Thankfully, there is one cancer that I no longer have to worry about. I just need to figure out when exactly my seven-year-old twin daughters will have sex for the first time.
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In 2013, around 12,000 American women will be diagnosed with invasive cervical cancer and more than 4,000 will die from it. Globally, cervical cancer is the third most common cancer in women worldwide, killing >275,000 every year. But these numbers will go down, must go down, because cervical cancer is now a fully preventable disease. Or isn't it?
For us cancer researchers, good news is often not good enough and too spread apart. In this long war, we became weary of unfounded celebrations. When asked when exactly our discoveries will make a difference in the clinic, we balk and hesitate, as we have been scarred by the many times that our discoveries did not translate into a cure. Yet this time is different, this victory is unequivocal, scientific research has led to the development of vaccines that can make cervical cancer history. Now all there is left to do is to get people vaccinated. Startlingly, this seemingly simple objective is proving to be a monumental task.
Cervical cancer originates in the lower portion of the uterus, and if not detected and treated early it will eventually metastasize and kill. Virtually all cervical cancers are caused by the Human Papilloma Virus (HPV), which is present in about half of sexually active people. With the advent of easy diagnosis via Pap smears and effective surgical procedures, the rate of cervical cancer deaths dropped steadily in the U.S. during the 20th century, but the numbers have now stabilized. The disease remains a leading cause of death for women in developing countries, where access to screening and treatment is scarce.
The vaccines effectively create immunity against the cancer-causing HPV strains, and if deployed at a large scale they would eradicate cervical cancer as well as other HPV-caused cancers, such as penile cancer and head and neck carcinomas in both males and females. Shockingly, a number of economic, political, and ideological issues now blunt this phenomenal scientific achievement.
For developing countries that need these vaccines the most, the price tag is simply too high. The retail price in the U.S. is about 130 dollars per dose, with three shots required over six months. Encouragingly, the GAVI Alliance recently selected HPV vaccines for support, raising 4.3 billion dollars from donors and negotiating a price of 5 dollars per dose. In sub-Saharan Africa, the HPV vaccination campaign has gathered strong support from leaders and the population, and more than 30 million girls are expected to be vaccinated by 2020, yet another 300 million could benefit in low income countries.
Paradoxically, in the U.S. and other countries where the vaccines are free or affordable to many, unnecessary controversies are delaying their widespread use. Currently, only 30 percent of eligible girls and virtually no boys are receiving the vaccine. Why not? Some prominent politicians have promoted the unfounded claim that the vaccines are not safe. Science proves them wrong, as more than 46 million HPV vaccines had been given in the U.S. with an outstanding safety record. Shockingly, last year five Catholic bishops in Canada banned HPV vaccines from the Calgary Catholic School board, postulating that HPV vaccination would increase sexual activity in their youth. Again, science proves them wrong, as a recent study found no increase in sexual activity among those vaccinated. By the way, the international Catholic Medical Association has no ethical or scientific issue with HPV vaccination.
Perhaps the most insidious obstacle toward HPV vaccination resides in a nasty little parenting decision. When exactly should we vaccinate our boys and girls? The answer is key, because vaccines should be applied at least six months before the first exposure to the virus.
Which brings me back to the key question: when will my daughters have sex for the first time?
Well, in the very specific case of my twin seven-year-old daughters, I don't think vaccination will be necessary until they are in their early twenties, right? I think is fair to assume at this point that these precious little girls who love their daddy so much will wait until they graduate from college to have sex with their husbands during their honeymoons, right?
Wrong. Wake up, Joaquin.
The average American has their first sexual experience at 16.9 years of age.
Wow, really? Hold on a minute, that can't be right, I am sure they polled the wrong population. They must have surveyed some very liberal place, like Los Angeles or New York. I am sure that it was much later for women in my circle of friends. I am going to send a few emails to all these women that I respect and admire asking when exactly they had intercourse for the first time.
The answers are in: 17, 15, 14, 16, 14, 15, 14, 15, 16, 23 (the outlier). Average: 15.9. Darn it.
Okay, given the overwhelming evidence, I think I should vaccinate my girls when they turn 13.
Ouch. The thought of taking two 13-year-old teenagers to the doctor for an HPV vaccination is freaking me out. What if they start asking questions about the vaccine? What am I going to say, that it's just another flu shot? I could not possibly tell them the truth about the vaccine, because if I did it would surely lead to a conversation about sex. Now, that's scary. Furthermore, by telling the truth I would be implying that they are ready for sex, which of course they would not be. I wish I could vaccinate them right now, before this whole thing gets any more awkward.
HPV vaccines can be administered as early as nine.
OK, I will vaccinate them at nine. Better yet, maybe I don't have to be there; they could go with their mom. Yes, that's right, they will go with Mom.