HPV Vaccination Programme

[AnneWiddecomesArse]

I'm a bit side swiped by this.
I've read some stuff in papers etc. but now my DD has been offered the vaccine in this school year (she's 12 years old); and it's time for a decision.
What are your thoughts/research on this ?

Wrt to the benefit term: to ask families to act on the basis that "it is likely to be extended beyond five years" this requires established trust and belief. There is no finding here, obviously.

Previous pledges of a "one-shot stop" have been broken, with other vaccinations. After huge mumps outbreaks with waning immunity from the MMR, we now have warnings of measles outbreaks at universities this year because of MMR immunity waning. All these cases will happen at a time in someone's life when it is more severe and dangerous than childhood disease. More vaccinations are being recommended - and this is after children will have had at least two already.

There is no reason to believe "it is likely to be extended beyond five years".

The other very worrying thing about the story above is that perfectly normal people will say that I am scare-mongering.

Thus, not only is the mother not allowed to raise her concerns - and is threatened with the loss of her child unless she ceases and desists with her "claims" - nobody else is either. One mustn't talk about such things, apparently. I disagree.

Sidge - minor changes are CIN 1 or 2. Often these are monitored to see if they return to normal, even in older women. There is no "intervention" bar taking a look, which has no effect on the cervix at all.

When they talk about intervention they are talking about LEEPs, cone biopsies etc, which, 10 years ago were administered here there and everywhere. Nowadays I believe they are much more careful.

The point is that cervical cancer can develop before the age of 25 so smears should be available then to catch it when it is at CIN 3 or just beyond. Not when it's actually cancer.

PIMS, no vaccine has a perfect safety record. Gardisil's is definitely worse than cevarix's though. I'm very sorry about your friend. Cases like hers really do strengthen the case for earlier screening.

Ungrateful, yes, 80% of people have hpv at some point in their lives and over 90% of them will recover without even realising they have it. The remainder may have the cell changes and screening can pick them up at an early stage (as long as it is offered early enough and frequently enough!) and treat them before they get to the cancer stage.

Sidge, I'm pretty sure that they just monitor minor changes to make sure they either resolve themselves or don't get any worse. If they persist then further investigation/treatment can be carried out if required. Personally I'd rather have them monitor me than just assume that any change will resolve itself without any problems because I'm under 25! Juule is right, the early changes don't really show any symptoms.

Rita, why should it be a 12 month old's responsibility to protect a grown woman during pregnancy? Surely she should be perfectly capable of having her own immunity tested? It's a bit of a gamble relying on other people when you have no idea of their immunity status. Vaccines are not 100% effective, particularly after one dose, and immunity can wane over time so you have absolutely no idea whether people you come into contact with every day could put you at risk. It's certainly not a gamble I would take.

Yes, nowadays they just recall CIN I and II and refer CIN III, IV (and invasive ca of course) - historically they used to treat CIN II more aggressively which is now known to be potentially risky.

Look I don't work for the screening authorities, I'm just at the business end! But I understand that the age was changed as there is no evidence that screening before 25 reduces the risk of invasive cancer, and that there is no evidence that screening is effective in women aged 20?24 years. Women younger than 25 years of age who develop cervical cancer are as likely to have been screened as unscreened apparently.

But that's looking at screening as a programme, and of course not on an individual level. There is no "one size fits all" approach, we have to offer the best we can on a national basis based on research and resources.

I would definitely support an early screening approach,and just pay for my daughter to have them if they aren't available on the NHS, wihch is a scandal really. I think it's a no brainer.

Why is "one size fits all" being promoted with regard to the vaccination though if it can't be used for screening services. Especially if there's no risk to the act of screening, whereas vaccination carries a risk.

Do you think the HPV vaccination programme is "one size fits all" Blueberties? I'm not sure it is, there is always the option to decline or postpone the vaccine.

Just re-read that post and it sounds really snarky, sorry! It's not meant to be, read it in a pondering, hmm, type of voice!

That's ok, same difference

Yes - definitely one size fits all in that there's no tailoring to the individual physiology or even sexual experience, and if you refuse to take part in school programmes there certainly used to be a letter given out that you'd then have to pay at the GP if you wanted it later. Maybe that's changed now.

And whereas you can opt in or out of vaccination, you can't opt in to early screening because it's not offered.

That's the way I see it. I'm lucky enough that I can afford to choose, vax, screening, whatever but this rationing of service to anyone who chooses something different from the mass vaccination programme is very scary.

Oh I see what you're saying.

GP surgeries have never been funded to provide HPV to school aged girls, the funding is given to the school health teams. So whilst there is the option to postpone the vaccine within school years (ie not have it in Y8 but Y10 for example) the programme didn't allow a girl to have it at her GPs surgery rather than in school.

If the vaccine isn't taken up at school at all but then requested at a GP surgery once the girl is post-school age I think the GP is funded to provide it - I know we give HPV to the 6th formers but I don't know at what age the funding is cut off.

