During my long years in scientific research and medical device product development, one of the great goals that is often repeated (rarely by the researchers themselves but politicians and the public) is a prevention or “cure” for cancer. Setting aside the simple fact that there are over 250 different cancers, each with its own cause(s), pathophysiology, prognosis and cure(s), and setting aside the fact that we can cure some cancers, albeit with radical treatments, simple prevention and cures have been elusive.
Many people have hyped foods or supplements as “natural” prevention for cancers, but the evidence that any of these things work is missing. Or a myth. Or just don’t work.
Actually, one of the best ways to prevent cancer is get immunized against certain cancer causing viruses. And there is one medical discovery that can prevent one of these viruses. It’s easy to get the prevention. It’s very safe. And it really works.
What is this cancer causing virus?
Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the USA. There are more than 40 HPV sub-types that can infect the genital areas of males and females. Additionally, some HPV types can also infect the mouth and throat. HPV is generally transmitted from personal contact during vaginal, anal or oral sex.
HPV is linked to cancers in men and women, and because there are so many subtypes, research has established which HPV types are linked to certain cancers.
- Cervical, vulvar, vaginal, and anal cancers can be caused by HPV types 16, 18, 31, 33, 45, 52, and 58.
- Genital warts are caused by HPV types 6 and 11. Although genital warts are generally benign (though unsightly), there is a small chance they develop into cancers.
- Various precancerous lesions of the cervix, vulva, vagina, and anus can be caused by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58
- Oropharyngeal and penile cancers are caused by subtypes 16 and 18.
HPV is believed to cause nearly 5% of all new cancers across the world, making it almost as dangerous with regards to cancer as tobacco. According to the CDC, roughly 79 million Americans are infected with HPV–approximately 14 million Americans contract HPV every year. Most individuals don’t even know they have the infection until the onset of cancer. About 27,000 HPV-related cancers are diagnosed in the USA every year.
How can that horrible virus be prevented?
The original HPV quadrivalent vaccine, known as Gardasil (or Silgard in Europe), can prevent infection by human papillomavirus, substantially reducing the risk of these types of cancers. An HPV bivalent vaccine, known as Cervarix, is used in some countries, but only provides protection again two of the subtypes most associated with cervical cancer.
The new version of Gardasil, recently cleared by the US Food and Drug Administration, protects teens and young adults from 9 subtypes of HPV, helping prevent more cancers.
According to the package insert, Gardasil 9 is indicated in females aged 9-26 years for the prevention of cervical, vulvar, vaginal, and anal cancer caused by HPV types 16, 18, 31, 33, 45, 52, and 58; genital warts caused by types 6 and 11; and various precancerous or dysplastic lesions of the cervix, vulva, vagina, and anus caused by types 6, 11, 16, 18, 31, 33, 45, 52, and 58. The vaccine is also indicated in males aged nine through 15 years for the prevention of anal cancer caused by types 16, 18, 31, 33, 45, 52, and 58; genital warts caused by types 6 and 11; and anal intraepithelial neoplasia grades 1, 2, and 3 caused by types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Currently in the United States, the Advisory Committee on Immunization Practices (ACIP) recommends that preteen girls and boys aged 11 or 12 are vaccinated against HPV. The immunization is also recommended for teenage girls and young women up to the age of 26 who did not receive it when they were younger, and teenage boys and young men up to the age of 21.
Let’s be clear here. Gardasil prevents cancers–serious, life threatening cancers. And frankly, I do not know of any other medical or “natural” treatment that has this much evidence in support of its actual usefulness in preventing not only one, but at least five types of cancer. I don’t believe in “miracles” or making more out of medical procedures than what’s really there, but the HPV vaccination is pretty close to a “miracle.” With it, we could essentially eradicate, or dramatically reduce, some types of deadly cancer.
Who are these anti HPV vaccine barbarians?
Despite the fact that the HPV vaccination saves lives, there are groups, even in the medical community, that are opposed to Gardasil and consider it unsafe or ineffective. I’ve written about many of them.
Two of the most famous, Drs. Christopher Shaw and Lucija Tomljenovic of the University of British Columbia, Department of Ophthalmology, wrote a recent article attacking the HPV vaccine:
All drugs are associated with some risks of adverse reactions. Because vaccines represent a special category of drugs, generally given to healthy individuals, uncertain benefits mean that only a small level of risk for adverse reactions is acceptable. Furthermore, medical ethics demand that vaccination should be carried out with the participant’s full and informed consent. This necessitates an objective disclosure of the known or foreseeable vaccination benefits and risks.
