Don’t bash Melinda Messenger. Anxiety about the HPV vaccine can’t just be ignored

Dr Chris Steele, the resident doctor of ITV’s This Morning, took Melinda Messenger to task on the show last week. The issue was her unwillingness to give her daughter the HPV vaccine. She had written an article on the subject for the Daily Mail and Dr Steele suggested her decision should not have been made public as it would affect the choices of other parents.

The HPV vaccine, when it was introduced, was a game-changer. It may prove in the years ahead to be one of the great public health interventions of recent times.

Every year almost 300,000 women die of cervical cancer, the vast majority in developing countries. Death rates from cervical cancer in developed countries dropped by 80 per cent after the introduction of pap smear screening, which was itself a spectacular success, identifying abnormal cell changes years before they become cancerous, thus allowing us to treat and monitor higher-risk women. In the UK alone, around 3,000 women a year are diagnosed with cervical cancer, of whom almost 70 per cent will be alive five years after diagnosis.

Seventy per cent of the two most common types of cervical cancer, squamous and adenocarcinoma, are caused by the human papilloma virus (HPV). Other high-risk subtypes are also implicated. HPV can cause not only cancers of the cervix but also vagina, anus, vulva, penis and oral cavity.

Seventy-five per cent of sexually active adults are exposed to HPV; 90 per cent of women will clear the virus from the body within two years of exposure, thus leaving 10 per cent with chronic infection at higher risk of cervical cancer if they contracted the higher-risk subtypes.

It is estimated that the impact of the HPV vaccine, administered to young girls in varying protocols around the world, will lead to a significant decrease in the number of women contracting and dying of cervical cancer. (But, regardless of the vaccination, all women will still require regular pap smears.)

The two major vaccines available are the Cervarix vaccine and the Gardasil vaccine, which each cover different subtypes; both have demonstrated a 90 per cent effectiveness at preventing future infection.

Arguments against the vaccine have in the main been exposed as fallacies. Fears that the vaccine would somehow increase teenage sexual precocity and lead to higher rates of promiscuity have been unfounded.

Concerns that the vaccine might be useless for those already exposed to HPV or even to other strains of HPV have been allayed by the fact that protection against certain strains seems to cross-protect against others in many cases.

Where I part company with my colleagues is the almost brusque dismissal of potential vaccine side effects as nothing more than ‘unproven reports’. I have worked in gynaecological oncology and taken care of women with cancer — I look forward to the day that I or my descendants can refer to the conditions in the past tense. That hope, however, has to be tempered with the knowledge that no medical advance has ever occurred without being accompanied by complications or side effects. We will not gain the trust of patients if we dismiss their concerns out of hand.

The most common side effect of the vaccine is pain at the injection site, occurring in 85 per cent of patients. Fainting, dizziness, headaches and skin rashes occur half the time. The potential side effects of the vaccine considered in various papers is considerable (including chronic fatigue, nausea, swollen joints, gastrointestinal problems, drowsiness, menstrual disorders, bronchospasm). But these were found to occur no more frequently in vaccinated versus non-vaccinated girls.

Additional studies into the alleged link between potential side effects have also found no relationship between the vaccines and these conditions.

Two more serious potential complications — complex regional pain syndrome and postural orthostatic tachycardia syndrome — have been investigated in a comprehensive review by the European Medicines Agency and no link was found.

The potential long-term impact on ovarian function of the HPV vaccine is currently being studied; over 200 premature ovarian failure occurrences have been reported to US authorities following administration of the HPV vaccine. Statistically this may be insignificant but it still represents over 200 young women who have had their lives changed permanently. It has caused sufficient concern for the American Academy of Paediatrics to issue a warning drawing attention to this potential side effect.

I do believe that every case of a young man or woman falling ill after vaccination must be looked into. These are not simply numbers on a spreadsheet.

Thus far, however, the weight of evidence is overwhelmingly reassuring. To parents on both sides of the argument I would say we have a vaccine that has the potential to save lives, that has been studied extensively and that, after nine years of use, has proven to be safer than many other medical interventions.

Regardless of whether they have been vaccinated, women will still require regular pap smears to detect the changes that lead to cancer, so choosing not to vaccinate your child or even leaving the decision to them for the future should not be turned into a moral stick with which to beat people over the head with.

Either way, women will be screened regularly and those without the vaccine will not simply be left to their fate.

  • Eliz52

    I think many of us are sick of being ordered into cancer screening and with no “real” information. Cervical cancer has always been a fairly rare cancer in the developed world, despite the hype. (0.65% is the lifetime risk)
    There are no randomized controlled trials for pap testing, a must for all population cancer screening programs.
    We do know that huge numbers of women have been worried sick and harmed by over-screening and inappropriate screening, and often the screening is without informed consent, sometimes with no consent at all. (you need one for the Pill, not true, this would be like saying, men need a colonoscopy before they can have Viagra) Almost all of this damage was avoidable if we’d followed the evidence and put women first, and respected consent and informed consent.

