Imagine that a common cancer becomes completely preventable by simple vaccination. Wouldn't you want all people at risk to get the vaccine?
Cervical cancer is the second most common cancer in women (after breast cancer). It is diagnosed in about 10,000 American women each year. Currently, precancerous and cancerous lesions are detectable with Pap smears, and cancerous lesions can be cured by surgery, radiation or chemotherapy. Nonetheless, every year cervical cancer kills about 3,700 American women. Almost all cervical cancer is caused by human papilloma viruses (HPV). Not all women who become infected will get cervical cancer. If they do, it will occur years or decades later.
Pharmaceutical companies have formulated vaccines against the most common cancer-causing strains, and studies show that one such vaccine is very effective at preventing HPV infection in girls and women. It is estimated that widespread use of the vaccine can prevent at least 85 percent of cervical cancer cases. Annually, this would save the lives of more than 3,000 women in the United States, and a quarter million if the vaccine is applied worldwide. Moreover, economic studies show that the vaccinations would be cost-effective, saving dollars in addition to lives. More analysis is under way, and if all goes as expected, then the vaccine will likely be approved this year.
Just how much cancer is prevented will depend on how widely the vaccine will be used. HPVs are transmitted sexually and are probably the most common sexually transmitted pathogens, infecting more than half of all sexually active adults. Because HPV is so prevalent, women who encounter it are likely to do so shortly after becoming sexually active. Ideally, therefore, HPV vaccines should be applied to preteen children.
Individual states determine their own child-vaccination policies. North Carolina closely follows the recommendations of the U.S. Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP). North Carolina currently requires that children be immunized against 10 infectious diseases before they enter educational or daycare programs, although children may be exempted for medical or religious reasons. North Carolina is a "universal immunization" state, which means that the state provides required vaccine to health-care providers at no cost (although providers may charge patients a small administration fee). Our universal immunization policy has been highly successful, with compliance levels exceeding 99 percent.
When the HPV vaccine is approved, ideally the ACIP will recommend that all girls receive the vaccine at age 11 or 12; that is, before they become sexually active. (The current vaccine will not be approved for use in boys, but such vaccines are coming.) But even if the ACIP recommends universal coverage, states could decline to add HPV to their required-vaccine lists. Then, although the vaccine would be available, many girls would not receive it either because their families are not aware of it or because they cannot afford it. These factors would mean that only a fraction of girls would receive the vaccine. And for viruses as prevalent as HPV, high vaccination coverage is critical for protecting our children.
Since HPV vaccination would dramatically reduce our daughters' risk for cervical cancer, why would anyone not want to require it? Some argue that a program targeting preteens would weaken "abstinence until marriage" programs. They say that kids might view vaccination against a sexually transmitted disease as an endorsement of premarital sexual activity. It is no such thing; no more than requiring seatbelts endorses reckless driving. HPV vaccination will just be a life-saving tool that will protect our kids.
Another objection is that mandatory vaccination takes the decision out of the family. True. But there are times when public-health considerations are paramount, and the protection of children from cancer is one of those times.
Abstinence is the best policy for limiting the spread of sexually transmitted diseases. But long experience shows that abstinence programs are not fully effective. And, someone who has lived a chaste life can become infected on her wedding night. The question we should ask ourselves is: Should our daughters be needlessly exposed to risk for cervical cancer? Of course not. When this lifesaving vaccine becomes available, let's promote universal HPV immunization.
• Dr. James Curran is a professor of biology at Wake Forest University.