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WTF? Cervical cancer vaccine due soon


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A new vaccine that prevents most forms of cervical cancer will be widely available as early as this fall after a federal advisory panel recommended Thursday that all 11- and 12-year-old girls receive the immunization.

The Advisory Committee on Immunization Practices stopped short of recommending that states make the vaccine, called Gardasil, mandatory for admission to school. But the panel advised that the vaccine should be included in the federal Vaccines for Children program, which offers free immunizations to about 45 percent of children nationwide.

The vaccine ideally is given before a girl has had sex and is potentially exposed to the sexually transmitted virus that causes cervical cancer, which is why the panel recommended it for preteen girls. The panel suggested the vaccine is acceptable for girls as young as 9.

"It's an incredible development that we have a vaccine that helps prevent cancer. It's fabulous, and it's something that should be offered to all women," said Dr. Ruth Shaber, director of women's health services for Kaiser Permanente in Northern California.

Because Gardasil is aimed at stopping a sexually transmitted disease, conservative groups, while supporting the vaccine, have asked that state governments not make immunization mandatory for school attendance. And some parents have said they would be reluctant to give the vaccine to their young daughters.

Janice Crouse, a spokeswoman for the Abstinence Clearinghouse and Concerned Women for America, two conservative organizations, said she "applauds" the vaccine but added that making it mandatory would "fly in the face of a lot of people's beliefs and values."

In San Francisco, mom Maxine Prestwich said she would not want to give the vaccine to her two daughters, ages 5 and 7, when they reach adolescence.

"I would be opposed to making it mandatory. They need to give people the choice to do it or not, not force it on us," Prestwich said. "I don't live my life in such a way that I am concerned about STDs. And I don't worry about it for my daughters."

Gardasil won approval from the Food and Drug Administration on June 8 and was then sent to the advisory panel for consideration. The panel's recommendation now goes to the head of the Centers for Disease Control and Prevention, who will decide within months whether to make it an official standard of care for physicians nationwide. CDC recommendations are not mandatory, but physicians usually add them to their standard practices.

With just the advisory panel's recommendation, at least two major insurance plans -- Kaiser Permanente and WellPoint -- announced Thursday that they would cover Gardasil and offer it as a standard vaccination for preteen girls. Kaiser officials said they hoped to have a supply of the vaccine by fall. The vaccine costs $360, which includes three injections over six months, although most patients won't pay that amount if it is covered by insurance.

Whether the vaccine becomes a school-attendance requirement in California is up to the state Legislature, said Michelle Mussuto, a spokeswoman for the Department of Health Services. Immunizations also can be made mandatory through a change in government regulations, but that process is rare, Mussuto said.

California has six required immunizations now, all of which must be completed before kindergarten. Two more immunizations are recommended, but not required, for children about to enter seventh grade. Part of the reason the advisory panel recommended that girls receive the Gardasil vaccine at age 11 or 12 is that they are likely to get other immunizations at the same time.

In clinical studies, Gardasil, which is made by pharmaceutical giant Merck & Co., prevented infections from two strains of human papilloma virus that cause 70 percent of cervical cancer cases. It also prevented infection from two additional strains that cause 90 percent of cases of genital warts.

Cervical cancer is the second-most common cancer among women worldwide and the third-most fatal, causing 290,000 deaths a year.

The disease is rare in the United States, where regular screening for adult women catches most precancerous cases; about 3,700 American women die of cervical cancer every year. But the virus that causes the cancer, the human papilloma virus, is the most common sexually transmitted disease in the United States by far. The CDC reports that the virus infects at least 80 percent of women by the age of 50.

Because the virus is so common, it's important for girls to be immunized before they become sexually active, doctors said. The clinical studies focused on women and girls ages 9 to 26. Merck is currently conducting studies on boys and men, who can become infected with the virus and pass it on to women and who also can contract a rare form of penile cancer from the virus.

The federal advisory panel recommended that all women up to age 26 be vaccinated against the virus, though it is still unclear whether the vaccine is effective in women who have been exposed to the virus. Kaiser said it will not cover the vaccine for women who already have had sex.

