By Antonio D. French
Filed Monday, March 26, 2007 at 12:32 PM
A couple of weeks ago, State Rep. Sam Page (who is rumored as a possible candidate for Lieutenant Governor in 2008) talked to Pub Def about his bill (HB 802) to add the new vaccine for the human papilloma virus (HPV) to the list of required immunizations for Missouri's school-aged children. Labels: State_House
According to the Centers for Disease Control and Prevention, approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.
Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with "high-risk" types of HPV is the main risk factor for cervical cancer.
Click here to learn more about HPV.
11 Comments:
Regarding the HPV vaccine, I have a few comments. Currently, there is only one manufacturer. The price is very high for the vaccine. Soon, there will be another manufacturer. The price should decrease. Vaccinating young girls now might not be necessary. It would be better to see what side effects come to light on older women and then vaccinate young girls, after the safety is better understood.
3/26/2007 9:42 PM
Are you basing your decision on facts of one manufacturer and a higher cost? I think that is pretty short sighted when it comes to health.
Having said that, I think that it is pretty early to require vaccination, though I haven't read anything that points to a later vaccination being just as helpful in prevention.
I would rather see the money that would be spent on this go instead to 2 things: 1) Sex education for young women that teaches self-respect and self-worth along with absinence is best but also teaching reproduction and the problems associated with young mothers (child rearing, future education and job loss, etc.) and 2) breast exams to the poor, disadvantage women. This is a proven way of preventing breast cancer.
Then revisit the vaccine as more studies come to light.
3/26/2007 10:28 PM
Merck does have the corner on the HPV vaccine. However, the next one to be FDA approved for distribution does not protect against the same strains as Gardasil and will not have the same efficacy against cervical cancer causing HPV.
Rep. Page is not backing one pharmaceutical company over another. He is instead trying to protect women from contracting HPV will can ultimately lead to cervical cancer.
Regarding Morris' comment about further studies, those are in process at a number of research institutions nationwide. I would counter your argument about money being spent on this vaccine to be spent on "pro-abstinence, pro-respect" and health screenings. Breast cancer and cervical cancer are not the same thing. By the time a woman is screened for HPV, it may be inappropriate to counter with treatment for cervical cancer (if symptoms illustrate the condition).
That being said, this is not a one or the other kind of decision. I will quote what I posted on ACC about a month ago,
Requiring such a vaccination as prevention does not preclude attempts to instill moral values as families see fit.
Rep. Page is truly making strides to prevent young women and girls from being exposed to a potentially fatal disease.
Public health has three core functions: assessment, assurance, and policy. What better example than protecting young women from a preventable virus, assuring the community of a vaccines efficacy and treatment options, and finally developing policy to address the need for appropriate conversations around sexual expression.
I wholeheartedly agree that as a community we need to engage and re-engage our young ones in conversations about appropriate expressions of "sexual-ness" and along with that, discussions about "sexuality." But we as a public health community also have a responsibility to protect the vulnerable and in this case, young women and girls, from succumbing to a preventable disease.
I encourage anyone who is concerned about this bill or about HPV to contact Rep. Page.
Mary E. Homan, MA
Senior Research Assistant
Controlling Asthma in St. Louis
Saint Louis University
School of Public Health
Salus Center, Suite 300
3545 Lafayette Ave
Saint Louis, Missouri 63104
Ph: 314.977.8102
Fax:314.977.1674
homanme@slu.edu
3/27/2007 11:47 AM
Just some food for thought. Cervical cancer is very rare in women married to Jewish or Muslim men. In the Far East, it is a major killer of women. What's the difference?
Jewish and Muslim men are circumcised. Circumcision in the Far East is virtually unknown.
For some, a vaccine may be needed. But should a vaccine for a sexually-transmitted disease be mandated?
Some could say that circumcising boys and less promiscuity of lifestyles of the young men and women would probably make cervical cancer very, very rare.
Just food for thought. To some, God's mandate of circumcision to Israel made sense both for the boys and serious protection for the girls and women.
