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Chattanooga: New research raises questions on HPV vaccine

By: Emily Bregel
(Contact)

Included in this article

Tim Jones

A recent study calling into question the cost-effectiveness of a vaccine that helps prevent cervical cancer has not diminished Chattanooga gynecologists’ support of it.

“It’s the first thing we’ve had that’s worked this well,” said local gynecologist Lane Griggs. “If we can get this to be like a polio vaccine and get 100 percent coverage of young girls and maybe young boys, we could maybe wipe out cervical cancer.”

But some parents still have concerns about vaccinating young girls for a sexually transmitted disease, and a local doctor objected to the aggressive marketing of the vaccine, called Gardasil.

Cervical cancer can be caused by human papillomavirus, or HPV, the most common sexually transmitted disease, according to the U.S. Centers for Disease Control and Prevention.

The cost-effectiveness study, published in the New England Journal of Medicine, concluded that vaccinating against HPV makes economic sense for young girls but not for women in their 20s, even though the costly vaccine is recommended for women up to age 26.

The vaccine protects against two strains of HPV that cause 70 percent of cervical cancers, according to the drug’s manufacturer, Merck & Co.

Harvard School of Public Health researchers found that vaccine’s cost-effectiveness decreases steeply as women age. Also, the study assumed life-long effectiveness of the vaccine, which has not yet been proven.

An editorial accompanying the study raised questions about the lack of data on long-term effectiveness of the vaccine and criticized assumptions that it will not hinder natural immunity against the disease.

Local gynecologic-oncologist Don Chamberlain said he strongly supports vaccinating girls as young as 9 against HPV. But he said that financially it doesn’t make sense for the health care system to absorb the cost of vaccinating women who already are sexually active because of the high probability that they already have been exposed to the virus.

“For that population to expect the health care system to provide (payment for) that, when the cost-benefit ratio is so unfavorable, isn’t realistic,” he said.

The vaccine, which comes in a three-dose series over the course of six months, does not protect against 30 percent of cervical cancers, so the CDC still recommends that women get screened with regular Pap tests, which detect cancer or abnormal cells in the cervix lining that may lead to it.

State epidemiologist Dr. Tim Jones said the vaccine has been shown to be effective and very safe, despite thousands of adverse effects reported by the public to the U.S. Food and Drug Administration. Those effects, which may not have been caused by the vaccine, include cases ranging from fainting after the shot to reported deaths, according to the FDA. An FDA statement said it found no pattern to suggest the deaths were caused by the vaccine.

SOCIAL CONCERNS

The HPV vaccine has raised a number of concerns among some parents here who are reluctant to vaccinate their daughters against a disease that is transmitted through sex, doctors said.

Dr. Kirk Brody, a local obstetrician-gynecologist, said he has encountered a number of parents who did not want their children to get the vaccine.

“I think that the parents’ concerns are, ‘Well, am I sending my child the wrong message?’ I try to tell those parents that three shots is not gonna undo 17 or 18 years of morals that you’ve taught your child,” he said.

Kathryn DeNovo of Why Know Abstinence Education said the local group does not think a vaccine will alter the sexual behavior of teenagers. But the nonprofit does have concerns about possible mandates that might hinder parents’ ability to make the decision for themselves, she said.

A number of states are considering requiring the vaccine for school entry, while allowing for parents to opt out, and legislation mandating the vaccine has passed in Virginia. As of now, the state of Tennessee has no plans to mandate the vaccine, Dr. Jones said.

MARKETING PUSH

Some point to the aggressive, award-winning marketing campaign by Merck & Co. — featuring a commercial urging girls to become “one less” statistic — as overplaying the need for broad HPV vaccination.

Dr. Charles Adams, an internal medicine physician in Chattanooga, said direct-to-consumer marketing of prescription drugs is “highly unethical,” and Merck’s ads may be creating hype over a cancer that is not a big killer in the United States.

“If something gets put out through the right channels, then everyone believes it,” he said.

The National Cancer Institute estimates that 11,070 new cases of cervical cancer will occur in the United States in 2008. Comparatively, an estimated 182,460 women will be diagnosed with breast cancer in 2008.

Because of the widespread use of Pap smears, cervical cancer incidents and deaths have declined 50 percent in the United States over the last 30 years, according to the National Cancer Institute.

Signal Mountain resident Phyllis Mescon said the marketing of the vaccine convinced her that her 17-year-old daughter Caroline should get vaccinated.

“The first I heard I said, ‘She’s getting it.’ The marketing was very effective,” she said.

Despite the low incidence of cervical cancer in the U.S., it is nevertheless a highly lethal disease if not caught early, Dr. Jones said.

“Statistics are one thing, but if you’re a person that gets it, statistics don’t matter because it’s an awful disease,” he said. “My viewpoint is if anyone is dying from a preventable disease, we oughta do anything reasonable to prevent it.”

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