommended for girls at an age before engaging in any sexual activity. Having the vaccine does not imply, in any way, that the child is sexually active. Parents can weigh the risks and benefits of any medical procedure. In this case, one must weigh the tears due to a few injections at the age of 13 against the tears due to possible cervical cancer some years later.

Coincidentally there is an unexpected bonus. It has been discovered that the same strains of HPV which the vaccines protect us against is also responsible for an increase in head and neck cancers (probably transmitted by oral sex). So the same vaccine also guards against a second type of cancer.

The U.S. needs to have a national organized vaccination program similar to that of the U.K. which implements a national school-based vaccination program. This has proven to yield high coverage compared to on-demand provision. Parents, health professionals, teachers, and government need to get the message heard. Public advertisements and broadcasts should support such a campaign.

Come on USA, let's make use of the years of research that yielded the first cervical cancer vaccine. The vaccine is safe. Prevention is better than a cure.