Last week brought the much awaited news that the FDA has cleared the path for approval of Gardasil, Merck’s HPV vaccine that promises to significantly reduce the risks of cervical cancer to women who are vaccinated before exposure to the virus. The studies reported that none of the women who received the vaccine developed precancerous lesions of the cervix during the study period! And, that’s great news!
Not only will the vaccine most likely significantly lower the rates of cervical cancer, but there are other great benefits as well: there will be way-fewer rates of genital warts (condylomata), because the vaccine also protects against some of the “low-risk” HPV subtypes. And, there will be significant cost savings by reducing the numbers of colposcopies, treatments, and follow-ups of these problems. Many of our young patients will be spared the sometimes traumatic first experiences with a gynecologist that these problems sometimes dictate, and they’ll avoid the potentially fertility-risking treatment procedures such as LEEP and conization.
There’s a lot that will need to be worked out and perfected with this in the years to come, like how to effectively vaccinate adolescents before they’re sexually active, whether to vaccinate boys (the vectors) or not, and whether to include additional less prevalent viral subtypes in the vaccines. But this is a great start.
Gynecologists see enough HPV-related disease to understand the importance of vaccination, but the problem is that we frequently don’t see young women until after they’ve become sexually active. (See my previous blog entry about new thoughts about timing the first visit with a gynecologist.)
The big picture is that 75% of high school students admit to having premarital sex, and that’s where these problems frequently start. As with most things, we tend not to address issues unless they’re right in front of our noses. The prospect of near-future sexual activity is something that most parents don’t want to think about with their young teenagers, but we’re going to have to get over that hump and make this vaccination a standard of care if we want to prevent this disease.
A couple of disclaimers: The availability of the vaccine in no way sends the message that having sex may be taken lightly. Abstinence and safe-sex programs still have their roles in pregnancy prevention, disease prevention, and psycho-social indications. And, the vaccine will not eradicate the need for a yearly gyn checkup and cervical cancer screening. Just because there will (hopefully) be far fewer abnormalities, doesn’t mean we’ll quit screening for cervix cancer and other problems.