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SKEPTOID BLOG:

Preventable Cancer on the rise in the US.

by Stephen Propatier

January 9, 2013

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Donate Some major cancers are declining, according the recent US annual cancer report. Human Papilloma Virus related cancer is not one of them. This is in spite of the fact that we have a very effective vaccine for prevention of HPV. Overall, the report shows lower cancer rates in the U.S. among all genders and racial and ethnic groups for the most common cancers, including lung, colon, anal, breast and prostate. HPV related cancers, like cervical cancer, are increasing despite the vaccine. This disparity is blamed on the poor rates of vaccinations in young boys and girls.

What is the reason for this apparent failure? What can be done to fix it? Gardasil is a FDA approved vaccine for HPV. It protects against the HPV strains that can trigger cervical cancer and genital warts. It has been in use since 2006. In 2009 Cervarix was approved and became another vaccine option. Despite two options vaccination rates are poor. In 2010, only 48.7% of girls ages 13 through 17 received at least one dose of the three-dose HPV vaccine (Cervarix joined Gardasil as the second HPV vaccine in 2009), and only 32% received all three recommended doses. Considering the U.S. government's Healthy People 2020 target is 80% vaccination among girls ages 13 to 15 for all three doses, those immunization rates are lagging. Comparatively, vaccination rates are much higher in Canada, the U.K. and Australia."

Normally, I would point the finger of blame at the Anti-Vaccination movement as the primary culprit. In this case, the evidence points to other compounding factors. The anti-vax movement is alive and well in Canada, UK and Australia. Yet there are better HPV vaccination rates in those countries. So if the anti-vaccine movement is not solely responsible What other factors are involved?

In my opinion there are multiple factors contributing to the extremely poor vaccination rates. The recommended treatment age is a sensitive age for child-parent relationships. Fundamentalist religious groups regard the vaccine as indirect approval of teen sexual activity. There has been strong conservative resistance to education about the vaccine and requirement of the vaccine for children. The vaccine will also prompt a difficult discussion with children at a young age. The anti-vax rhetoric and fear mongering give parents a reasonable "out" to avoid a difficult proposition.

CDC recommendation:"Cervarix and Gardasil are licensed, safe, and effective for females ages 9 through 26 years. CDC recommends that all 11 or 12 year old girls get the 3 doses (shots) of either brand of HPV vaccine to protect against cervical cancer. Gardasil also protects against most genital warts, as well as some cancers of the vulva, vagina and anus. Girls and young women ages 13 through 26 should get HPV vaccine if they have not received any or all doses when they were younger. Gardasil is also licensed, safe, and effective for males ages 9 through 26 years. CDC recommends Gardasil for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not get any or all of the three recommended doses when they were younger. All men may receive the vaccine through age 26, and should speak with their doctor to find out if getting vaccinated is right for them. The vaccine is also recommended for gay and bisexual men (or any man who has sex with men) and men with compromised immune systems (including HIV) through age 26, if they did not get fully vaccinated when they were younger."

That is the sticking point for this vaccine. Making parents discuss a sexually related topic with 11-12 year old girls and boys. In the US sexuality is always an educational and political nightmare. It is a common theme in the US to avoid the topic or come up with unrealistic answers. IE: abstinence. If you add up parental hesitancy with anti-vaccination proponents fear mongering, like Michelle Bachmann, you get a medical fail.

Despite anti vax rhetoric multiple lines of good evidence show Giardasil is safe and effective. A study, published in the journal Archives of Pediatrics & Adolescent Medicine, researchers looked at the medical records of 189,629 girls and women ages 9 to 26 within the Northern and Southern California Kaiser Permanente health care systems. All the women received at least one dose of Gardasil between August 2006 and March 2008. By the end of the study period, 44,000 participants had received the recommended three doses of the vaccine. The researchers examined the rate of emergency department visits and hospitalizations for women in the two weeks following their vaccination and again a couple months later. Aside from some episodes of fainting and skin infections, the authors found no other safety concerns. There were some reports of seizures and allergic reactions, but a five-member safety committee of medical experts with no ties to the Kaiser study team or Merck and Co., which funded the study, concluded that these reactions were not related to the vaccine. Efficacy is documented in the research. Beyond that there is a strong statistical analysis demonstrating the clear benefits. In populations across differing ethnicity high vaccination rates equals low cancer rates and low vaccination rates equals high rates of HPV cancer.

If I offered a proven injection that would prevent pancreatic cancer people would line up around the block to get it. Call it a vaccine and several would get out of line. If I required people in the line to have a conversation with their pre-teen children about sex and STD's; the 47% figure for the HPV vaccine would correlate well with my theoretical line around the block.

Cancer is a terrible disease and everyone agrees that stopping cancer is a laudable goal. Religious fundamentalism, anti-vaccine rhetoric, and societal taboo's should not be stopping us from utilizing this vaccine. There are very few "good" trade offs in cancer treatment. Radiation, surgery chemotherapy are all risky, painful, and sometimes tortuous for cancer patients. Having a injection that prevents; lung cancer, colon cancer, breast cancer is a dream, nothing more. If we fail to take advantage of this treatment option we will be guilty of a criminal failure of the public health system for this generation. We must do everything we can to support this public health initiative. 21 states have initiated legislation for education or mandatory vaccinations, 41 states are considering similar legislation.

I would support mandatory vaccination for 9 year olds. I would love to see HPV related cancer rates fall by 85% in the next 20 years. This is easily achievable. We just have to have the will to step over the vocal minority and do what is scientifically reasonable.

I am very certain that some of the 12,000 young women with cervical cancer and the 3000 women who die from it annually wish their parents had considered it.

More Reading:

CDC Q&A for HPV

National Council for state legislature.

References:

http://seer.cancer.gov/report_to_nation/

 

by Stephen Propatier

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