Doctors noted Thursday that the vaccine will not pre-empt the need for regular screening for the virus and cervical cancer, including annual Pap smears. The vaccine does not prevent all forms of the virus, for starters, and there also is no evidence yet of how long the vaccine lasts. It's possible young women will need a booster shot in their late teens or early 20s.

In fact, Shaber said she isn't certain that all girls need to be immunized at age 11 or 12. Some families might want to wait a year or two to give their daughters the maximum protection. If a girl is immunized at age 11 and the vaccine only lasts five years, she said, that could leave her vulnerable as a teenager.

"Depending on the family, it's OK to wait a couple years," Shaber said. "The grim fact is a lot of girls are starting to have sexual activity in their midteen years. You want to catch them before they're exposed."

Panel's suggestions

The federal Advisory Committee on Immunization Practices recommended:

-- That the cervical cancer vaccine routinely be given to all 11- and 12-year-old girls.

-- That girls and women ages 13 to 26 receive the vaccine, regardless of whether they are sexually active.

-- That physicians have the option of giving the vaccine to girls as young as 9.

E-mail Erin Allday at eallday@sfchronicle.com.

http://www.sfgate.com/cgi-bin/article.cgi?...MNGAAJN9JE1.DTL

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are you objecting to giving the vaccine that young? or are you saying people who object are wrong.

i think that it doesn't condone sexual activity to give it at a young age, it's just doing it way ahead of time. they give the Hep B vaccine at a simmilar age and no one flips a bitch over that.

a friend of mine got HPV from her fiancee. he hadn't had all that many sexual partners, and always used protection (you can get HPV even with a condom.) she had to have part of her cervix removed and now she may not be able to have children. if she had waited till marriage she still would have gotten it from him. no matter how safe our "girls" are you can't always know if the guy had just one exposure to it, and as it's virtually impossible to detect in men, so...

anyway. i got my Hep B at 10. didn't have sex until much later. didn't take the vaccine as a sign that i should be off boffing.

just my take on it.

penny

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I'm still not clear as to why being a virgin means that you can get the vaccine and having had sexual partner(s) means you cannot. What about screening a girl/woman for HPV and if she is clear, then she can get the vaccine. Strange, strange, strange. I'm 27 and have never been told I have HPV, despite having had MORE THAN A FEW sex partners! lol I don't kiss and tell!

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I'm annoyed that the federal government is attempting to suggest that something like that be made mandatory for young girls. A parent should make that decision. it doesn't have anything to do with sex but the issue that they get the right to attempt to control the health of a young girl. especially when they say it should be ALL girls and they haven't even addressed the vaccines ability to help those already stricken with hpv and those over 27. The fact that they stopped short of making it mandatory for admission to school burns me too because that makes the "WE control your kids not you" thing just a little bit too much.

I realize kids are haivng sex at younger and younger ages every generation but forcing them to take a vaccine isn't like forcing them to wear a condom or find bcps that suit them. who the hell knows that these vaccines are totally safe? in ten years after all of these girls have been vaccinated what happens if theres a "situation" some hidden problem in the vaccine that mutates while the kid grows hormonally? then what?

this is just a little too control freakish to me. It reminds me of the "ritalin and anti-depressants are GOOD for kids days"

lilie

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the reason it applies to girls not boys is because only women get cervical cancer. they aren't trying to stop herpes per se but prevent a cancer later in life.

and as for the comparison to bcp or condoms that presupposes that all girls have consensual sex. my first time was a rape. it makes me cringe inside to think of someone ending up with hpv because their parents couldn't stand the thought of their pure innocent virginal little darling even thinking about sex so they refused the vaccine but then the girl gets raped/molested? what are parents going to do, screen potential molesters?

personally, i think all this upcry i read in the media about encouraging promiscuity & lowering morals absolutely IGNORES the scores of women and girls who are forced into sex. it's wrong to leave them at risk for infection from a predator. wrong wrong wrong.

fuck, i can't imagine how i'd feel if i'd have ended up with an std from that attack.

god, to know that there was a vaccine, that i could have been vaccinated but Mom & Dad wouldn't let me because 'nice girls don't get the vaccine'!!! that's what it boils down to: nice girls don't get the vaccine, they don't need to. as long as you are a nice girl, you won't need it. only bad girls get the vaccine, and if you get it, then that means you are planning on being a bad girl. BULLSHIT! being a nice girl doesn't protect you from predators. trust me on this one. i was about as virginal, naive and nice as you could get.

