Cancer is bad; cancer prevention is good. That seems simple enough, but the recent controversy over Gardasil, a vaccine for cervical cancer, doesn’t seem to be going away

Gardasil produces immunity to four strains of the sexually transmitted human papilloma virus (HPV), which cause cervical cancer and genital warts. This year the governments of Ontario and the Atlantic Provinces intend to use the drug as part of a program to immunize teen and pre-teen girls. A similar Gardasilbased program for girls in BC is being considered for next year. Meanwhile, opposition to the immunization programs is coming from some highly credible sources.

A Few Facts

According to the Canadian Medical Association, cervical cancer is the second most common cancer in women between the ages of 20 and 44, with HPV causing the majority of cases. Cervical cancer is slow-growing, so Canadian women have been advised that regular Pap tests are a good way to detect the cancer in its early stages. When it’s caught early, treatment is the relatively simple matter of removing the cancer cells through a procedure that is only a little more involved than the Pap test itself. But there are still 400 women every year who die from the disease.

Gardasil, manufactured by the drug company Merck-Frosst, is almost 100 percent effective against the four types of HPV that cause 70 percent of cervical cancers and 90 percent of genital warts. In clinical trials, researchers discovered that girls in the 9 to 15 year old group, who had been given the vaccine, showed a much larger immune response to HPV than did women in the 16 to 26 year old age group. For this reason, health authorities recommend immunizing girls in late elementary or early high school.

Confusion still exists

It seems that much of the discussion in the media hasn’t fi ltered down to the people who actually qualify for the vaccine. On campus, many women know little or nothing about Gardasil. Those who have heard about the vaccine aren’t t rushing out to get it, and of those we spoke to, most say the cost of the vaccine, at close to $400, would prevent them from getting it.

Natalie, a physical education student, says she has no strong opinion on the subject, but feels confi dent that if public health offi cials recommend the vaccine then it must have positive health benefi ts. “It would be a good idea for the government to cover it,” she said. It shouldn’t be expensive if they want people to get it.”

“I need to find out more about it,” says Katrina, a music student. She felt the cost of the vaccine would defi nitely prevent her to getting it.

Shelley, a visiting SFU student, said she hasn’t thought too much about it. “It’s not worth the trouble to fi nd out,” she says. “I just concentrate on things I have more control over, like exercise and living a healthy lifestyle.”

Desiree, who is studying social work, thinks the vaccine is a good idea. “My mom works in a hospital and I heard about it from her. A lot of my friends are getting it.” Desiree said she hopes to get immunized some time in the next year, but at the moment, cost is a barrier.

Finally, Sara, a Print Futures graduate has decided against the shot. About the government’s plan to immunized teen girls, she says, “I feel that the money would be better spent educating children about staying healthy in ways that we know have positive longterm effects: eating properly, exercising, staying positive. If I had a child in school I wouldn’t trust it to be used. It’s too risky to be thrown into schools so quickly.”

Access to Health Care for All?

Susan Briggs, instructor in the English Department at Douglas, says she was unsure how to counsel her daughter about the HPV vaccine because information about Gardasil was so contradictory. She made the decision to pay for her daughter’s immunization after asking her family doctor whether she had immunized her own daughters. Her doctor said yes. Briggs felt that this was a solid endorsement and felt comfortable recommending and paying for her daughter’s vaccine shortly after.

But Susan Briggs is also concerned about all the girls who can’t pay for the vaccine. She points out that the Canada Health Act promises to provide equal health care for all. As it stands, there is a big divide between those who can afford the vaccine and those who can’t.

Opposition from Surprising Corners

While women weigh the pros and cons of getting immunized against HPV, the debate rages on in the media. In the September issue of Common Ground, Alan Cassels comes out swinging against Gardasil. He says, “what’s most striking about this issue is the crass vaccinemongering coming from public health offi cials who seem bent on pushing the vaccine as if there were an imminent epidemic.”

Cassels, a well-known thorn in the side of the medical establishment, is no fl ake. He has caused all kinds of discomfort to mainstream medicine by publishing Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All into Patients, which he coauthored with Ray Moynihand. Cassels is also a credible academic affi liated with the School of Health Information Sciences at the University of Victoria.

Some in mainstream medicine agree with Alan Cassels. Also published this August in the Canadian Medical Association Journal (CMAJ) was a commentary by Abby Lippman of McGill University’s Department of Epidemiology, Biostatistics and Occupational Health. Ms Lippman has several concerns she believes need to be addressed before the vaccine is used in a “full scale rollout of an HPV vaccine campaign.”

Lippman points out that, at the moment, there is no epidemic of cervical cancer in Canada. In fact, she says, there has actually been a decline in the number of women diagnosed and the number of deaths from the disease. She also believes that because cervical cancer is slowgrowing, death rates in women who go for routine Pap tests are extremely low. She suggests that money would be better spent trying to recruit women from groups who routinely forgo Pap tests.

Lippman says the goals of the HPV vaccination program are unclear. She says if the goal is to create “herd immunity”— group resistance to a disease—then the vaccine should be given to men as well as to women. If the vaccine is being given to prevent cervical cancer then it should offer immunity to all types of cancercausing HPV strains.

Doing the right thing

Public health officials remain confident that the HPV vaccine is a worthwhile cancer prevention strategy. Dr. Murray Fyfe, Medical Health Officer for Vancouver Island makes several points in response to the concerns raised my Alan Cassels and Abby Lippman.

The goal of the immunization campaign, reports Dr Fyfe, is to reduce the risk women will get cervical cancer from the two strains of HPV, type 16 and 18. While it’s true that there is no epidemic, every year 1,350 women will be diagnosed with the disease and 400 women will die of it. In both men and women, HPV causes genital warts as well as cancers of the penis, anus and vulva.

According to Dr. Fyfe, it’s quite normal to begin a vaccination program without knowing the answers to questions such as how long vaccine will protect against the disease, as was the case in 2004 when health officials began immunizing against a potentially fatal form of pneumonia. He says that before it was approved for use, Gardasil was subjected to a thorough scientific review by Health Canada. Also, the World Health Organization’s Advisory Committee on Vaccine Safety has reviewed all the data on the safety of the vaccine.

Decisions, decisions

So how to decide whether Gardasil is a good idea or not? Like every other consumer choice, it’s a matter of doing the research and choosing an option that works for you. Even if Gardasil protects against HPV it does not provide immunity to other sexually transmitted infections such as AIDS and Chlamydia, and it doesn’t mean you can forgo regular Pap tests. On the other hand, if having a shot means you don’t have to be included in that group of 400 women who will die of the disease this year, it might be worth it.

“At the moment, there is no epidemic of cervical cancer in Canada. In fact, there has actually been a decline in the number of women diagnosed”

HPV, Cancer and Your Cervix

• There are more than 100 types of human papilloma virus (HPV); 40 are sexually transmitted
• HPV types 16 and 18 can cause cervical cancer, types 6 and 11 can cause genital warts
• In the US, most of the women who were diagnosed with cervical cancer had never had a Pap test, or had not had one in the last 5 years
• Cervical cancer in its early stages can be treated successfully with a minor procedure
• Risk factors for cervical cancer included early onset of sexual activity, contact with higher numbers of sexual partners, use of birth control pills, lowered immunity as a result of another medical condition, and occurrence of other sexually transmitted diseases.