Monday, March 29, 2010

Pre- Gardasil Essential for Sexually Active Women—the HPV Test

Question: would you get a possibly risky vaccine if you thought it was going to be of little, if any, benefit?

Answer: yes, if you follow current medical advice and fail to do your own risk/benefit analysis.

Gardasil, the anti-HPV vaccine that is marketed for the prevention of cervical cancer, is currently approved for use in girls and boys from age 9 to 26 in the US. It’s also approved for women up to age 45 in Australia and may soon be approved for women up to age 45 in the US, too.

However, Gardasil doesn’t cure existing infections. There’s even some evidence that it might cause existing infections to become persistent—Merck’s trial originally showed that women with existing infections were more than 46 percent more likely to suffer a lesion, although they then determined that the study was “unbalanced.” After subtracting women who had extra risk factors, such as a smoking habit, Merck found that the vaccine conferred a very slight benefit. Overall, the combined studies showed an extra risk of a little more than 11 percent from vaccination with Gardasil for infected women. Even in clinical trials that include only uninfected women, so far the results come in at just a 17-45 percent reduction in cervical abnormalities caused by all types of HPV.

Since up to 80 percent of women will be infected with HPV at some point in their life, particularly in the earlier, usually more sexually active years, it’s recommended that the vaccine be administered—at a cost of roughly $500, including the $360 cost of shots and administration—before a child becomes sexually active.

That makes sense as long as you’re OK with the potential side effects. (The FDA says those are limited to fainting and blood clots, although it’s looking into some mighty peculiar cases of rapid-onset ALS “mediated by immune response.” Anecdotal evidence shows a possible risk of post- Gardasil autoimmune disease and neurological issues, including intermittent and ongoing paralysis, seizures, arthritis, Guillaine-BarrĂ©, Graves Disease, etc.; however, the FDA and CDC consider the links to be statistically insignificant.)

But I’m completely at a loss to understand why the CDC advises that getting an HPV test ahead of vaccination is unnecessary.

Sure, that’s almost certainly true for a kid who has yet to have sex. Although HPV has been found in non-abused children, even newborns, because the virus is spread skin-to-skin, the vast majority of cases are spread sexually. (Of course, the obvious issue here is that, if you can find an older teenager willing to say in front of their parents that they’re having sex—wow.)

And there are limits to the effectiveness of the HPV test. Although the current test is sensitive to 14 high-risk strains, it can’t yet tell you which strain you’ve been infected with, though a follow-up test IS available that can check for extra-high risk 16 and 18 if the first test is positive. It can’t tell if you have a “hidden” infection, nor can it tell you if you have had HPV in the past and are now almost certainly immune to that strain.

We also have to get over the idea that we have sweat sleeplessly or go in brandishing swords if an HPV test is positive. It’s positive? So what? Your immune system is just busy working on flushing it out and creating an immunity. What YOU have to do is work on supporting your immune system by eating your fruits and veggies, giving up the ciggies and getting enough zzzzs. You also have to protect any partner(s) with some very safe sex. Then get another test in a year or so.

Right now, the HPV test is recommended only for women older than age 30 in combination with Pap smears. (And it’s worth noting that when you get a combination Pap/HPV test, you can relax with a 99.84 percent certainty that you won’t develop cervical cancer within the next three years if the results are negative. Seems like a no-brainer to me.)

However, if it were me contemplating getting three expensive and not-without-risk shots of Gardasil or Cervarix, I’d sure want to find out, as best I could, whether there was any point at all.

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