3/27/2007 12:45 PM
Some food for thought that Helen Louise forgot to mention.
http://content.nejm.org/cgi/content/abstract/346/15/1105
The study that is "food for thought" shows that
"Women with "low-risk" partners - men who had previously had fewer than six sexual partners - had a similar risk of cervical cancer,"
The bizarre thing is that the study has 847 uncircumcised men with 166(19.6%) cases of HPV versus 292 circumcised men with 16 (5.5%)having HPV.
I am not a biological scientist but if you have a larger sample of uncircumcised men and a larger percentage have HPV you have slanted the numbers.
If the study had at least the same amount of uncircumcised as circumcised men then maybe you could tell if circumcision has something to do with HPV, but it doesn’t.
BTW the HPV vaccine costs about $120 - $140 per dose.... What dose a circumcision cost?
3/27/2007 8:30 PM
Couldn't access any article on the subject.
Is there possibly a connection to surveying a very small group of people in a very or highly promiscuous society? The universal facts cannot be denied, it seems to me. Rare or non-existent in Jewish/Muslim societies while off the charts as a killer in Asian cultures. How does one justify these known facts?
Also, it is or has been noted that there is more penile cancer in uncircumcized men than in those circumcized.
As I introduced those facts, they are just food for thought. I do think global or universal data is worth taking into account.
I am personally aware of an adult man who underwent circumcision due to causing his wife problems. It was, of course, very painful as an adult.
There is a book written by a physician entitled "None of These Diseases" that shows how many of the Jewish Torah or Old Testament regulations had definite health and medical benefits. In fact it showed how not circumcizing until the 8th day allowed for the function of blood clotting to take place, which it wouldn't before then.
As to the cost, any side effects of the vaccine are still unknown. How much does it cost to circumcize a baby boy? Why was it at one time recommended?
3/28/2007 9:00 AM
Helen Louise,
Please f/u your argument with facts. Your anecdotal evidence is interesting but without quantitative methods, it fails to illustrate your point that circumcised males will diminish rates of HPV in women. I also wonder about your statements "highly promiscuous society" (by what standards, a cohort model? a quasi-stratified experimental design intervention??) and also "the universal facts [about the link between promiscuity and HPV???] can't be denied." Did I interpret that correctly? Let's not forget the male is the carrier and for all intents and purposes, he could pass it onto his wife.
I cite the following from Van Howe RS., "Human papillomavirus and circumcision: A meta-analysis," Journal of Infectious Diseases, 2006 Sep 25; [Epub ahead of print]:
There was no significant association between circumcision status and HPV infection (random-effects model summary effect OR=1.20, 95%CI=0.80-1.79) in these three studies. If the eight studies using accurate diagnostic methods are adjusted for the method of determining circumcision status and failure to sample the penile shaft using meta-regression the summary effects odds ratio is 1.25 (95%CI=0.95-1.67). CONCLUSIONS: The medical literature does not support the claim that circumcision reduces the risk for genital HPV infection. To correctly assess the risk of HPV infection in circumcised males, the penile shaft needs to be sampled for HPV infection.
Also please see, Aynaud, O. Piron, D. Bijaoui, G. Casanova, J M., "Developmental factors of urethral human papillomavirus lesions: correlation with circumcision," BJU International, 84:1(Jul 199)):57-60 that concludes
Being uncircumcised did not seem to increase the risk of HPV urethral infection in young men. Genital bacterial infections and urethral HPV lesions appear to be linked. Urethritis can induce squamous metaplasia of the urethral epithelium, which appears to favour the colonization of the anterior urethra by HPVs.
