Have you taken your daughter for a cervical cancer jab yet? I know several doctors who have vaccinated their daughters against human papillomavirus (HPV) types 16 and 18, which cause 70% of cervical cancers.1 One has vaccinated her sons too, on the back of an editorial in The Lancet, which argued that all adolescents should be immunised against HPV.2 This would prevent the transmission of these cancerous strains to unvaccinated women, and the vaccine (Gardasil) has the added bonus of protecting against HPV types 6 and 11, which cause 90% of genital warts.3 Having spent hours in a stuffy clinic trying to freeze these off, I would consider this a huge bonus all round!
Not everyone agrees though. Dr Angela Raffle, a public health specialist who overseas cervical screening in the Bristol area, described the editorial as 'disastrous for public health'.4 She went on: 'Countries with high mortality and no screening can achieve major gain from vaccination. But rushed introduction in Europe will worsen HPV-related illness by undermining existing screening and leaving women less protected than now.' 4
True, girls who have been vaccinated might not bother to undergo cervical screening in later life. However, the vaccine only protects against 70% of cases of cervical cancer and it is not yet clear how long the protection lasts for. So cervical screening would still be needed to check the effectiveness of the vaccine and to pick up the 30% of cancers that are not covered. However, screening is itself no picnic—minor smear changes cause considerable anxiety, and later-stage, pre-cancerous changes are unpleasant to treat and can have significant side-effects.
If the vaccine works as well as the manufacturers (Sanofi Pasteur MSD) claim, the side-effects of screening would be greatly reduced, because, as well as protecting against cancer, it should also reduce smear abnormalities at all stages.1
The biggest challenge is convincing the tabloid newspapers of the wisdom of vaccinating pre-teen girls and getting the cash-strapped NHS to foot the bill for a national immunisation plan. The immune response to the vaccine is better if it is given at an early age. No-one suggests that the rubella jab encourages girls to have sex, but the knowledge that cervical cancer is caused by a sexually transmitted infection has turned HPV vaccination into headlines such as 'Sex jab for schoolgirls'.
Immunisation programmes are already in place in the USA, Australia, and several European countries, but the Government's plan to introduce immunisation for girls in their first year at secondary school looks like missing the boat this September.
The decision was supposed to be announced by the Joint Committee on Vaccination and Immunisation in January 2007, but now seems destined to be delayed until at least June this year,5 too late for introduction at the start of the school year. This may just be traditional British scepticism, but the record NHS debts do not help and one Department of Health source has suggested Gordon Brown wants to make the announcement himself, on becoming a 'woman friendly', twinkle-toothed premier. Quite how friendly this would be to those girls who miss out on protection for the sake of political expediency is unclear. In the meantime, the vaccine is only available privately (£241.50 for three injections plus labour), or from a brave GP prepared to risk the wrath of the PCT.6
- Siddiqui M, Perry C. Human papillomavirus quadrivalent (types 6, 11, 16, 18) recombinant vaccine (Gardasil). Drugs 2006; 66 (9): 1263–1271.
- Should HPV vaccines be mandatory for all adolescents? Lancet 2006; 368 (9543): 1212.
- Raffle A. Human papillomavirus vaccine policy. Lancet 2007; 369 (9559): 367–368.