Wednesday, February 25, 2009

The Outrageous Jade Goody: Food for Thought about Gardasil and Cervical Cancer

Jade Goody, Britain’s brash reality TV celebrity, is still sparking controversy and discussion even while she’s dying.

Goody’s personal tragedy has done more to highlight the importance of regular smear tests and the risks of casual sex and smoking than perhaps anything else in the UK. When she found out—very publicly—that at the young age of 27 she is unlikely to survive the cervical cancer that has metastasized to her bowel, liver and groin, the rate of women seeking Pap smears in Britain soared by 21 percent.

So what’s to think about? Well…

Is HPV Getting Worse?

International focus on Jade Goody’s case threw up some unpleasant statistics.

Smear tests detect pre-cancerous changes, called CINS, as well as actual cancer. CINS are caused by persistent cases of HPV (human papillomavirus), a very common STD that normally resolves itself. However, in Britain the incidence of cases of the highest grade of pre-cancerous change, CIN3, in 20-24 year-olds has risen from 15.8 percent of all cases in 1999 to 19.3 percent of all cases in 2004.

This seems to suggest that any or all of the following are true:

· HPV incidence and virulence is worsening.

· Young women’s immune systems—healthy immune systems are the reason that most HPV cases clear up on their own—are weakening. Britain’s diet has notoriously deteriorated in the past decade, while the prevalence of smoking in the UK is greater in the 20-24 year old age group than in any other, and girls are now more likely to smoke than boys. Smoking increases the chance of an HPV infection becoming persistent by up to 27 times.

· Girls are having more unprotected sex with more partners at a much earlier age.

Bottom line: Regardless of whether you think Gardasil’s a good thing or not, take HPV seriously. Consider that it may be worsening (one of the fears about Gardasil is that it may create fiercer replacement diseases) and take the necessary steps to protect yourself.

Screening Age Row

And then there’s the NHS row. According to the Journal of Family Planning and Reproductive Health Care, researchers are upset with the 2004 NHS (Britain’s National Health Service) decision to quit offering Pap smears to women younger than 25 in England (women in the rest of Britain can still have the test at 20).

The NHS says that it is following guidelines set by the International Agency for Research on Cancer because cervical cancer in under-25s is extremely rare, but changes in the cervix are very common. Screening at 20 could therefore result in unnecessary, frightening, and potentially harmful interventions.

But Professor John Shepherd, a cervical cancer specialist and spokesman for the Royal College of Obstetricians and Gynaecologists, notes that some ten percent of cases are found in women under 30, and believes that younger women should be screened. Experts also note that fewer women come for the test when they start later, perhaps because it has not become a regular part of their adult life; they’re also concerned that women who have had the Cervarix vaccination will think they are fully protected and ignore the necessity for smear tests. Would Jade Goody be looking at a happier outcome had she gone for a Pap smear at 20 or even 25?

Bottom line: The American Cancer Society currently recommends starting regular screenings by three years after becoming sexually active, or by the age of 21, whichever comes first. Do it, whether or not you’ve had the Gardasil shot. Or, if the NHS/IGR guidelines make sense to you, discuss them with your doctor and, at the very outside, get the test by age 25.


Anonymous said...

I enjoy reading your column. It's always seems quite sensible to my way of thinking.
I suppose if a person is sexually active at a very young age, with multiple partners, and had the bad habits of smoking and poor diet that lower the immune system, then cervical changes before age 25, may be more likely to have happened. Can a person pay for a pap test privately? (I"m not from the UK)
Since the Gardasil shot only protects for 2 strains of HPV that cause cervical cancer (and 2 wart causing strains),then I don't see that as the answer.

My daughter took the shot and her health has been changed with auto immune symptoms, aching joints, severe fatigue, headaches, etc. Before the vaccine,she had a healthy good lifestyle. For her, it wasn't worth the risk.

My hat is off to you for writing this column to get the word out. The public needs to be taught to care for and respect the one and only body that is their own.

Anonymous said...

My daughter's health has changed since taking the vaccine too as she has developed epilepsy. We live in the U.S. and my charge to Merck is how it created a frenzy about HPV & Cervical Cancer. According to the American Cancer Society, cervical caner is not the its list of top 10 deadliest cancers. Cervical cancer rates have drastically been reduced thanks to annual paps tests. 3rd world countries have the HPV/cervical cancer battle, but the USA does not.

Kristin Johns said...

To the first commenter:

Thanks for the nice compliment. As to getting a smear test privately, I'm sure it's possible, but I live in the US so that's mostly what I know about.

However, I have also experienced the ministrations of the NHS. I'd imagine that under-25 NHS patients could get a Pap smear quite easily if they asked the right way. If it were me, I'd trot in there and say (ficticiously, I assure you!)that I'd been having it away with multiple partners six ways from Sunday since I was 13, smoke like a chimney, and eat nothing but donner kebabs. Refusing a Pap smear under those circs would be professional suicide.

I do also think, however, that if I hadn't ever had sex (are there any women under 25 like that?)I'd follow the English guidelines, not the ACS ones.

I'm sorry to hear about your daughter. The potential for auto-immune disease is, I think, one of the scariest things about Gardasil.

Kristin Johns said...

To the second commenter;

I couldn't agree more with you, although I do worry that HPV is becoming nastier.

Personally I don't believe Gardasil is the answer because of its inherent limitations, and the Prevnar/replacement disease parallel unnerves me; however I'm not sorry that I became far more aware of HPV as it's definitely something that I need to talk to my kids about.

Epilepsy? I'm so sorry. Has it continued or was it limited to convulsions afer the shots?

Anonymous said...

see this video about the side effects of Gardasil:

Anonymous said...

To say that HPV is not an issue in America is an understatement. People who believe that are part of the problem, and why more and more people are contracting this STD. There needs to be more awareness on this issue. Women need to know that it is VERY important to stay up to date on their annual pap smears. Just because you have ALWAYS had normal pap smears and have been in a relationship with the same person for years upon years doesn't mean that you are safe. HPV can lay dormant for YEARS. It is VERY important to stay consistent with your pap smears!