3/28/2007 5:16 PM
Oh and also, RE: cost of circumcision, please see Schoen, Edgar J. Colby, Christopher J. To, Trinh T., "Cost analysis of neonatal circumcision in a large health maintenance organization," Journal of Urology, 175:3,Pt1 (Mar 2006):1111-5:
RESULTS: Postneonatal circumcision was 10 times as expensive as neonatal circumcision (1,921 dollars per infant vs 165 dollars per newborn), and was medically indicated for 9.6% of uncircumcised males. Cost benefits of circumcision resulted from prevention of infant urinary tract infection, balanoposthitis, phimosis, HIV infection and penile cancer. Assuming initial neonatal circumcision cost to be 200 dollars, the future health care cost offset (avoided) was calculated as 183 dollars (range 93 dollars to 303 dollars in 95% of simulations). CONCLUSIONS: Multiple lifetime medical benefits of neonatal circumcision can be achieved at little or no cost. Because postneonatal circumcision is so expensive, its rate is the most important factor determining future cost savings from newborn circumcision.
3/28/2007 5:19 PM
Maire, I certainly can't match your references. I do question just how universal the tests in question ran. Did they cover other nations, nationalities, etc.
I have lived in the Arab/Muslim world. I have friends who are in the medical field. One who served many years in the Far East and is all too familiar with the extremely high rate of cervical cancer. Several other friends, one an oncologist, seemed to be in agreement that there is a coincidence of how rare the disease is in women married to circumcized men. I can assure you that in the Muslim world, a woman most likely does not have several or many sex partners. A man perhaps, but not a woman. She would risk death.
I raised this issue with a gynecologist who agreed that often the HPV virus is passed on by the man and often it's origin is behind the foreskin.
The fact that a physician of many years noted it in his book, along with these many other experiences, I tend to give it credence that others in the medical field have affirmed.
Admittedly, despite men being circumcized, if a woman has multiple sex partners, she does increase her risk.
Compared to the Muslim world, yes, we are a higher promiscuous society. Listen to some of their rants and understand their practices, and you will agree with me in this regard. The U.S. is considered a depraved nation by many Muslims, if not most; and most of that is attributable to our sexual mores.
I worked in a middle and high school. It is amazing how many very, very young girls have already engaged in sex. I assure you, that is not the case in a Muslim society.
It probably isn't the case in the Far East either, but perhaps the men who are 99% uncircumcized aren't meticulous in their private cleanliness--thus their wives suffer a consequence.
After having said all this, feel free to shoot me down.
3/28/2007 6:19 PM
Maire, hope you're still there. In today's Post-Dispatch:
WHO Urges Circumcisions to Curb AIDS
WASHINGTON POST
Thursday, Mar. 29 2007
JOHANNESBURG, South Africa — The World Health Organization on Wednesday urged nations with rampant AIDS epidemics to begin offering free or subsidized
circumcisions in hopes of reventing millions of new nfections and deaths.
The new recommendations, endorsed also by the United Nations AIDS agency, came in response to growing evidence that removing a man's foreskin lowers his risk of contracting HIV by 60 percent — a higher rate of protection than that offered by many vaccines.
Circumcision campaigns could prevent 5.7 million new infections in Africa over the next 20 years, the organization says in a statement issued from Geneva.
"The recommendations represent a significant step forward in HIV prevention," Kevin De Cock, director of the organization's HIV/AIDS department, says in the
statement. "Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before
we can expect to see an impact on the epidemic from such investment."
Three experiments, including two that reported results in December, have largely quelled debate in the scientific community over the value of circumcision.
Recent discussions have focused on how to increase the number of circumcisions performed, specially in sub-Saharan Africa, where HIV rates are highest and
public health systems generally are rudimentary.
Wednesday's announcement also urges nations to prioritize circumcision for adult men most at risk of contracting HIV, rather than infants.
Most traditional African societies historically have circumcised boys in rituals signifying the arrival of manhood, but those rites have declined amid rapid modernization, especially in eastern and southern Africa. Regions that continue to circumcise widely, including most of West Africa, have much lower
rates of HIV.
Demand for circumcision has grown in several nations as news of the studies has spread. But no nation has yet embarked on a major effort to expand services.
3/29/2007 7:19 AM
AIDS, right-o, which is NOT HPV. Totally different issue at hand; related but not correlated therefore remember that correlation is not causation (as in the case of circumcision and HPV).
Helen Louise, if you want to talk more, email me. homanme at slu dot edu
3/29/2007 11:45 AM
Post a Comment
<< Home