It’s About Cancer, Not Sex

Wed, February 14, 2007


Cross posted from The Soccer Mom Vote

By the time I was a 28-year-old, third-year law student, I had been dutifully getting my yearly Pap tests and GYN exams like a good girl for well over a decade.

And every year, the Pap results came back negative. I annually congratulated myself for getting to the doctor’s office for the exam, even though I would rather have been doing my least favorite thing — reviewing my Federal Income Tax outline — than facing the stirrups.

Sitting at my groovy, second-hand formica kitchen table in my tiny law student apartment, I was opening my mail when I came across the letter from the doctor’s office. Assuming it was good news, as usual, I casually opened it and read its contents.

I couldn’t focus. I started to hyperventilate. I had to read it more than once to fathom the news — Stage 2 irregularities. Come in right away for additional testing.

Possible cervical cancer? At 28? When there had only been one person I had been with for the past four years?

Fortunately, there was no cancer, just “suspicious” cells that were dispatched as quickly as possible, hopefully never to return. But I have been reliving those terrifying moments a lot in the last few weeks, as there has been a major uproar by some over whether girls should be required to get a new vaccine that can prevent cervical cancer.

Thar’s right. PREVENT. CANCER.

For me, after that horrible scare that led to treatment and, I believe, issues that treatment may have caused with my fertility, I can’t believe there is anyone who would make a political cause out of trying to prohibit girls from receiving a vaccine that could spare them the scare of cancer.

But there are.

Certain vocal politicos want to make this an issue not about health and protecting lives, but about supposed morals and premarital sex, and oppose the use of the vaccine. Opponents claim that if we let young girls have a vaccine that would prevent the majority of cervical cancers, that will lead to increased teen promiscuity. As a result of this flawed logic, the Governor of Texas, and others, are coming under fire for ordering, or even considering, that all girls of a certain age receive the vaccine as a health issue.

The vaccine is recommended for girls ages 9 through 12 in order to give their immune systems a chance to develop the highest levels of antibodies needed before adulthood to fight off the virus that causes cervical cancer. Cervical cancer is the second most common cancer among women — second only to breast cancer.

So here is my question — if this vaccine prevented breast cancer, would there be any opposition?

It’s hard for someone who survived a bad scare many years ago, and who still must be vigilant just in case they didn’t get all those “abnormal” cells, to fathom how anyone could want to make an anti-cancer vaccine a political issue and not one about health and saving lives.

If there was a vaccine that was available today to prevent breast cancer or lung cancer or even prostate cancer, would there be the conservative outcry we’re hearing about a cervical cancer vaccine?

I think not.

I believe it’s safe to say there would be no opposition — everyone would be on board and there would be huge celebrations across the planet about such a miraculous medical breakthrough. But a handful of people are trying to make us believe that by protecting our daughters from most kinds of cervical cancer, which is caused by a sexually transmitted virus, that we are handing them a Get Out of Jail Free card in terms of their sexuality. That, in essence, parental approval of the vaccine equals telling our daughters it’s OK to be sexually active in your teens because you won’t have to worry about getting HPV.

I don’t know about you, but that sounds like a stretch to me.

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8 Responses to “It’s About Cancer, Not Sex”

  1. Lawyer Mama Says:

    Amen, sistah! I commented over on SMV too.

  2. stickdog Says:

    The Facts About GARDASIL

    1. GARDASIL is a vaccine for 4 strains of the human papillomavirus (HPV), two strains that are strongly associated (and probably cause) genital warts and two strains that are typically associated (and may cause) cervical cancer. About 90% of people with genital warts show exposure to one of the two HPV strains strongly suspected to cause genital warts. About 70% of women with cervical cancer show exposure to one of the other two HPV strains that the vaccine is designed to confer resistance to.

    2. HPV is a sexually communicable (not an infectious) virus. When you consider all strains of HPV, over 70% of sexually active males and females have been exposed. A condom helps a lot (70% less likely to get it), but has not been shown to stop transmission in all cases (only one study of 82 college girls who self-reported about condom use has been done). For the vast majority of women, exposure to HPV strains (even the four “bad ones” protected for in GARDASIL) results in no known health complications of any kind.

    3. Cervical cancer is not a deadly nor prevalent cancer in the US or any other first world nation. Cervical cancer rates have declined sharply over the last 30 years and are still declining. Cervical cancer accounts for less than 1% of of all female cancer cases and deaths in the US. Cervical cancer is typically very treatable and the prognosis for a healthy outcome is good. The typical exceptions to this case are old women, women who are already unhealthy and women who don’t get pap smears until after the cancer has existed for many years.