    It should be a scandal that women have been treated like mere bodies to be herded up for screening. No responsibility is taken for those left worse off…damage to the cervix can lead to health, psych and obstetric issues.
    No one wants to know about this large group of women.
    Here in Australia where serious over-screening has been in place for decades, 77% of women (who follow the program) end up having a colposcopy/biopsy.
    Over-screening provides no additional benefit to women, but leads to more false positives, excess biopsies etc. (and it wastes a fortune)
    The fact is almost ALL women are HPV- and cannot benefit from pap testing (but can be harmed by false positives and over-treatment) and women can test themselves for HPV easily and reliably, no need for a speculum exam.

    Programs should never be left to vested interests, but should be independently assessed, reviewed regularly, and change with the evidence.
    Too often women are scolded if they choose not to screen or to screen less often or use something like HPV self-testing; screening for women is presented as mandatory, a must, this is wrong at every level.
    We talk about equal rights for women, yet permit these programs to abuse the legal rights of women and to cause worry and harm.

    There was never a need to harm so many to help a few women, look at The Netherlands and their evidence based program.
    No population pap testing, just 5 HPV tests or HPV self-testing at 30,35,40,50 and 60 and a 5 yearly pap test is ONLY offered to the roughly 5% of women who test HPV+
    MOST women are HPV- and having unnecessary pap testing, excess biopsies and being over-treated.
    I’d be cautious with Gardasil and wouldn’t trust a word coming from the medical profession, I’ve listened to them give misleading and incomplete information to women for decades in relation to pap testing and breast screening. Unethical tactics have been used to boost screening numbers, can you believe celebrity endorsement is used to promote breast screening?
    I don’t have either test, HPV- women cannot benefit from pap testing, and I believe the risks exceed any benefit with mammograms. (over-diagnosis and over-treatment is a serious risk) The Nordic Cochrane Institute is a reliable source of real information, it’s an independent, not for profit, medical research group.(head over to their website)
    So I’d urge people to do their own research with cancer screening and Gardasil and say NO if it doesn’t meet your risk v benefit assessment.
    People should not be bullied, judged and silenced if they choose not to screen or have concerns about Gardasil – in fact, that says to me we have to be even more careful. Bullying says to me, stop, take your time here, do your research, ask questions and make an informed decision. It’s important too to find a doctor who’ll work with you, not simply expect you to screen. I also strongly disagree with paying doctors to reach cervical screening targets, this potential conflict of interest is never mentioned to women.

  • ID

    What’s all this about all women will still need to have pap smears? Surely it is a personal choice whether to submit to this test or not? The vast majority of women will clear the virus or not get it at all. Those who have been vaccinated have reduced their risks even further and may make an informed decision based on their lifestyle to decline a very invasive test for something they are highly unlikely to get. The choice is theirs, and patronising policing of women’s bodies should stop.

  • Ananas Merveilleux

    What I fear is that based on the majority, the minority will have to submit to unnecessary health interventions that don’t even apply to them, or face some sort of punitive consequences. For instance, full disclosure (TMI): I have never, er, fooled around and fell in love as Elvin Bishop said. Giving me this vaccination for something that I likely will never get is ludicrous, and just pumps me full of additional junk that I’m already preventing on my own by living a lifestyle that most people would find boring, to say the least.

    What’s next, the AIDS vaccine that’s supposedly on the horizon? Now with the gender identity chaos in full swing, will I have to submit to a prostate exam too (since apparently, there are “women” — cheap imitations, as far as I’m concerned, but them’s fighting words in some jurisdictions — who have prostates), even though I obviously am not in possession of one?

    I’m no Luddite or anti-vaxer in the least, but a lot of this modern medicine is a racket whereby the medical establishment has taken to cleaning up the messes of irresponsible people who simply don’t look after themselves and expect other people to mitigate the consequences. People wouldn’t get diabetes if they ate properly. They wouldn’t get liver failure if they didn’t drink to excess. And they certainly wouldn’t get STDs if they weren’t getting their jollies off anything with a pulse.

    People need to take responsibility for their own health. HPV is a disease that you choose to get. Unfortunately, the entitled me-first culture of “anything goes,” and the feminist war against “slüt shaming,” makes it incredibly difficult for physicians to counsel patients on lifestyle modifications that could improve their health and cut down on some of the overbooking that doctors have too.

    But alas, it seems the absolute right to şcreŵ around with impunity has become sacrosanct in our society. It’s one thing for doctors to encourage patients to eat better and drink less. But telling them to find a hobby that doesn’t involve Tinder, or go home and play Han Solo instead of hooking up with everyone at Mosley’s Cantina, is downright blasphemy that brands you a backwards bigot.

    I have never heard of Melinda Messenger (sounds like the code name for a chatroom program that Microsoft never developed?) but she is absolutely right to take interest in and express concern about her daughter’s health. More parents should do so and stop trying to be “cool” and “hip” and “up with the times.” She’s doing the right thing, in being proactive about protecting her daughter. Parents who are nonchalant saying “they’re going to do it anyway” are guilty in my opinion of child abuse. Applause to this woman. There is a lot more at stake for the public health and the structure of society — everything from healthcare costs, to the demeaning and cheapening of women through sexualization of the culture — than a simple shot in the arm.