I paid for an HPV jab today...

[happiestblonde]

I'm in the unfortunate age group that Labour missed out when changing various health policies. Basically, I cannot get a smear test on the NHS until I'm 25 and am too old by a fair few years to get the HPV vaccine on the NHS. A friend of mine who is young, healthy etc - but happens to have parents living in Monaco who demanded she went for a smear test whilst visiting them - found she had pre-cancerous cells and had to have them lazered out. I truly hate to think what could have happened if she hadn't had the test.

So, today I had to pay £60 for a smear test and £580 for the jab (including £100 for the consultation) at a private medical practice because I value my health more than the money (which wasn't lying around, I'm now in a terrible position rent-wise). I understand money is tight and there are various medical reasons for putting the age back but my doctor, and my usual GP, both agreed that there are young women within a certain age range who have been seriously let down and are now at risk.

Am I alone in thinking this is terrible? :(

I can agree with you on the vaccine, even though the vaccine is a lot less effective if you have already been sexually active I think it should be offered to all (and I could even include males in that).

But right now it's new and therefore expensive.
If the patent had already ended, things would have been different.

I cannot agree with you on the screening issue though.
PAP screening, although very successful at reducing cervical cancer death rates are not perfect.
And they're worse in young people.

There are two reasons for this.

Cervical cancer is very rare between the ages of 20-25.
Abnormal cells are very common, but often self limiting.

This means that you end up treating lots of things which will never cause problems while not improving the odds of survival.

Which is what the best evidence available, such as this, indicates.

I'm using this paper as an example as it's open source but just in case you're not comfy with the format, I'll summarise the key data below.

No evidence that screening women aged 22-24 reduced the incidence of cervical cancer at ages 25-29.
Screening was associated with a 60% reduction of cancers in women aged 40.
This increases to 80% at age 64.
Screening was particularly effective in preventing advanced stage cancers.

If you look at the young women who did get cancer then you'll see that almost all of them had PAP smears done which detected cancer at an early stage.
Because they had symptoms.

The numbers don't add up for PAP screening to be started any younger and it's probably England that are correct with the age at 25 rather than the rest of the UK with the age of 20.

Does that make sense?

It does to a certain extent but not entirely. Having spoken to both my GP and the private doctor I saw today, both of their opinions were that screening should start at 21/22. While there is some evidence that young girls were being treated for 'abnormalities' that were actually natural changes (because so many people get HPV without it being harmful), there is also a great deal of cost cutting going on here.

I don't think that is the primary motivation.

But even if value for money was the primary goal, this is good choice of a service not to be provided.

Little or no evidence of a negative effect.
Large numbers of costly and risky over-treatment.
Does not have the QALY related benefit that other therapies do, such as HPV vaccination.

Quite frankly, I'm glad that my taxes are being put to better use than marginal screening.

In the same way I approve of the relatively high starting age for low risk mammography and feel that PSA testing for men is over-emphasised.

Low risk mammography is not screened early because the radiation is harmful. Girls die because HPV that leads of cervical cancer isn't caught early enough due to cost saving techniques. What if someone you knew was affected in this way, would you still be happy your taxes were spent elsewhere?

ignore the 'low risk mammography' bit - i know didnt make sense - tired, you know what i mean.

I'm not sure I agree that unnecessary treatment is carried out. In NI, screening does start earlier. If you get a result with 'borderline changes' you are asked to come back 6 months later. If it is normal, you have another test 6 months later and then it goes to yearly if that is normal. If it is abnormal then it is further investigated by colposcopy and then treatment is administered if necessary. If you have a higher level of changes detected then this may all happen a bit sooner. It seems to focus more on monitoring and allowing the cells to go back to normal (as they sometimes do) rather than rushing into (potentially) unnecessary treatment.

A small percentage of people with HPV will go on to develop cervical cancer. So just because you have abnormal 'pre cancerous' cells you do not have cancer. I worry that the hpv vaccine gives people a false sense of security. I find it scary that it may replace screening because it is 'saving money' even though it is not 100% effective and does not protect against all the strains of hpv.

I'd like to say first, the evidence is pretty easy to follow.

88 page version

8 paragraph version

And I'd also like to answer two other points.

"I'm not sure I agree that unnecessary treatment is carried out."

All screening, everywhere and for every condition leads to unnecessary treatment.

That's a mathematical certainty.

The question is about minimising harms/costs and maximising benefits.

The evidence point to 25 being a bad cut off in the case of PAP screening.

Interestingly in N.I. they offfer screening at 20 but only at 5yr intervals, less frequent than England, Scotland & Wales.

"I find it scary that it may replace screening because it is 'saving money' even though it is not 100% effective and does not protect against all the strains of hpv.".

There is no suggestion that the HPV vaccine is replacing screening.

All the bodies involved have been eager to make this clear.

DB can you provide a link that shows how much unnecessary treatment is carried out?

I'm curious because it would seem that treatment is only carried out when the abnormal cells persist and after they have been closely examined. Of course there will be more treatment with screening but how can you determine whether it was unnecessary? Are you suggesting that we should not screen at the risk of unnecessary treatment? I'm not really sure I get your point.

Also, if it is the screening that results in unnecessary treatment then how does the vaccine decrease this when the screening will carry on alongside it?

I had my first smear test when I was 18 or actually maybe it was just before my 18th birthday

hi i have just been told that i have abnormal cells and i would like to find out were i can get the hpv jab from and how much it would be as i am 25 and would like to rest my mind that i have done every thing in my power to try and stop these abnormal cells from comeing back and i will pay for the jab or if i can have it funded i dont know as i am unemployed

just google and you will get something close to you or speak to your doctor.

i paid for my daughter to have the hpv when she was 15 as has already been said it is most effective before sexual activity - but i don't know how effective it is after you are sexually active, and ofcourse it shouldn't mean that you don't go for smears when eligable.

again, i googled and found a rpivate practice nearby it cost me £350 ish

Out of interest, which of the jabs did you select to have?

Good for you OP! I had my first smear at 17 and also had abnormal cells removed before 25.

emmaplus - do you know the reason for the abnormal cells? Is it possible you have already been exposed to HPV?

i dont know much about it but i did not know there were diferent ones i will pay for them all if it will help me out and i have too girls to so want to get as much info on this matter before they get to the right age to have it

no am not sure it passably is hpv but info i have read on the net says that it will help clear hpv if you get it again.

I don't think that's true emmaplus. I very much doubt that you can get financial help to get the vaccination, and I think you would be wasting your money tbh. I assume you are having another appointment regarding the abnormal cells, and they will be able to advise your further.

i am just looking into this but you might be right. i have to go on thursday so they can look into it thanks for your thoughts any way

I hope everything goes ok on Thursday for you.

thankyou

Emma, abnormal cells sometimes resolve by themselves with no treatment - the doctor will be able to tell you what level of changes there are and what the next step is. Custardo is right though, the vaccine isnt effective if you are sexually active. The best thing you can do is go for regular smears (which you would need to have anyway, even with the vaccine) the vaccine doesn't protect against all strains of hpv either. I think it would be a waste of your money too - sorry! Good luck with your appointment.

Get a better GP - the NHS only pays GPs for smear tests in the over 25s, but a GP can still do them if they want.

My first GP when I went on the pill booked me for my first smear at the same time.

I know a 17 year old getting smears every 3 months