    4. Merck’s clinical studies for GARDASIL were problematic in several ways. Only 20,541 women were used (half got the “placebo”) and their health was followed up for only four years at maximum and typically 1-3 years only. More critically, only 1,121 of these subjects were less than 16. The younger subjects were only followed up for a maximum of 18 months. Furthermore, less than 10% of these subjects received true placebo injections. The others were given injections containing an aluminum salt adjuvant (vaccine enhancer) that is also a component of GARDASIL. This is scientifically preposterous, especially when you consider that similar alum adjuvants are suspected to be responsible for Gulf War disease and other possible vaccination related complications.

    5. Both the “placebo” groups and the vaccination groups reported a myriad of short term and medium term health problems over the course of their evaluations. The majority of both groups reported minor health complications near the injection site or near the time of the injection. Among the vaccination group, reports of such complications were slightly higher. The small sample that was given a real placebo reported far fewer complications — as in less than half. Furthermore, most if not all longer term complications were written off as not being potentially vaccine caused for all subjects.

    6. Because the pool of test subjects was so small and the rates of cervical cancer are so low, NOT A SINGLE CONTROL SUBJECT ACTUALLY CONTRACTED CERVICAL CANCER IN ANY WAY, SHAPE OR FORM — MUCH LESS DIED OF IT. Instead, this vaccine’s supposed efficacy is based on the fact that the vaccinated group ended up with far fewer cases (5 vs. about 200) of genital warts and “precancerous lesions” (dysplasias) than the alum injected “control” subjects.

    7. Because the tests included just four years of follow up at most, the long term effects and efficacy of this vaccine are completely unknown for anyone. All but the shortest term effects are completely unknown for little girls. Considering the tiny size of youngster study, the data about the shortest terms side effects for girls are also dubious.

    8. GARDASIL is the most expensive vaccine ever marketed. It requires three vaccinations at $120 a pop for a total price tag of $360. It is expected to be Merck’s biggest cash cow of this and the next decade.

    These are simply the facts of the situation as presented by Merck and the FDA.

    For a more complete discussion on GARDASIL with sources, click on my name.

  3. PunditMom Says:

    Stickdog, Cervical cancer isn’t deadly? It’s the second deadliest cancer for women. Let me know when you get a suspicious Papr smear and then let’s talk. Sure, there are probably issues with the studies, but for those of us who have had brushes with this type of cancer, not of our own doing, this could be a God-send. Don’t claim to be the bearer of “facts” when there are plenty of other facts that contradict.

  4. mhatrw Says:

    Cervical cancer is not even in the top 10 in terms of US cancer deaths, thanks to the extensive HPV screening in our country.

    In medical cost vs. benefit modeling (which strongly informs national medical public policy making and far too strongly informs the medical policies of HMOs), the most critical component is a value called “cost per life year gained.”

    If the cost per life year gained is under $50,000, that is generally considered a decent investment by US medical policy makers. If “cost per life year” gained is over $100,000, that is generally considered a wasteful medical policy because that money could surely be put to much better use elsewhere. Yes, this is cruel and heartless to some degree, but wide scale medical cost allocations do need to be made and, more relevantly, are continually made using these cost plus risk vs. benefit analyses. Think HMOs. Now consider why pap smears, blood tests and urine tests aren’t recommended every month for everyone. Testing monthly could definitely save more than a few lives, and there is no measurable associated medical risk. But the cost would be astronomical versus the benefit over the entire US population when comparing these monthly tests to other therapies, procedures and medicines.

    Now on to GARDASIL. By the time you pay doctors a small fee to inventory and deliver GARDASIL in three doses, you are talking about paying about $500 for this vaccine. And because even in the best case scenario GARDASIL can confer protection against only 70% of cervical cancer cases, GARDASIL cannot ever obsolete the HPV screening test that today is a major component of most US women’s annually recommended pap smears. These tests screen for 36 nasty strains of HPV, while GARDASIL confers protection against just four strains of HPV.

    Now let’s consider GARDASIL’s best case scenario at the moment — about $500 per vaccine, 100% lifetime protection against all four HPV strains (we currently have no evidence for any protection over five years), and no risk of any medical complications for any subset of the population (Merck’s GARADSIL studies were too small and short to make this determination for adults, these studies used potentially dangerous alum injections as their “placebo control” and GARDASIL was hardly even tested on little kids). Now, using these best case scenario assumptions for GARDASIL, let’s compare the projected situation of a woman who gets a yearly HPV screening test starting at age 18 to a woman who gets a yearly HPV screening test starting at age 18 plus the three GARDASIL injections at age 11 to 12. Even if you include all of the potential medical cost savings from the projected reduction in genital wart and HPV dysplasia removal procedures and expensive cervical cancer procedures, medicines and therapies plus all of the indirect medical costs associated with all these ailments and net all of these savings against GARDASIL’s costs, the best case numbers for these analyses come out to well over $200,000 per life year gained — no matter how far the hopeful pro-GARDASIL assumptions that underpin these projections are tweaked in GARDASIL’s favor.

