nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Tuesday, March 2, 2010

HPV and Cervical Cancer

There's a new study showing that the HPV vaccine may not be as effective in preventing cervical cancer in older women  (this is the abstract, it costs money to view the article). This, combined with the finding that new infections with HPV in older women (over 40) rarely progress beyond the point of dysplasia (CIN 2) and therefore do not become cervical cancer, makes a partial case for the conclusion that HPV-related cervical cancer is a result of infection occurring early in life.

Recall my post from last year, where I discussed news reports that this vaccine may make the PAP smear obsolete; those reports were premature--and typically media-stupid. The vaccine prevents cervical cancer of a certain type, therefore the PAP smear will continue to be a mainstay of cervical cancer detection.  Estimates are that the vaccine is not effective for 30% of HPV. Also, HPV is a sexually transmitted infection, and associated with multiple partner exposure (or multiple partner exposure by a partner:  this would be called the Thanks-A-Lot-Buddy syndrome).

Supplement:  Lots of discussion here in Texas about the Governor's initiative to immunize all young girls.  Where there is no harm to others, I'm all for individual liberty.  The problem is that willful failure to protect the public is a risk that others shouldn't have to be exposed to:  someone who is infected and sexually active (male or female) is the modern equivalent of Typhoid Mary.  For those who consider required vaccination an unconstitutional violation of their freedom, the Supreme Court decided this issue 200 years ago in favor of public health and safety (a smallpox vaccine case).

The vaccine is recommended for all girls 11-12 years old.  The immunity appears to be lifelong, and adverse reactions are in line with other vaccines considered safe.  For more information, see here.

As a preventive medicine specialist, I support universal HPV vaccination for 11-12 olds, ideally prior to becoming sexually active.  An interesting question is whether the vaccine would break the chain of transmission if given to boys--we don't know the answer yet; the studies haven't been done.

Bottom line is, if you are a young woman, or you have a teenage daughter, I strongly recommend getting the vaccine.  And now, not later in life. For parents who believe their daughter would never be sexually active, welcome to the ranks of Delusional Parents.  For young women who are not sexually active now, believing they don't need it, it may be too late when you change your activity.

Doc D

Opinions are entirely my own.

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