UK: Will you give your daughter the cervical cancer jab?

[Guest guest]

'Looking at those figures, you have to ask whether the most sensible

response is to put a drug that has little long-term safety and efficacy data

behind it into the immune system of all our young girls and women? "

http://www.dailymail.co

uk/health/article-1051578/Will-daughter-cervical-cancer-jab.html

Will you give your daughter the cervical cancer jab?

By Isla Whitcroft

Last updated at 2:19 AM on 02nd September 2008

The pink leaflets are ready, the posters are poised to go up and the

advertising slots have been booked both on kids and primetime TV and radio.

Tomorrow marks the start of a new academic year. It is also the launch date

of a campaign which heralds the introduction of the biggest mass vaccination

programme for more than a decade.

By the end of September, there will hardly be a Year Eight girl (aged 12-13)

in the country who doesn't know that, barring an opt-out, she is shortly to

receive three injections of the drug Cervarix, which will offer her 70 per

cent protection against cervical cancer.

Later in the year, another 300,000 girls aged 17 and 18 will be vaccinated

before they leave school. By 2012, most girls over the age of 12 should have

received the vaccine.

Made by pharmaceutical giant Glaxo-Kline, Cervarix works by creating an

immunity against the two strains of the human papillomavirus (HPV), numbers

16 and 18, responsible for 70 per cent of all cervical cancers.

For the Government, the programme - reputed to have cost tens of millions of

pounds - has been seen as little short of a community medicine triumph.

'This vaccine could save the lives of 400 women a year,' pronounced public

health minister Dawn Primarolo earlier this year, shortly after it was

announced that GlaxoKline had won the contract to supply the drug over

its rival Merck, who make the more expensive vaccine, Gardasil.

'It is an exciting opportunity to immunise young girls against the future

risk of cancer, the impact of which will be felt by women and their families

for generations to come,' she said.

And, on the face of it, who could argue? Cervical cancer is a dreadful

disease.

The HPV (said to be carried by one in ten girls under 16) is sexually

transmitted and once it enters the cervix causes cell mutation which, if

undetected, will lead to cancer.

Once the cells are past the pre-cancerous stage, treatment is notoriously

drastic. 'Women who are caught early and end up having just a hysterectomy

are the lucky ones,' says consultant gynaecologist Ind from the Royal

Marsden Hospital and St '.

'It is not uncommon to see a woman in her early 30s who has lost her bowel,

vagina, bladder and colon to the disease.'

Quickly introduced

In that context, perhaps it is laudable that the vaccine programme has been

introduced in the UK so quickly (the drug was approved by the European Union

only in September 2007 and has yet to receive full approval by the American

FDA).

Indeed, there has been some criticism that the Government had not acted as

quickly as European countries such as France, Italy and Germany who began

their programmes a year earlier.

But look more closely and it is not hard to see why many British experts are

uneasy about the rush to vaccinate all our young girls.

Cervical cancer may be a nasty disease, but it is also, thanks to our

world-class screening programme - where all women from 25 to 64 are eligible

for a free cervical screening test every three to five years - very rare in

the UK.

Around 3,000 cases are diagnosed each year and about 940 women die. While

this is 940 too many, it equates to less than three deaths per 100,000 of

population and does not even begin to compare with the carnage caused by

breast or lung cancer.

We have one of the highest rates of teenage sexual activity in the developed

world. We should be experiencing an epidemic of cervical cancer,' says

Ind.

'The fact that we are not is down to our screening programme. I fear that

introducing another preventative method will dilute both money and attention

away from this.'

Indeed, one of the main worries about the mass vaccination is that girls

will then feel 'safe' against cervical cancer and ignore the screening

programme.

That would be nothing short of disastrous, because the jab gives protection

only against HPV 16 and 18 which are implicated in around 70 per cent of

cervical cancers.

Smear tests still needed

There is still a 30 per cent chance that another strain could cause cancer,

making it vital that women go for regular smears.

Cervarix is also very new - large-scale trials go back only six years - and

there is no way of knowing just how long protection will last.