    Several studies have been done, and they have been published in several prestigious medical journals:

    None of these studies even so much as consider a strategy of GARDASIL plus a regimen of annual HPV screenings starting at age 18 to be worth mentioning (except to note how ridiculously expensive this would be compared to other currently recommended life extending procedures, medicines and therapies) because the cost per life year gained is simply far too high. What these studies instead show is that a regimen of GARDASIL plus delayed (to age 21, 22, 23, 25 or 27) biennial or triennial HPV screening tests may — depending on what hopeful assumptions about GARDASIL’s long term efficacy and risks are used — hopefully result in a modest cost per life year savings compared to annual HPV screening tests starting at age 18.

    If you don’t believe me about this, just ask any responsible OB-GYN or medical model expert. Now, why do I think all of this is problematic?

    1) Nobody is coming clean (except to the small segment of the US population that understands medical modeling) that the push for widespread mandatory HPV vaccination is based on assuming that we can use the partial protection against cervical cancer that these vaccines hopefully confer for hopefully a long, long time period to back off from recommending annual HPV screening tests starting at age 18 — in order to save money, not lives.

    2) Even in the best case scenario, the net effect is to give billions in tax dollars to Merck so HMOs and PPOs can save billions on HPV screening tests in the future.

    3) These studies don’t consider any potential costs associated with any potential GARDASIL risks. Even the slightest direct or indirect medical costs associated with any potential GARDASIL risks increase the cost per life year gained TREMENDOUSLY and can even easily change the entire analysis to cost per life year lost. Remember that unlike most medicines and therapies, vaccines are administered to a huge number of otherwise healthy people — and, at least in this case, 99.99% of whom would never contract cervical cancer even without its protection.

    4) These studies don’t take in account the fact that better and more regular HPV screening tests have reduced the US cervical cancer rate by about 25% a decade over the last three decades and that there is no reason to believe that this trend would not continue in the future, especially if we used a small portion of the money we are planning on spending on GARDASIL to promote free annual HPV screening tests for all low income uninsured US women.

    5) The studies assume that any constant cervical cancer death rate (rather than the downward trending cervical cancer death rate we have today) that results in a reduced cost per life year gained equates to sound medical public policy.

    As I said before, if any of you don’t believe me about this, please simply ask your OB-GYN how the $500 cost of GARDASIL can be justified on a cost per life year gained basis if we don’t delay the onset of HPV screening tests and back off from annual HPV screening tests to biennial or triennial HPV screening tests.

    The recommendations are already in:

    The USPSTF strongly recommends … beginning screening within 3 years of onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 years …

  5. Gunfighter Says:

    “…a handful of people are trying to make us believe that by protecting our daughters from most kinds of cervical cancer…that we are handing them a Get Out of Jail Free card in terms of their sexuality.”

    Only the stupid people/ PM

  6. Mamacita Says:

    Hmmm, now I’m really confused. Also, with two teenaged daughters, 13 and 16, I’ll have to make up my mind soon. Great discussion, though!

  7. Kelley Says:

    I agree, PunditMom: opposing the vaccine on the basis that it would lead to increased promiscuity is just plain ridiculous.

  8. coolbeans Says:

    “…opposing the vaccine on the basis that it would lead to increased promiscuity is just plain ridiculous.”

    Of course it is. But it’s not ridiculous to keep an eye on how this vaccine is marketed and pushed for other reasons. Most of those have been addressed in previous comments.

    I want my daughter to have a choice whether or not to receive this shot. The reality is that by the time she’s 12, it will likely be on the “routine” list. If this is indeed the reality in a few short years, there will be those who cite statistics celebrating the decline in cervical cancer rates since the shot became available. But those numbers have been dropping on their own – without a shot.

    Please visit this site. Compare the numbers for breast cancer and cervical cancer. There is a big gap in those numbers. To compare cervical cancer to breast cancer is apples and oranges. Also, look at the numbers for ovarian cancer. I might be reading these numbers all wrong, but how is cervical cancer “the second deadliest cancer for women.”?

    This boils down to the medical and pharmaceutical communities being responsible in fact reporting and not exploiting our fear of the word “cancer” no matter what organ name precedes it.

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