On June 8, 2006, the United States Food and Drug Administration approved a vaccine against human papillomavirus (HPV) marketed by Merck and Company. Almost immediately, television commercials appeared touting Gardisil, the new “cervical cancer vaccine.” Web campaigns were launched to spread the word about HPV, which can cause cervical cancer, and to create awareness about the vaccine, recommended for girls and women ages 9 to 26. The marketing campaign has left some parents and young women scratching their heads, uncertain as to how HPV is spread, what the vaccine actually prevents, and whether they or their daughter need it.

What is HPV?
Human papillomavirus (HPV) refers to a group of viruses that includes more than 100 different strains or types. Approximately 30% of HPV strains are sexually transmitted and can infect the genital areas of men and women. Most people who become infected with HPV will have no symptoms and will unknowingly carry the virus. Some strains of HPV cause genital warts, and the presence of HPV increases the risk of developing cancer of the cervix, anus, or genitals.
According to the Centers for Disease Control, more than 50% of the adult population is infected with a sexually transmitted type of HPV, though only a fraction of that group has experienced symptoms. HPV is heavily linked to the development of cervical cancer; particularly HPV types 16, 18, 31, 33, and 45, as well as a few others.

About Cervical Cancer
There are two main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. About 80-90% of cervical cancers are classified as squamous cell carcinoma, while the remainder fall into the adenocarcinoma category. Adenocarcinomas are becoming more common among women born in the last 20 to 30 years, while the incidence of squamous cell carcinoma is decreasing.

Pap smears, designed to spot cellular changes in the cervix, are recommended annually. Because of this screening tool, the incidence of death from cervical cancer has declined by about 4% annually since 1952, although 2007 is projected to see a rise in cervical cancer diagnoses. The American Cancer Society estimates that in 2007, about 11,150 cases of invasive cervical cancer will be diagnosed in the United States. About 3,670 women will die from cervical cancer in the United States during 2007. According to Dr. Joan Walker, a gynecologic oncologist at OU Medical Center, this year an estimated 160 Oklahoma women will be diagnosed with cervical cancer that could have been prevented by the vaccine.

What is Gardasil?
Gardasil is a new vaccine that immunizes against the four most common types of sexually transmitted HPV (Types 6, 11, 16, and 18). Types 6 and 11 are considered “low-risk” strains, meaning that they are unlikely to lead to pre-cancerous changes, though these strains cause about 90% of genital warts. Types 16 and 18 cause about 70% of cervical cancers. The vaccine is most effective when used prior to any exposure to the virus, hence the recommended age range of 9-26. Gardasil is a series of three injections (costing approximately $120 per shot) over a six-month period.

In Oklahoma, females age nine through 18, with parental permission, may be vaccinated through the Vaccines for Children Program. To receive the free vaccine at the Oklahoma County Health Department, girls must meet these criteria:

• be uninsured or have insurance which doesn't cover vaccines, or
• be Native American, or
• be on Medicaid.

Girls who don't fit the above guidelines need to see their physician for the vaccine. Private insurance covers the vaccine, typically paying around 80% after a deductible is met. The vaccine is currently voluntary in most states, though some have introduced legislation to make the vaccine mandatory for all girls prior to entering the sixth grade. Texas Governor Rick Perry signed such a law in February and now all girls entering sixth grade are required to receive the vaccinations, though parents may opt out by signing an affidavit objecting to the vaccine for philosophical or religious reasons.

Important Considerations
The prospect of mandating a vaccine against a sexually transmitted disease for preteen girls does not sit well with some parents. Some fear that it will be one more strike against abstinence education, while others argue that they hesitate to proceed with any vaccine that lacks data on its long-term effects. Others simply feel it is a decision that needs to be made within a family. While the majority of moms polled (unscientifically) for this article conceded that they would probably vaccinate their daughters (or encourage vaccination in their older daughters), most did so with reservations.

Marketing campaigns for Gardasil have omitted important information about HPV and how it is spread. The television ads show attractive teenagers while a voice-over gives information about the “vaccine that can prevent cancer.” While Gardasil may indeed be an effective tool for reducing the likelihood of developing cervical cancer, parents and older patients need far more information to make an informed decision than what is provided in the advertising. Valuable information can be found at Cancer.org and the Centers for Disease Control website, cdc.gov. Questions and concerns should be addressed with health care providers.

Dr. Walker points out the continued importance of regular pap smears and HPV screenings in addition to the vaccine, but feels the vaccine will have a dramatic impact on cervical cancer rates, perhaps eliminating 70-75% of all cervical cancers. “It will take 10 years to see the effect of lowering of CIN 3 [precancer] rates and 20 years to see the decline in cancer rates. But I am excited to watch it happen.”