The way in which HPV vaccines are often promoted to women indicates that such disclosure is not always given from the basis of the best available knowledge. For example, while the world’s leading medical authorities state that HPV vaccines are an important cervical cancer prevention tool, clinical trials show no evidence that HPV vaccination can protect against cervical cancer.
Similarly, contrary to claims that cervical cancer is the second most common cancer in women worldwide, existing data show that this only applies to developing countries. In the Western world cervical cancer is a rare disease with mortality rates that are several times lower than the rate of reported serious adverse reactions (including deaths) from HPV vaccination. Future vaccination policies should adhere more rigorously to evidence-based medicine and ethical guidelines for informed consent.
Before we get to their unsupported points, let me point out something. Tomljenovic and Shaw are strongly supported financially by the key antivaccination donors, very wealthy ones. Although I am offended by the Shill Gambit, which is a logical fallacy that states that financial support from a group can imply that scientific ethics or morals have been purchased, and they can’t be trusted. Well, if that argument is to be used against Paul Offit, about whom we have solid evidence that he invented a vaccine that has saved hundreds of thousands of lives in this decade, then it can be used against Tomljenovic and Shaw whose sum total contributions to medical science are poorly written, poorly designed research.
The article, Human papillomavirus (HPV) vaccine policy and evidence-based medicine: Are they at odds?, was published in the Annals of Medicine in December 2011. I don’t want to denigrate the authors, Tomljenovic and Shaw by relying on some sort of strawman fallacy, but I question why two individuals who are associated with a medical specialty, ostensibly involved with the eyes, are so obsessed with vaccines.
Furthermore, they have a long history of anti-vaccination papers, most published in low impact journals. For example, they recently published an article correlating aluminum with autism, though the correlation is specious and providing no causality. One of the worst mistakes of research is conflating causality and correlation.
The irrational, and scientifically unsupported, anti-HPV vaccine beliefs of Tomljenovic and Shaw have been prevalent in the public discourse about the vaccine for quite awhile.
Unfortunately, on 4 December 2013, the anti-HPV vaccine crowd got a somewhat larger audience. Katie Couric, a popular “journalist” who used to have her own morning TV show broadcast an episode where Ms. Couric interviewed a mom who claims that Gardasil killed her daughter. And some of the interview used the unscientific claims of Shaw and Tomljenovic.
Prior to airing of the show, Couric claimed that she will cover all “sides” of the HPV issue, which means that she has fallen for the false balance issue for the HPV vaccine–unfortunately, there aren’t two sides. There isn’t a debate. There isn’t a conversation. There is simply great science supporting the HPV vaccine, and believing lies, misinformation, and post hoc fallacies.
The science behind the HPV vaccines
But in case you’ve come here because you want to find out if the HPV vaccine (and Gardasil specifically) is safe and effective, here’s your handy pocket/smartphone/tablet guide:
- The HPV vaccine has been shown to reduce the rate of HPV infections in adolescents and young adults. (Citation)
- The HPV vaccine has been shown again to reduce the rate of HPV infections in adolescents and young adults. (Citation)
- The HPV vaccine has been shown to reduce the rate of HPV infections in gay men. (Citation)
- The HPV vaccine has been shown once again to be effective in reducing the rate of HPV infections in adolescents and young adults. (Citation)
- One of the key HPV vaccine researchers did not change her mind about the safety and effectiveness of the vaccine.
- The HPV vaccine was shown to have produced no significant adverse events in a large study of nearly 200,000 young women given 350,000 doses of Gardasil. (Citation)
- The HPV vaccine was shown to have produced no significant adverse events in an even larger study of 300,000 young women given nearly 700,000 doses of the HPV vaccine. (Citation)
- The HPV vaccine does not turn your children into crazy sex maniacs. (Citation)
- The HPV vaccine adverse event rate cannot be accurately determined from data from Vaccine Adverse Event Reporting System (VAERS). (It’s dumpster diving.) (Citation describing how to critically examine VAERS and other post hoc data)
If any of the anti HPV vaccine group could present data this robust, this highly peer-reviewed, this well accepted, then maybe they could contradict the scientific consensus with respect to HPV vaccines. But until that point, and I don’t expect it will ever happen, then the anti HPV vaccine crowd is merely pushing the agenda of the anonymous vaccine deniers who think that an hours worth of research on the internet is equivalent to real scientific research, who think that the shilling of Tomljenovic and Shaw is real science, and who try to manipulate heartbreaking stories of people who want to blame vaccines for the deaths of loved ones, but have no evidence that vaccines were involved.