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Exactly Libby what if you take this magical vaccine and end up with FAR more problems that the ones you took it for. then what? you're raped and screwed physically as well as mentally. maybe for the rest of your child bearing life.

lilie

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I just worry about the longterm consequences of the vaccine, since hte FDA seems to let drugs on the market to allow consumers to be the "guinea pigs."

Well, this is really a lot simpler. This ISN"T a drug. It isn't a medication that someone is going to take a daily basis for years.

This is a vaccine for a virus. Viruses are relatively simple. Getting an effective vaccine for a virus is a long process, but once the work is done the scientists have a darned good understanding of the virus and how it works. Most problems with vaccines occur shortly after injection. Off hand I can't think of a single vaccine that has caused problems years later. The only long term negative affect that has appeared is finding that the body sometimes loses immunity for unknown reasons. Thats why there are booster shots for some vaccines.

- Complain about the shortened certification process on drugs now (which I personally have concerns with). But remember 15 years ago all the AIDS activists who screamed that drugs took too long to get approved and that it was a government conspiracy to kill homosexuals. The FDA, to its credit, stood on its head and totally revamped its approval process and rules. You can't have it both ways.

I have been following the development of this vaccine for several years. It is a tremedous breakthrough and the beginning of controlling a major cancer type. To review the numbers, this vaccine could save 203,000 women from dying EVERY YEAR! It could save at least $2 BILLION in medical expenses each year. And this vaccine will prevent 80% of genital warts cases. Pretty incredible. Now about the vaccine cost......

a.m.

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the reason it applies to girls not boys is because only women get cervical cancer. they aren't trying to stop herpes per se but prevent a cancer later in life.

not trying to nitpick, but, HPV is human papaloma virus, more commonly known as genital warts.

----

as for testing for it, when my husband and i first got serious we went and got full STD screenings and we were both told they couldn't screen for either herpes or HPV. maybe things have changed, but at the time that's what they said. they said the only way to know as a male if you were a carrier is if you had symptoms (many don't) and for women if you either had visible symptoms (which of course all don't) or had an abnormal papsmear. maybe things have changed, this is just what i was told several years ago.

penny

and go AM for the good post. the history of this vaccine is interesting, and it is such an important step in preventative medicine.

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yes, nice post, a.m.

Also: "Clinical trials evaluating Gardasil vaccination of boys and men are underway, a Merck spokesperson tells WebMD." http://www.webmd.com/content/article/123/115099.htm

I often see people use the same line of reasoning with vaccines as with psych meds - it *might* have terrible effects years and years down the line even if we only know of beneficial effects now, therefore it should not be used at all. So they don't take the meds or get the vaccine, and people suffer and sometimes die.

I'm going to get the vaccine, because there are people who think it shouldn't be available to me because they want to use *my potential death from cervical cancer* to control my sexuality, my body, my free will. I'm also going to get it because, as with all vaccines, I have a responsibility to my fellow humans to ensure I'm not carrying nasty preventable contagious stuff.

I wonder if parents would be as upset if it were their boys they were vaccinating? After all, everyone knows adolescent boys go out and sleep with people, and that's just boys being boys, but if adolescent girls have sex even with just one person, they're sluts who need to be controlled by fear of things like genital warts and cervical cancer.

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You're a man a.m you'll never have to take this or suffer a single side effect....

lilie

Weeeeeellll. That ain't exactly true. The next application that is under study is testing the vaccine in men with the knowledge that you need to treat both sides of the situation. So we can probably expect to see it introduced for men in a couple years.

There is a well documented effect in virology and epidemiology called the Herd Effect. You don't have to have 100% vaccination to prevent or even eliminate a disease. The vaccination effect is synergistic. The more you vaccinate the greater the reduction of the disease.

[EDIT] There IS now available a test for HPV. It has been available for a year or two but few doctors routinely test. To my surprise they have started advertising it on cable TV last week, telling women to ask their doctor for it! I imagine they are springboarding off the vaccine news. But hey, the winners are healthy women!

a.m.

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