Sunday, October 30, 2005

Will the New Cervical Cancer (HPV) Vaccine Encourage Sexual Activity?

...because fear of cervical cancer is a major reason why teenagers avoid sex.

From the Washington Post:
A new vaccine that protects against cervical cancer has set up a clash between health advocates who want to use the shots aggressively to prevent thousands of malignancies and social conservatives who say immunizing teenagers could encourage sexual activity.

Although the vaccine will not become available until next year at the earliest, activists on both sides have begun maneuvering to influence how widely the immunizations will be employed...
Technorati Tags: HPV, Cervical Cancer, HPV Vaccine, Cervical Cancer Vaccine

1 comment:

Anonymous said...

It's important to remember that the "new cervical cancer (HPV) vaccine" is still only one component of a comprehensive cervical cancer screening program. For the forseeable future, even the cohort of young women who were vaccinated in childhood (13-18 years from 2006, approximately) will continue to need conventional cytology based screening likely via Pap smear.

This is for many reasons. First, the vaccine works in vitro with a remarkable and exciting efficacy profile. What we don't know, however, is how this profile might change in vivo. Secondly, we do not know how long protection is conferred via the vaccine, e.g., when/if boosters are needed. Thirdly, we do not know the effect of behavioral and biological co-factors such as HIV infection or cigarette smoking, both of which have a profound effect on HPV. Furthermore, we do not know if the vaccine offers any benefit to those who are already sexually active.

Moreover, what if parents opt out of this vaccine in the way some do for other childhood immunizations? Finally, this vaccine will only benefit those who have not been exposed to HPV via birth or before sexual debut. For those of us who work with teens, we can attest to the wide variation in age of sexual debut as well as heterogeneity in parental knowledge of that debut. The converse of this is that the vaccine makes most sense for those who have never been sexually active meaning women today must still receive conventional screeniing. Many important sub-populations (African Americans, Latinos) in the U.S. have a lower uptake of medical resources in general and of immunizations in particular, so, there will never be 100% coverage.

Clearly, there remains a long-term role for cytology-based screening. Let us also not forget that the greatest global burden of cervical cancer is in developing countries. As a new vaccine, what will its price point be? Will it be offered at prices developing countries can afford (unlikely, given that Viet Nam, for example, has approximately US$4 per PERSON [not woman] for all Ministry of Health activities)?

While we in this country may have the luxury of debating whether introduction of this vaccine will encourage sexual activity, many women in developing countries do not have the power to negotiate their own reproductive lives. Perhaps a more globally useful question is How will the women who most need this vaccine afford and receive it?