The worst case scenario is that the Government could be paying a fortune for

a vaccination that may protect young girls for only the next six or so years

So just as they hit the peak years for sexual activity they are totally

unprotected.

Furthermore, with the possibility that women will stop going for smears

because they think they're protected, the vaccination programme could end up

being counter-productive and costing more lives than it saves.

But according to Dr Elliman, a consultant community paediatrician who

works for Haringey NHS Trust and Great Ormond Street Hospital and sits on

the cervical cancer screening board, this is an unlikely scenario.

'The girls receiving the jab are many years away from the age of screening,'

he explains. 'In addition, in all the literature it is made extremely clear

that the vaccination is not a substitute.

'For all its merits, our screening process doesn't prevent cancer, it simply

picks it up at an early stage. The vaccination is the only thing that

actually prevents HPV 16 and 18 from causing cancer.'

However, some people feel the programme is a case of taking a sledgehammer

to crack a nut. 'Six million women carry the HPV virus at any one time,'

says Woollams, founder of the charity CancerActive and a former

biochemist.

Protection

'In the majority of cases the immune system renders it harmless. Only 3,000

women get cervical cancer each year and less than 1,000 actually die.

'Looking at those figures, you have to ask whether the most sensible

response is to put a drug that has little long-term safety and efficacy data

behind it into the immune system of all our young girls and women?

'The best protection against contracting HPV and therefore cervical cancer

is to use a condom. It gives you 100 per cent protection. For a fraction of

the money you could run a very effective sex education campaign.'

The Government refuses to release the cost of the vaccination programme,

claiming commercial confidentiality. But given that, privately, Gardasil

costs around £160 per injection, it will not be cheap.

In July, the British Medical Journal calculated that by using Cervarix -

cheaper than Gardasil because it protects only against strains 16 and 18 and

not 6 and 11, the strains responsible for genital warts - the Government

will save up to £18million in the first year alone.

Either way, huge sums are involved and there has been criticism that drug

companies funded charities and doctors to lobby the Government in the battle

to ensure the programme went ahead.

In America, where the vaccination programme using Gardasil has been in place

since June 2006, some experts are now expressing unease about the scheme.

Twenty seemingly healthy girls died within a few days of being injected with

the vaccine which has a similar generic make-up to Cervarix.

These deaths have been dismissed as coincidence by Merck who make the

American jab, although both Cervarix and Gardasil list fainting, dizzying

and sore arms as side-effects.

Here in the UK, the awareness group JABS is reporting an upsurge in calls

from parents who are worried about possible side-effects.

Last month, an article in the New England Journal Of Medicine claimed that

serious questions regarding the overall effectiveness of the vaccine

remained unanswered.

It pointed out that studies into the vaccine were carried out on girls aged

15 to 24 so there is no way of knowing how the drug will affect

pre-pubescent girls, how long it will last and whether there was the

potential for interference with the body's natural defence against other HPV

strains.

So parents are being faced with an agonising decision. Do they say no to the

vaccine and risk their child contracting a dreadful disease.

Or do they put their trust in a drug for which evidence of safety and

efficacy is probably insufficient and at worst may do harm?

YES

Vernon, 50, is an office manager from Northampton. She has three

children , 26, , 23, and Sophie, 12, who will be having the jab

She says... I WAS diagnosed with pre-cancerous cells at 33, after a routine

smear.

I had always been very careful to keep up with my smear tests and there had

never been a problem before. So when the doctor told me I needed

investigating it was quite a shock.

I knew people who had had breast cancer but I was the only person I knew who

had been in this situation, so I felt very alone.

Between 1990 and 1995, I had four operations to have abnormal cells lasered

away, but they kept returning. My children were very young and it was a

worrying time.

But I was relatively lucky because although the abnormal cells kept coming

back they were only graded as a low risk.

Even so, the laser treatment had unpleasant side-effects - painful, heavy

periods and abnormal bleeding for several months afterwards which badly

affected my quality of life.

The last treatment was done under local anaesthetic and was extremely

painful.

I had also become aware of just how awful cervical cancer can be if it

becomes aggressive and how the treatment can involve extensive surgery.

Each time I went back for my test results I was in a panic about what the

doctor would say.

