Dear Surly Amy,
My sister wonders if she should get her daughters the Gardasil vaccine. My instinct is that she should, though I am also hesitant to recommend or take drugs that have not been around for very long. Would you know of any reputable sources that would allow my sister to make an informed choice about risk of new vaccine vs. risk of her daughters’ contracting HPV/cervical cancer? She’s a very rational person, but of course the safety of her daughters is so central to her that she is bound to be influenced by pure anxious emotion, as would I in a similar situation.
~Kaloikagathoi
Dear Kaloikagathoi,
If I had a daughter I would definitely get her the Gardasil vaccine. I would get it for my son too. The Human Papillomavirus virus has been definitely linked with cervical cancer. Of the 11,000 people diagnosed with cervical cancer, the cancer kills approximately 4,000 women every year. And that is a mostly preventable risk? Sign me up.
According to the Center For Disease Control, as of September 15th, 2011 40 million doses of Gardasil® were given out. Out of that 40 million there were 20,096 reports of adverse events. Of those adverse events 92% were considered to be non-serious. Non serious defined as:
Of the adverse events reports following Gardasil® vaccination were mild and included, pain and swelling at the injection site (the arm), fever, dizziness, nausea, and fainting. Syncope (fainting) is common after injections and vaccinations, especially in adolescents.
Of the reported adverse effects only 8% were considered serious. Serious defined as:
Any VAERS report that indicated hospitalization, permanent disability, life-threatening illness, congenital anomaly or death is classified as serious. As with all VAERS reports, serious events may or may not have been caused by the vaccine.
It should be noted here that Vaccine Adverse Event Reporting data can not be used to prove a causal association with the vaccine. The reports are taken anytime after a vaccine has been administered so many other causes and factors could be at play. For example, if a blood clot is reported after a vaccine it could be caused by an underlying illness and not the vaccine itself.
Correlation, as they say, does not equal causation.
That being said, I am not here to imply that vaccines are 100% safe. 1-2 out of every 100,000 people in their teens are affected with Guillain-Barré Syndrome after a vaccine. Things such as allergic reactions to vaccine ingredients and blood clots can occur. However, that is a really minimal risk when compared with the yearly diagnosis and deaths from cervical cancer, that can now be mostly prevented with the HPV vaccine.
Yay science!
More info on health concern reporting in relation to the HPV vaccine can be found here on the CDC website.
Info on the Human Papillomavirus can be found here.
And frequently asked questions about HPV can be found here.
Here is another link on HPV from the Mayo Clinic website.
As always, I am not a doctor and you should seek out medical advice from a professional health care provider.
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Hey, thanks!
Now, here I have to confess to not being as good at math as I’d like.
I think I am right that this means there is a 0.05% risk of an adverse reaction, and 0.004% risk of a seriously adverse reaction.
Meanwhile, if the population of the US is 312,684,493, and 20 million people have HPV now, then that means there is a 0.06% chance of any American having it.
Meanwhile, if 12,000 women in the US get cervical cancer each year, what is the risk, in percentage, of any average American woman getting cervical cancer? This is where I have no idea how to proceed. It would be comparatively easy to calculate how likely it would be for an American woman to get cervical cancer in any one year, but more useful would be to figure out the chances of getting it during her sexually active life span. There are, apparently, 156842733.304 female people in the US now, but one would only want to count the sexually active ones. Let’s say we should exclude approximately 12% of that number, so there are 133316323.3084 potentially sexually-active women in the US.
But I really have no idea how to turn a yearly risk into a life-time risk.
Anyone?
You lost me with all of your math, but:
~27% of American women test positive for HPV.
http://www.cancer.gov/cancertopics/causes/hpv/hpv-prevalence0308
Also HPV can be spread to men and cause penile cancer and performing oral sex with an HPV+ partner can cause HPV (and therefore cancers) to spread in the mouth and throat… and kissing someone with oral HPV can spread HPV orally.
So… you know, just fucking vaccinate.
Like Elyse, I’m not quite following the math that you’re doing (where are you coming up with some of these numbers, by the way?), mainly because I’m not sure where you’re going with these particular calculations. The average American woman’s risk of developing cervical cancer during her sexually active years is not the only risk faced when it comes to HPV. Elyse brings up the risks to men. I’d also like to point out that not everyone who becomes infected with HPV will develop cancer, but they can still spread the virus to others (more on that if you follow Elyse’s link and others on that page).
I think however you add it up, you’ll find that the risk of becoming infected with HPV is larger than the risk of side effects from taking the vaccine–especially keeping in mind what Amy said about VAERS reports’ inability to prove causal relationships.
