I spent a lot of free time reading up on hepadnaviruses today. That sentence was so wrong. But let it never be said that I have held back the inner geek here.
Also, today, I was reading more closely two articles about HPV that were recently published in the NEJM. The Human Papilloma Virus is one of those nasty sexually transmitted infections that stick around, mostly unbeknownst to the body, for quite some time. Recently, you might have read the news that a vaccine has been developed against HPV that is thought to be 100% effective. This is particularly notable because HPV has one of the tightest correlations to cancer of all viruses out there. Specifically, it accounts for nearly 90% of all cases of cervical cancer in women. Let me repeat- 90%.
There are two sides to this story. On the one side is the vaccine. It's highly effective, but it only works if you have not already been infected with the virus. In many cases, viral infection occurs early in life (through sexual transmission), and the resulting cancer does not emerge until much later. So, in order to truly make this vaccine effective, it would be ideal to immunize adolescents before they are sexually active. This has caused a controversy, predictably. Immunization advocates and health professionals are proposing mandatory vaccinations for children somewhere between the age of 10 to 12. There is a contingent of opponents, who worry that vaccinating at this age gives children yet another free ticket to have premarital sex at a young age. Basically, if you've heard these arguments about condoms and birth control, you can pretty well substitute the HPV vaccine in there. This is pretty disturbing to me, for a couple of reasons:
- Would parents really rather their daughters potentially developed cervical cancer? I mean, yes, these parents believe their daughters are not going to be sexually active until they are married. But, are they willing to bet their daughters' health (or lives) on it?
- How does getting a shot in the arm or thigh lead to a kid thinking hey, you know what I can do now? Go get busy! I truly do not see how that logic works.
- Let's say you have a perfect angel of a daughter who has every intention of waiting until she gets married. This is, of course, the worse possible scenario, but what if this daughter gets sexually assaulted? In addition to the terrible trauma of being assaulted, now she might also be at risk of being infected with HPV and developing cervical cancer.
But that's just one side of the story. Here in the developed world, we have the luxury of choosing whether or not we would like to prevent developing cervical cancer. Even though getting HPV vaccines to Americans is important to eradicating the virus, we have good screening procedures in place for catching HPV and cervical cancer in the US. Okay, maybe not all women would characterize the screening procedures as good per se, but they are reliable.
In the developing world, there is a bigger problem. Forget the vaccine- for one thing, it is likely to be cost-prohibitive in the short term to implement in developing countries. In these countries, they have trouble even diagnosing women with cervical cancer until it is too far progressed to treat. But, the two articles in the NEJM point towards some hope in developing countries. Strategies have been developed to figure out how to screen for cervical cancer amongst a population of women not likely to be able to come into the clinic more than one or two times. Not only that, but an analysis has been done that proves that these one- or two-time screens are, in the long term, more cost-effective. They tend to catch the cancer early, there are very few false positives with the new screening technologies, and more lives are saved as a result. This translates to a 25-36% decrease in risk of developing cancer. That is highly impressive. The same can not be said of the handling of women's health issues in our great land of freedom.
No comments:
Post a Comment