I am delighted that Sophie has the opportunity to have the jab. She is aware

of my medical history, so, naturally, she is keen to be protected. I just

wish it had been available for my older daughter, , because I wouldn't

want either of my daughters to go through what I did.

Cervical cancer tends to affect young women with young families and if just

one life can be saved by the vaccine it will have been worthwhile.

I definitely don't subscribe to the argument that the vaccination will give

young girls the green light to behave in a sexually irresponsible way. Girls

who act like that are going to do it anyway, irrespective of an injection.

NO

lin , 55, a shop assistant from Harrow, Middlesex, has two children

, 15, and Gaby, 11. Gaby is due for the jab in September 2009 but will

opt out.

She says: Since Gaby suffered a bad reaction to a tetanus jab as a baby I

have become much more questioning about the idea of vaccination.

I am not against it, but if I am going to agree to something being injected

into my daughter I want to make sure it is safe, effective and has no

side-effects.

Cervarix answers none of my questions satisfactorily. So until there is more

long-term data I feel there are better ways of protecting my daughter

against cervical cancer.

We already have a good open relationship and I will be rigorous in educating

her about the perils of unsafe sex - not just in regard to cervical cancer

but also about genital warts, other sexually transmitted diseases and, of

course, unwanted pregnancy.

Using a condom gives 100 per cent protection against cervical cancer, the

vaccination can only offer 70 per cent at best.

I am not particularly impressed by the fact that this vaccine will be given

at school by an anonymous medical team.

It should be a matter between the parent, the child and their GP, who knows

the child and is aware of her medical history and can watch and record any

adverse side-effects.

I am fully expecting that both Gaby and I will be put under considerable

pressure for her to have the jab and I know in America those who opted out

have been made to feel as if they were bad parents, which is outrageous.

I don't think the vaccine will encourage promiscuity, there will always be

girls who sleep around, but I do think it will make girls more blase about

their sexual health, less likely to use a condom and less likely to go for

screening.

But my main concern is that we have no idea of the long-term effects of this

vaccine - whether it works, for how long and whether it can harm the

immune system.

I am not going to expose my daughter to that level of risk and she doesn't

want it either.

What you need to know

What causes cervical cancer?

Most cervical cancer is caused by the human papillomavirus (HPV). HPVs are

sexually transmitted and invade the cervix, although 90per cent of

infections are cleared by the immune system within two years.

If it remains, the virus begins to cause cell mutation which will lead, if

untreated, to cancerous lesions and eventually cancer. Most cases occur in

women aged 25 to 34.

How does the vaccination work?

Both Gardasil and Cervarix work by mimicking the structure of the live HPV

strains 16 and 18 and stimulating an immune reaction in the body which will

enable it to fight the real infection at a later date.

The vaccine does not contain live strains of HPV and tests so far show it

cannot cause the disease. There is no significant data on how long the

vaccination will be effective.

Who will receive the vaccination?

This year, all girls aged 12 to 13 will be offered the injection at school.

Any 17 to 18-year-olds will receive the injection as a 'catch-up' before

they leave school.

Why are we vaccinating so early?

For the vaccination to work, it has to be administered before the girl has

been infected by HPV. Given that around one in ten girls under the age of 16

already have the virus, it was thought best to vaccinate girls before they

were likely to have had sexual activity.

Can my daughter opt out?

Every parent will be asked to sign a consent form before the jab is given.

If your daughter wishes to have the jab and you don't, the final decision is

legally yours for a Year Eight girl, but not for a girl over 16.

• HELPLINES: www.nhs.uk/hpv or 0845 602 3303; www.jabs.org.uk

[Guest guest]

So to save 400 women, they're going to damage 10K? yeah, makes a lot of

sense to me.

Nita (crew chief) and the crew: 15, Jon 13, 11, 9,

7, Christian (7/16/03 to 8/22/04), 2 and Isaac, 2/3/08

http://momof6.dotphoto.com <http://momof6.dotphoto.com/> for not

necessarily current pictures

http://nitasspot.blogspot.com

Learn from the mistakes of others. Trust me... you can't live long enough

to make them all yourself.