The science supporting the safety and efficacy of HPV vaccines, including Gardasil, is strong, and almost irrefutable. Until the vaccine haters provide equivalent high quality data, they really have nothing to offer to a conversation, which has evolved to be a “debate” between real science and fabrications.
And if you think that the “research” of Tomljenovic and Shaw constitutes real science, then we need to explain what constitutes real science and real research. Oh, I think I did.
Editor’s note: This article was originally published in December 2012. It has been completely revised and updated to include more comprehensive information, to improve readability and to add current research.
- Ali H, Donovan B, Wand H, Read TR, Regan DG, Grulich AE, Fairley CK, Guy RJ. Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data. BMJ. 2013 Apr 18;346:f2032. doi: 10.1136/bmj.f2032. PubMed PMID: 23599298.
- Arnheim-Dahlström L, Pasternak B, Svanström H, Sparén P, Hviid A. Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study. BMJ 2013 Oct;347:f5906 doi: 10.1136/bmj.f5906. Impact factor=17.215.
- Bednarczyk RA, Davis R, Ault K, Orenstein W, Omer SB. Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics. 2012 Nov;130(5):798-805. doi: 10.1542/peds.2012-1516. Epub 2012 Oct 15. PubMed PMID: 23071201.
- Camenga DR, Dunne EF, Desai MM, Gee J, Markowitz LE, Desiliva A, Klein NP. Incidence of genital warts in adolescents and young adults in an integrated health care delivery system in the United States before human papillomavirus vaccine recommendations. Sex Transm Dis. 2013 Jul;40(7):534-8. doi: 10.1097/OLQ.0b013e3182953ce0. PubMed PMID: 23965766. Impact factor=2.594.
- Glick SN, Feng Q, Popov V, Koutsky LA, Golden MR. High Rates of Incident and Prevalent Anal Human Papillomavirus Infection Among Young Men Who Have Sex With Men. J Infect Dis. 2013 Sep 1. [Epub ahead of print] PubMed PMID: 23956439. Impact factor: 5.848.
- Klein NP, Hansen J, Chao C, Velicer C, Emery M, Slezak J, Lewis N, Deosaransingh K, Sy L, Ackerson B, Cheetham TC, Liaw KL, Takhar H, Jacobsen SJ. Safety of quadrivalent human papillomavirus vaccine administered routinely to females. Arch Pediatr Adolesc Med. 2012 Dec;166(12):1140-8. doi: 10.1001/archpediatrics.2012.1451. PubMed PMID: 23027469. Impact factor=4.140.
- McCarthy NL, Weintraub E, Vellozzi C, Duffy J, Gee J, Donahue JG, Jackson ML, Lee GM, Glanz J, Baxter R, Lugg MM, Naleway A, Omer SB, Nakasato C, Vazquez-Benitez G, DeStefano F. Mortality Rates and Cause-of-Death Patterns in a Vaccinated Population. Am J Prev Med 2013;45(1):91–97. doi: 10.1016/j.amepre.2013.02.020
- Mesher D, Soldan K, Howell-Jones R, Panwar K, Manyenga P, Jit M, Beddows S, Gill ON. Reduction in HPV 16/18 prevalence in sexually active young women following the introduction of HPV immunisation in England. Vaccine. 2013 Nov 5. doi:pii: S0264-410X(13)01492-8. 10.1016/j.vaccine.2013.10.085. [Epub ahead of print] PubMed PMID: 24211166. Impact factor=3.492
- Tomljenovic L, Shaw CA. Human papillomavirus (HPV) vaccine policy and evidence-based medicine: are they at odds? Ann Med. 2013 Mar;45(2):182-93. doi: 10.3109/07853890.2011.645353. Epub 2011 Dec 22. Review. PubMed PMID: 22188159. Impact factor=5.094.
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