Controversy About the Vaccine Against HPV (Genital Warts) And Cervical Cancer

There is much excitement in the scientific and medical community about the development of a vaccine against the virus that is the cause of cervical cancer. This vaccination for human papillomavirus (HPV), also known as genital warts, is also believed by many in the medical and scientific community to prevent future cervical cancer. While the vaccine is very effective against the virus associated with causing cervical cancer, long term studies are needed to confirm its effectiveness. It's one thing for parents to be aware the vaccination is being administered to guard against genital wart infection transmitted during sexual activity and is likely to reduce risk of cervical cancer. It's quite another to be told the vaccination is certain to guard against cervical cancer later in life. It's important to have the background information to make an informed decision about this vaccination.

The Journal of the American Medical Association presents follow up information on the risks of the vaccine against HPV(1). There is also a special communication(2) that discusses concerns about the way this vaccine was presented to the public by the manufacturer and professional medical associations.

The review of complications associated with the vaccine indicates that there may have been an increased risk of blood clots in the veins and fainting episodes. All other side effects, including 32 deaths after the vaccine, were considered to be consistent with what would happen to the general population without having received the vaccine.

Some of the issues discussed regarding the vaccine and its marketing and presentation were several fold:

• The vaccine is, thus far, believed to be safe and effective in preventing infection with the virus that is implicated in the development of cervical cancer.
• The vaccine was marketed by the manufacturer and professional medical associations as a vaccine to guard against cervical cancer as opposed to the primary target of HPV.
• There are no long term studies to confirm effectiveness in preventing cervical cancer.
• The vaccine was not directed to the highest risk population, where it would do the most good.
• Cervical cancer can be screened for effectively by Pap smears which can also prevent this disease.

One author also presented concern about the role of professional medical associations in promoting the vaccine due to their being supported by the manufacturer and possibly being influenced by this. The final editorial comment concludes with the following statement. "When weighing evidence about risks and benefits, it is also appropriate to ask who takes the risk, and who gets the benefit. Patients and the public logically expect that only medical and scientific evidence is put on the balance. If other matters weigh in, such as profit for a company or financial or professional gains for physicians or groups of physicians, the balance is easily skewed. The balance will also tilt if the adverse events are not calculated correctly." (3)

The decision to vaccinate or not vaccinate should be made with full informed consent between the patient or their guardian and their provider.

1. Postlicensure Safety Surveillance for Quadrivalent Human Papillomavirus Recombinant Vaccine: Barbara A. Slade; Laura Leidel; Claudia Vellozzi; Emily Jane Woo; Wei Hua; Andrea Sutherland; Hector S. Izurieta; Robert Ball; Nancy Miller; M. Miles Braun; Lauri E. Markowitz; John Iskander: JAMA. 2009; 302(7):750-757.
2. Marketing HPV Vaccine: Implications for Adolescent Health and Medical Professionalism: Sheila M. Rothman; David J. Rothman: JAMA. 2009; 302(7):781-786
3. The Risks and Benefits of HPV Vaccination: Charlotte Haug: JAMA. 2009; 302(7):795-796.