The exact risk profile will depend on a variety of factors, including whether the risk is constant over time for both vaccinated and un-vaccinated women. However you can get a rough idea: Let’s accept your estimate of about 133316323 sexually-active women in the US, and also assume that the average life expectancy of a woman at the average age of her first sexual encounter is about 60 years (probably a reasonable guess given current demographics). Then the approximate lifetime risk of a sexually-active woman getting cervical cancer would be 60 * .009% = .54%, and the approximate lifetime risk of that same woman dying from cervical cancer would be 60 * .003% = .18%. These are clearly much higher risks than either the risk of an adverse reaction (.05%) or a serious adverse reaction (.004%). Consider also that the more serious “serious adverse reaction”s will almost certainly be far less common that the less serious ones – so having to spend a day or two in the hospital would be much more common than permanent disability or death from the vaccine. I think we can all agree that even spending a day or two in the hospital is far preferable to getting cervical cancer, even if you fully recover from the cancer.
I realize I left out a couple of steps in that calculation. The average annual risk of getting cervical cancer can be calculated by taking the number of cervical cancer cases per year (12000) and dividing by the number of sexually-active women (133316323) which yields .00009 or .009%. Likewise the average annual risk of dying from cervical cancer can be calculated by taking the number of cervical cancer deaths per year (4000) and dividing by the number of sexually-active women (133316323) which yields .00003 or .003%. These risks will probably not be exact numbers going forward, because of changes in sexual practices and life expectancies as well as other societal or environmental changes that affect cancer rates, but they should be good enough to get a rough idea.
Thanks so much – very helpful.
Thank you to Amy and Elyse for mentioning that boys should also receive the HPV vaccine.
For those having trouble with the numbers, I recommend this infographic at http://www.informationisbeautiful.net/2011/is-the-hpv-vaccine-safe-v-2-0/ for a simple, graphical representation of all the numbers, including sources.
That is an amazing graphic!
OT: am I just blind, or are there no sharing buttons anywhere? (And if not, I would like to politely suggest that y’all add ’em so I can share this terrific blog!)
If males are also carriers of this virus but suffer no long term health risk ( I assume ) then why don’t ALL boys get the vaccine as well as the girls?
It’s becoming more common for males to receive it. I had to get my vaccinations for college back in August, and was recommended to get the Gardasil vaccine. It’ll become more common as the years progress.
Males can suffer long-term health consequences from HPV. Head and neck cancers from HPV is rising rapidly and is significantly more prominent in men. There are also anal and penile cancers.
The main reason why women were the first to be approved for the vaccine is because they were easier to study as irregular pap-smears are much easier to detect than things like tonsillar cancer (which is another reason why people should get the vaccine – the cancers that are harder to detect).
Unfortunately, I am still not within the groups who can receive it where I live (which I have been told is now women up to age 46 and men up to age 26).
Despite not being well known there is a ton of research showing a link between between HPV and oral cancers, the initial hypothesis goes back into the 70s, but the nature of the technology made it difficult to test until PCR was widely available and cheap, and then the scientists were still pretty cautious until they better understood the mechanism. But the scientific consensus among relevant experts is very strong now. A couple papers among the 60 or so I have read on this include:
Ang et al. (2010). Human papillomavirus and survival of patients with oropharyngeal cancer. The New England Journal of Medicine.
Auluck et al. (2010). Trends in oropharyngeal and oral cavity cancer incidence of human papillomavirus (HPV)-related and HPV-unrelated sites in a multicultural population. Cancer.
Chang et al (1990). Detection of human papillomavirus (HPV) DNA in oral squamous cell carcinomas by in situ hybridization and polymerase chain reaction. Arch Dermatol Res.
Deng et al. (2011). Prevalence and clinical features of human papillomavirus in head and neck squamous cell carcinoma in Okinawa, southern Japan. Eur Arch Otohinolaryngol.
Furniss et al. (2009). Human papillomavirus 16 seropositivity is associated with risk of head and neck squamous cell carcinoma, independent of tobacco and alcohol use. Annals of Oncology.
I was just young enough to get the shots, and I’m getting them for my daughter when she turns 12. I’m all for it, since you can end up with HPV without knowing it.
Kaloikagathoi – Pap smears check only for abnormal cells. Normal Paps will not bother to check for HPV unless you specifically request the test. There are currently four major strains which cause either warts or cancer. Many people are currently carrying or have carried HPV in the past, without ever being aware of it. It also occasionally disappears on its own. So, what I’m saying is that the rates we have are what is actually being caught by doctors, and Pap smears are not covered by some insurance plans (mine included). So, someone could have it most of their life, and if they are male, may never test accurately positive, and his partner could end up with cancer. It’s worth the vaccine.
IIRC, the Obama Administration’s plan for women’s health (effective in 2014, I think) should make preventative visits and checks (including paps) free, as well as bc being free (and domestic violence counseling, which I feel should be free for men and women, but maybe I just don’t fully understand the proposal). If that is in fact the case, I hope we start seeing a huge spike in all people getting their necessary preventative checks, and a downward spike in people suffering from preventably advanced illnesses.