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.
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.