Second Opinion: Give your daughter a healthy sex life with the HPV vaccine

Last week I was in Galway Cathedral and the December issue of Alive! caught my eye. The front page of this 16-page, Catholic newspaper, 240,000 of which are distributed free to churches throughout the country every month, referred to an article on page 12 about the human papillomavirus (HPV) vaccine: "What are they doing to your daughter?"

Scare tactics are used throughout the article and hysterical claims are made about the vaccine in an attempt to deter parents from having their daughters immunised: "Young girls full of the joys of life, high achievers with no health issues, have become shadows of their former selves, in constant pain and in need of full-time care."

Crosshead
Minister for Health, Dr James Reilly, according to Alive!,"knows there is no evidence that it [the vaccine] will prevent even one cancer".

The Hiqa 2008 report – The Role of Human Papilloma Vaccines in Reducing the Risk of Cervical Cancer in Ireland – is misrepresented in the article: "The protective effect of the vaccine against invasive cancer has not yet been demonstrated."

The truth is that research studies are not around long enough to show that the vaccine reduces the incidence of invasive cancer as, according to Hiqa, this can take up to 20 years to develop.

“The longest duration of follow-up in relation to vaccine efficiency, reported in published clinical trials, is approximately five years.”

Infection with HPV is the main cause of cervical cancer and the Hiqa report makes very clear that “the vaccine is effective in preventing cervical dysplasia, the condition that can lead to cervical cancer”.

Following infection with HPV, cervical cells can change and progress through a number of stages before becoming cancerous, then invasive. Stages CIN (cervical intraepithelial neoplasia) I, 2 and 3 refer to changes in cervical cell nuclei, ranging from mild, moderate to severe dysplasia.

Pre-cancerous changes
The classifications refer to pre-cancerous changes in the cervix caused by HPV infection. When cell nuclei exhibit dysplasia they look darker, angrier, and out of shape under a microscope. Severe dysplasia can progress to carcinoma-in situ (cancer in a defined site), followed by invasive cancer.

“Data from randomised controlled trials [RCTs] have demonstrated vaccine efficiency against CIN 2/3.” Although the report is five years old, Hiqa confirmed last week that its position on safety and cost effectiveness has not changed since 2008.

Strategies for the primary prevention of cervical cancer include changes in sexual practices, for example, lifelong monogamy and vaccination.

Irish studies have shown that a third of Irish males and nearly a quarter of Irish females are sexually active before the age of 17 so women and men having only one sexual partner in their lifetime is an unlikely scenario.

A national free vaccination programme for young girls before they become sexually active is the responsible and effective response.

Despite the vaccine's effectiveness in preventing HPV infection, conservative Catholic groups are against these vaccination programmes. Not because these groups are worried about side effects but because the HPV vaccine protects against a sexually transmitted infection.

One sexual partner
The attitude among these groups is that everyone should have only one sexual partner in their lifetime. Young girls should not be encouraged by the State to be anything other than monogamous. If they are not and contract HPV, then they can face the consequences, including cervical cancer.

It is time for Catholic churches to help stop the spread of conspiracy theories, and misinformation. Alive! should not be distributed through churches.

Scare tactics do not help parents who are worried about having their daughters immunised.

Side effects
The HPV vaccine is safe. Like all other vaccines there may be side effects. No medical treatment or intervention is 100 per cent safe. That is life. As the Hiqa report says "studies of [HPV] vaccine safety are ongoing" as they are for all other vaccines.

Agencies such as Hiqa that provide technical advice on the safety of vaccines have to examine the evidence from the perspective of society as a whole.

Benefits for the overall population must be weighed against any side effects that may be experienced by a minority of vaccine recipients. In the end, parents must make up their own minds and they do. In 2012 the HSE exceeded its target for HPV uptake for 12 year old girls. I say go for it. Anything that helps people enjoy a healthy sex life without having to pay a heavy price for it down the line is a good thing.

Dr Jacky Jones is a former HSE regional manager of health promotion
drjackyjones@gmail.com