The Healthy Home Economist 15 August 2013
When I was in medical school, I had my first abnormal Pap, and it was quite abnormal, a precancerous lesion described as CIN2 (now revealed to be one of the most inaccurately diagnosed pathologies). I had two very unpleasant “therapeutic biopsies” called colposcopies, and two years later, it was normal.
Back to cervical cancer. Once again, we have a one-size fits all recommendation for healthy women to prevent an extremely rare outcome – death from cervical cancer. Let’s take a look at how to evaluate the considerations for you or someone you know:
1. Not Indicated: I’m afraid that the propaganda around “One less” has been in service of fearmongering around a not-so-scary problem. In the developing world, and with the use of routine Pap smears, the incidence of cervical cancer deaths are 1.4-1.7/100,000. There are 15 (known) of 100 different strains of human papilloma virus, and the vaccines reportedly protect against 2 of these. The natural course of infection with any of these strains has been demonstrated to involve resolution of 70% of infections within one year and 90% within 2-3 years. Of the remaining, unresolved infections, only 5% of those typically progress to cancer. Thus, we have an effective, extremely low risk to no risk intervention that is already doing the job of detecting these misbehaving cells (the Pap), and if there is not spontaneous resolution, we have effective surgical interventions such as the Loop Electrosurgical Excision Procedure (LEEP).
2. Not Effective: So, if we are suggesting that this vaccine is unnecessary, is it effective at what it claims to do, which is prevent deaths? This question remains unanswered, despite fast-track approval by the FDA in 2006, because cervical cancer takes about 20-40 years to manifest. The trials that have been done – sponsored by the pharmaceutical company producing the product – have used HPV infection associated cellular changes called CIN1-3 as a surrogate for cancer.
Thus, the premise for asserting efficacy rests on speculation that abnormal lesions will progress to cancer, which we have already discussed, they do not, most of the time.