HPV: An Edmond Mom Tells Her Story
How HPV affects my life

I thank the Lord daily I'm okay. I give him thanks for allowing me to have a son. It has been a long road to obtaining my dream of motherhood, but I've been blessed and my dreams have come true. Unfortunately, this is not the case for many women in this world who've contracted HPV.

When I was 18 years old, I found out I had cervical dysplasia, abnormal cells on the surface of the cervix considered to be a precancerous condition, and would have to have outpatient surgery to remove the abnormal cells. You can only imagine the shock and horror not only I, but my family, felt. How was it possible at such a tender age to receive such devastating news? Unbeknownst to me, I had contracted HPV, human papillomavirus, a sexually-transmitted disease that causes the majority of cervical cancer cases.

No one deserves the lifelong scare of having HPV. I thought I was being safe. I had a steady boyfriend whom I loved-puppy love, but the love a teenager feels seems real and true at the time. I had no idea making the choice to be with him in a sexual manner would lead to health problems I never could have imagined.

Once diagnosed with HPV and cervical dysplasia, I still had no understanding of the virus, the potential problems it could cause, or how it could possibly destroy my chances of ever realizing my life long dream of being a mother. My doctor, a fantastic lady esteemed in her field, played it down as though it was not a big deal. I now believe she was merely trying to keep me from being scared out of my mind. Besides, HPV is so common amongst women I imagine to a physician who deals with the virus daily, it is the norm. I do wish I would have been given more information at the time of diagnosis so I could fully understand what was happening to my body and what would be my reality from then on.

Between the ages of 18 and 25, I had numerous biopsies taken. I had three surgeries to remove abnormal cells so they would not turn in to cancer. I had multiple other procedures performed to remove the pre-cancerous cells and to test for further problems and the potential of it spreading to my uterus. I can't explain the physical pain I endured, not to mention the emotional turmoil of always having the lingering question in the back of my mind-do I have cancer and will they have to do a hysterectomy before I have the chance to have children? It was scary. It was heart wrenching. It changed me forever.

I have not had a bad pap smear in almost seven years. My mom helped me research why my dysplasia kept reoccurring and one thing we learned was tobacco smoke really aggravates the problem. I smoked a pack a day for 10 years. Once I learned this important fact, I had my good solid reason to put down the cigarettes forever. I have now been a reformed smoker for almost six years and I have not had a bad pap smear result since!

There is no cure for HPV. It can come back at any time. The scare will always exist for me. There have been other circumstances of the disease that have impacted my life. I have an insufficient cervix due to having had so much of it removed. When I finally got pregnant with my son, I had to talk to my doctor about my medical history and together we decided I would need a cervical cerclage. In my fourteenth week of pregnancy, I literally had my cervix sown shut to support the growing baby in my womb so I would not miscarry. If I had not had this done, I most likely would have lost my son.

At 27 weeks, I went into pre-term labor. I can't say for 100% certainty it was because my now very small cervix was having a hard time supporting the baby in my womb, but the question is always there. At 30 weeks, I delivered my son despite the doctor's best attempts to keep him from being delivered early. He went on to spend the first month of his life in the neonatal intensive care unit. As I write this, he is 19 months old and is thriving! He is a blessing and a wonder to behold and it truly my miracle baby. Who knows for sure if my problems from HPV are part of the reason he came into this world before his tiny body was fully ready, but I've carried tremendous amounts of guilt and have had to work long and hard to forgive myself and be thankful he turned out to be healthy.

I hope and pray I'll be able to have more children, but I don't know. My annual exam is quickly approaching and each year the dread and fear of my pap results looms above me like a dark cloud. I can't begin to tell you of the guilt, shame, depression, and emotional damage I've experienced through it all. It has taken over a decade for me to realize I didn't deserve this. I was not being punished. I'm not dirty or bad. It happens to so many women and yet the education and the information, as well as the awareness still do not exist to prevent this vicious disease from destroying many more lives.

As parents, we have a responsibility to educate our children about HPV, especially our daughters who potentially bear the brunt of this wicked virus. Research the virus. Study it and the devastation it can cause and in turn, educate your children. Help them make better choices, or at least educated ones. Be glad and rejoice you've done all you can to help them avoid a life long struggle of the potentially fatal diagnosis of cervical cancer.

If you think HPV will not affect you, your family members, or your children, think again.
HPV is so common that by age 50 as many as 8 of 10 women who have sex will be infected with it. There are more than 100 types of HPV. The most dangerous types are HPV 16 and 18. Together, these two types of HPV account for an estimated 70 percent of cervical cancer cases.
(Above statistics from: http://www.makethecommitment.org/cervical_cancer/cause.asp)

Shannon Fields is a freelance writer and a Certified Pharmacy Technician at Innovative Pharmacy Solutions. She holds a BA in Psychology with a minor in English from the University of Central Oklahoma. Shannon lives in Edmond with her husband and two daughters.