Mary is a 16-year-old high school sophomore that has been my patient since birth. She has always been dreadfully afraid of needles and shots. I vividly remember her sports physical of last year. Knowing that she would need a tetanus booster, she managed to work herself into such a frenzy that she hyperventilated and vomited while waiting for the nurse to give her the shot. Afterwards, she sheepishly apologized and admitted total embarrassment, but she had worried about the shot all day. I remember her saying, "The only thing that got me through the injection was knowing that I wouldn't need another one for ten years...or possibly when I go to college. I'll deal with that when I get to it!"
This visit was for her yearly exam. With mom accompanying her Mary seemed in a happy and jovial mood. I was thinking of how to break the news that there was a new vaccine licensed for young women. As the end of the visit drew near, it was her mother who brought up the topic. "I understand that there is a new vaccine for genital herpes that will prevent cervical cancer," she said as Mary looked at her in stunned silence. "I have definite family history of cervical cancer and was wondering if Mary should get that vaccine." All the color left Mary's face. I was pleased with this appropriate lead into the topic and said, "Let's look at the facts about this new vaccine, and then we can all make an informed decision." With this, Mary was able to regain her composure and agreed to listen to the facts.
In June of the year 2006 the Federal Drug Administration approved a vaccine to help protect against diseases that are caused by certain strains of the Human Papillomavirus (HPV) that can cause cervical cancer, abnormal and precancerous lesions of the cervix and vagina, and genital warts. The vaccine is a series of three shots given over a six month period. Ideally the second dose is given two months after the first, and the third dose is given six months after the first. The cost for the three vaccines is around $360.00.
HPV is a virus that is the most common sexually transmitted infection in the United States affecting more than 20 million men and women. There are 6.2 million new infections reported annually. Each year there are 9710 new cases of cervical cancer and 3700 deaths attributed to HPV in the United States. The new vaccine, known as Gardasil, protects against types 6, 11, 16, and 18 of HPV. Although there are over 100 different types of HPV the four types included in the vaccine are responsible for about 70 percent of cervical cancer cases and over 90 percent of genital warts. The majority of other types cause no significant harm. Some may cause disease of the genital area. In most cases the virus goes away on its own. This is not the case for the four types covered by the vaccine which DO NOT go away. They persist and can cause genital warts which appear as small fleshy skin colored growths on or around the genitalia. They are usually painless and may go unnoticed. As a result they are easily passed on to sexual partners. These four types of HPV have also been associated with causing precancerous lesions of the cervix and vagina. Cervical cancer is the second most common cancer in women worldwide.
Studies have shown the Gardasil can greatly reduce the risk of cervical cancer in a young woman, if not prevent it completely. The National Survey of Family Growth reported that 26 percent of girls have vaginal intercourse by the age of 15 years, and 77 percent by the age of 19 years. In 2005, the Center for Disease Control estimated that at least 50 percent of sexually active people catch HPV during their lifetime. Having unprotected sex is essentially like playing Russian roulette for so many of the young men and women in the United States these days.
As a result, the FDA approved Gardasil for females 9 through 26 years of age. This recommendation is to target the population that has not been infected with the HPV yet. Once infected, the vaccine will offer no benefit. However, if one is infected with one particular type of HPV, the vaccine will still protect against the other three types. Once infected, the vaccine will not treat the disease. Although the vaccine is extremely effective, a woman who has completed the series of vaccines must still get routine cancer screening. As is the case with ALL vaccines, Gardasil is not 100 percent protective.
Gardasil is not recommended for a woman who is or plans to become pregnant. If a woman does become pregnant while undergoing the series of shots, it is recommended that she delay finishing the series until after the pregnancy. Women who are breastfeeding can safely receive the series of shots. This has been studied extensively. Gardasil has been shown to have very few side effects which include: pain, swelling, redness or itching at the injection site. A small number of patients have reported a low grade fever, but the side effects are very minimal.
I mentioned to Mary and her mother that I had just heard on the news that a state senator from Michigan had proposed a state law that would make the vaccine mandatory for all girls before sixth grade or by 11 years of age. After sharing all of this information I asked if they had any questions. I was braced for some resistance or haggling on the part of Mary, such as "How about I get the vaccine next year?" But she calmly sat there, thought for a minute, and said, "I'd be crazy NOT to get the vaccine, don't you think?" I was pleasantly surprised and said, "You're absolutely right!" Her mom was as shocked as I was and lamented, "My little girl is growing up."