Features

Stalking a silent killer

"Stalking a silent killer" Continued...

Issue: "Autumn books," Oct. 7, 2006

The Bill and Melinda Gates Foundation has funded some of the most well-known efforts to fight cervical cancer in developing countries. From 1999 to 2004, the foundation gave $50 million to establish and support the Alliance for Cervical Cancer Prevention, which works with local doctors and health agencies to set up screening programs in countries like Angola, India, and Tanzania.

In June, the nonprofit global health organization PATH announced it had received $27.8 million from the foundation for a five-year project to introduce the HPV vaccine in India, Peru, Uganda, and Vietnam. A spokeswoman for PATH said the organization had just started working on the project, and, like all global health programs, it would take a while to implement. Merck has promised to give projects like PATH's a discount on Gardasil.

In the United States, the vaccine is already for sale for $120 a dose, more expensive than any other vaccine on a price list published in August by the Centers for Disease Control.

Since it takes three doses to develop full immunity, American women can expect to pay $360 for full protection against HPV. Some private insurance companies have already agreed to cover the cost. So did the federal Vaccines for Children program, which provides free immunizations to uninsured or underinsured children. Since Pap testing, which usually costs less than $50 a test, has successfully kept U.S. cervical cancer at bay, Giuliano does not expect rates of the disease to drop significantly lower because of the vaccine. Rather, she predicted, the incidence of abnormal Pap tests and genital warts will decrease. Whether it will encourage promiscuity has not been tested.

"There have been studies looking at how women feel once they have been given an HPV test diagnosis," Giuliano said. "It's almost akin to having been diagnosed with one of the classic STDs. . . . Women don't know if they can have sex again or not. It does create a lot of anxiety even when they don't develop cervical cancer."

To develop immunity to HPV, women must receive the vaccine before they expose themselves to the disease. That puts the responsibility on parents to estimate when daughters will become sexually active and to decide whether and when a girl should get the HPV vaccine. The CDC recommended the vaccine for girls as young as 9, stirring a controversy similar to the debate over sex education in schools. States chose not to include the vaccine on their lists of shots required for school attendance.

Conservative family groups that oppose mandatory sex education and condom distribution at schools have said they support the use of the vaccine as long as parents, not schools, choose whether their children receive it. The Family Research Council issued the following statement:

"While we welcome medical advances such as an HPV vaccine, it remains clear that practicing abstinence until marriage and fidelity within marriage is the single best way of preventing the full range of sexually transmitted diseases, unwanted pregnancies, and negative psychological and emotional consequences that can result from sexual activity outside marriage."

Mao witnesses those consequences at the Harborview Women's Clinic, where every day she explains HPV to another patient who has never heard of it. "I've taken care of a lot of young women with fairly significant disease who end up getting procedures done to remove abnormal cells," Mao said. "I've had people tell me, 'I wish someone would have told me about HPV before I had sex with people, and maybe I would have had fewer partners or thought about it a little.' People don't understand the risk of having boyfriends when 15 or 16 years old other than just getting pregnant."

Lynde Langdon
Lynde Langdon

Lynde lives in Wichita, Kan., with her husband and two daughters. She holds degrees from the University of Missouri in journalism, Russian, and business administration. She is in a long-term, committed relationship with the Lutheran church. Follow Lynde on Twitter @lmlangdon.

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