Christopher Labos: What we can learn from the HPV vaccine

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It’s sometimes hard to remember that cervical cancer used to be one of the most common and deadly cancers in women.

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While we talk a lot about the COVID vaccine, another vaccine made headlines last week. A new analysis from the UK estimates that widespread use of the HPV vaccine has reduced cervical cancer rates by about 90 percent and, according to the authors, “almost eliminated cervical cancer” in women born after 1995.

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It’s sometimes hard to remember that cervical cancer used to be one of the most common and deadly cancers in women. But since the 1950s, mortality from cervical cancer has fallen sharply. It decreased by two thirds between 1950 and 1997, mainly due to the introduction of the PAP smear by Georgios Papanikolaou in 1941. The PAP smear was a significant invention not only because of its effects on cervical cancer, but also because it had the premise that that cancer could be identified by looking at abnormal cells under a microscope. This discovery, which seems obvious to us today, was groundbreaking in the 1940s and demonstrated that suspicious cells could be identified early before they turned completely into cancer.

The PAP smear is useful as it allows clinicians to identify cervical intraepithelial neoplasia (CIN), essentially a precancerous lesion of the cervix. A CIN usually precedes a cancer diagnosis by several years, and its detection and early treatment can prevent cancer from developing.

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The benefits of the PAP smear can be seen from the epidemiological data. But the technology has its drawbacks. It is resource-intensive and requires regular screenings and follow-up exams, and patients must have regular and repeated contact with the health system for tests. It works very well here in developed countries where the benefits of decreasing cervical cancer mortality are well documented. But cervical cancer remains a problem in developing countries, where mortality rates are high and regular screenings with PAP tests are difficult to implement. The advantage of the HPV vaccine – and so do most vaccines – is that it is inexpensive and inexpensive. They are relatively easy to roll out over a wide area and are much less resource intensive than a strategy that requires regular testing and follow-up.

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The PAP test also allows you to identify and treat the precancerous lesions early on, but does not prevent them in the first place, while the HPV vaccine actually prevents the cancerous changes from developing. Since most cervical cancers are due to infection with HPV, a vaccine against the virus is effective at preventing the cancer. A 2018 Cochrane review, which included data from 26 studies and more than 70,000 patients, showed that the HPV vaccine reduced CIN rates by 99 percent in women aged 15-26. A 2020 study from Sweden showed a similar massive drop in cervical cancer rates of 88 percent in women vaccinated before the age of 17.

The current UK analysis essentially confirms these earlier findings and estimates that the introduction of the vaccine in England prevented more than 17,000 cases of CIN. The benefit was greater in younger age groups because, since HPV is a sexually transmitted infection, the greatest benefit is seen when you vaccinate younger patients who have not been exposed to the virus. The authors suggest that the high vaccination rates in British girls aged 12 and 13 years nearly eliminated cervical cancer and CIN in this group during the 10 year follow-up period.

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Unfortunately, there is often resistance to vaccines and news that exaggerate the risks will not help the situation. The now infamous Toronto Star headline about the dangers of the HPV vaccine had to be withdrawn after the newspaper finally admitted that it failed to acknowledge the plethora of scientific data that did not show an increased risk of vaccination. I will no doubt spend the rest of my life advocating the widespread use of scientifically proven vaccines because as more people get vaccinated, fewer people get sick. As simple as that.

Christopher Labos is a doctor from Montreal.

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