Los Angeles Times Examines Some Parents', Doctors' Reservations About HPV Vaccine Gardasil

Main Category: Cervical Cancer / HPV Vaccine
Article Date: 13 Aug 2008 - 11:00 PDT

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The Los Angeles Times on Monday examined the "serious reservations" some doctors and parents have about providing Merck's human papillomavirus vaccine Gardasil, which prevents transmission of strains of HPV that can cause cervical cancer, to young girls. According to data from Merck, about eight million girls and women in the U.S. have received at least one dose of the vaccine since FDA approved it in 2006 (Marsa, Los Angeles Times, 8/11). Gardasil in clinical trials has been shown to prevent infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases, and to prevent infection with HPV strains 6 and 11, which cause about 90% of genital warts cases (Daily Women's Health Policy Report, 7/24).

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and CDC have recommended that Gardasil be part of routine immunizations for middle-school age girls. Joseph Bocchini, chief of pediatric infectious disease at the Louisiana State University's Health Sciences Center, said the vaccine could prevent girls from experiencing psychological and physical pain following abnormal Pap tests. Gardasil "can actually prevent these infections and the cervical abnormalities that require more invasive interventions," Bocchini said.

Despite the recommendation of most medical groups, some doctors and parents are wondering whether the vaccine's benefits "outweigh its costs" and whether the shots offer any more protection than regular Pap tests, the Times reports. Some physicians and parents also are concerned that girls who receive the vaccine could be "lull[ed]" into a "false sense of security" that they are protected against HPV and cervical cancer and thus leads them to neglect regular cancer screening, which could boost cervical cancer rates, according to the Times.

Karen Smith-McCune, an ob-gyn at the University of California-San Francisco School of Medicine, said a widespread vaccine program might not be worth the overall cost. She said that it takes years for cervical cancer to develop so it is easy to prevent if HPV infection is detected early. Women overall have a low risk of developing cervical cancer and that up to 90% of HPV infections clear on their own. "The crux of it is that we know how to prevent cervical cancer," Smith-McCune said, adding, "One of the key questions is whether this huge outlay of money for the vaccine is a better strategy than reaching out to the women who aren't getting Pap tests and follow-ups."

In addition, some parents and doctors have expressed concern about potential side effects of the vaccine. Although FDA did not find serious side effects prior to approving the vaccine, an analysis by the public interest group Judicial Watch found nearly 9,000 negative side effects since the vaccine's approval. Laurie Markowitz, an epidemiologist at CDC, said it is difficult to determine whether the vaccine caused the side effects noting that the serious events could have happened in the absence of the vaccine. "The CDC and FDA checked out these reports very carefully," Markowitz said, adding, "And we've done calculations for the number of cases reported and the number of cases that you'd find in the general population and we have not found an increase."

Diane Harper, director of the Gynecologic Cancer Prevention Research Group at Dartmouth Medical School, said that the decision to administer Gardasil "should be up to parents," adding that efforts to mandating girls to receive the vaccine "are silly." Harper added, "While the vaccine will improve the health of American women, its real benefit is in the developing world. And no matter what, Pap screening shouldn't be neglected. That's still our best safety net" (Los Angeles Times, 8/11).

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