Blueberties/bm
You are totally missing the point!!
Screening will DETECT changes.
Changes that could require treatment.
Invasive treatment. Treatment that carries definate risk of infection, shock, fertility problems and treatment that is just for cell changes!
The treatment for cancer is significantly worse. No medical intervention is risk free!! You have the same chance of anaphylaxis to the rubber of the latex used to 'perform' the pap smear as you do for the injection.
Screening will not prevent all cancers, it's success rate in prevention of genital warts is zero.
It can not prevent, it can only detect and escalate to treatment. This is loaded with risks and complications!!'
This vaccine has a definite positive place in prevention of HPV

Blue I actually don't think you are lucky to be able to pay because I think it allows you more freedom to make unwise decisions.
If teenagers have to get 3 HPV injections at will there is a very high chance that the subsequent vaccinations won't be booked, rendering the first a waste of time and money. It is planned into school because once children start to have sex and become exposed to HPV it becomes less effective. Whether you choose to believe it or not many 12 year old are experimenting but hopefully won't have had too many experienced/ possibly infected partners. Also it ensures that the full schedule is completed unless consent is withdrawn. I know because as a 19 year old I had the first/ second hep A but failed to have the one a year later. When I joined the forces I then needed the whole course again i.e. waste of money and not fully protected.

thecaptaincrocfamily - you never need to "restart" a series, the immune system "remembers" earlier shots...

really with a five year lapse No, clearly the MOD medical centre staff were not aware of that fact ......strange.

Catherine, there is evidence that the gardisil (3 vaccine) does need to be given at the correct intervals to be fully effective.
If a dose is missed, you will have to start again.
Similar with hep b, health care workers require three initial doses and then a booster depending on blood levels.
If the initial doses are not given correctly this 'loading' has to be restarted

PIMS. The vaccine MAY prevent SOME strains of hpv that MAY cause cervical cancer. No guarantees and no way of knowing whether it has prevented them unless you get screened. Getting HPV (which the vast majority of people will do at some point in their life) does not mean that you will definitely have cell changes and, if you do have cell changes, that does not definitely mean you will need treatment and if they do need treatment chances are it will be a minor procedure with no long term effects.

Screening does PREVENT cervical cancer because it detects cell changes BEFORE they become cancerous. Since smear tests were introduced there has been a year on year reduction in cervical cancer cases so it is obviously preventing them. The majority of cases occur in the elderly (perhaps because they are less likely to go for smear tests).

It will be a minor procedure?
You said screening was safe.
No medical procedure is 100% safe, they all carry risk. Colposcopy, cone biopsy, laser treatment are not safe. They can cause potentially cause significant problems
Screening does not do anything but detect changes! Treatment is not minor!! I expect you have not had any to understand this.
The vaccine is 98% effective is preventing the most virulent forms of HPV
I saw a friend wither and die of a preventable disease.
You can't not argue that screening would have saved her. No treatment is 100% effective and prevention is better than cure.
Her cancer progressed soo quickly that screening would not have caught it. She was 24 ffs!!

The vaccine DOES prevent the most virulent strains of HPV (this is a well researched and evidenced fact- see earlier posts for references)
Smear tests and condoms WILL NOT prevent your daughter getting genital warts or the most likely pre cancerous forms of HPV

Treatment is only so effective. HPV is unlikely to be cured. The virus can lie in your system even after treatment.
I think that you are cutting your nose off despite your face sticking to your principles of 'vaccines are all evil' here.
This is a safe and very effective vaccine that can save lives and reduce the need for invasive and non curative treatment

PIMS, I'm not sure why you think screening wouldn't have saved her but the vaccine would have. At 24 had she even been offered a smear test yet? Considering that she had a 5 year old child it would have made sense for her screening to have started much sooner.

If you think screening does not prevent cervical cancer then you are disagreeing with the NHS and the cancer charities which all say that it does. I'm really not sure why you think that it doesn't. It is only through screening that anyone knows that they have cell changes and whether or not they will need to be treated.

I am perfectly aware of what the treatment involves.

HPV is usually harmless and in many instances your body fights it off itself and no cell changes (or only minor changes which can disappear by themselves) are caused and no treatment is required.

You seem to think HPV = definite serious cell changes = necessary invasive treatment or else cancer.

Even the majority of CIN cases will not go on to develop into cancer. I dislike risks being exaggerated to scare people into thinking no vaccine = death.

HPV Is usually harmless?
You tell that to my dead best friend! Come on!!! You are being totally hypocritical
That is like me saying to you and your dc, childhood vaccines don't usually cause lasting damage!! All looks great on paper, but when you are left clinging to the consequences, the consolation of 'this normally doesn't happen' just doesn't cut it.

My friend had her first pap smear at 19/20, after her son was born. She got it at her post natal check. She. was diagnosed with cancer 2 years later. It is unlikely that bribing that smear forward a year would have changed the outcome.
Screening ALONE does NOT prevent cancer. Screening and treatment will reduce the number of cases leading to cancer. But that figure is no where near 98%
why??? Because prevention really is better and safer than cure in this case.

HPV is usually harmless? You try consoling your daughter with that if she contract genital warts. I know some teenagers for whom that would be catastrophic, harmless as you think that is.

It frustrates me how narrow minded you are. This would be the same for heart disease. If a vaccine was introduced that could prevent heart disease, you would argue that early screening of cholesterol and blood pressure with commencement statin and ace therapy is safer. There is great evidence to say that starting these drugs early improves outcome, but it can't undo any damage already done to the heart. What about surgery as an option? ALL surgeries carry risk. Normally more risky than vaccines themselves and is still not a permanent cure.

So please, tell me how you can possibly think that treatment is better than prevention for this disease which can cause fatal cancer???

Yes PIMS the HPV is usually harmless. (I'm not sure how this is hypocritical) Around 80% of people will contract it at some point in their life and the vast majority will not have any ill effects. A small minority may develop minor cell changes which may not need treatment and can disappear by themselves. Some people may develop more serious cell changes and these MAY develop into cancer if left untreated.

In your friend's case an earlier first smear could have meant an earlier second smear which may have caught the cell changes. It does definitely suggest that 3 yearly isn't enough if her cancer was able to develop in 2 years. Screening is the only way to detect cancer regardless of whether or not you have the vaccine. The vaccine is not 100% effective against ALL the types of hpv that can cause cancer ( 3 out of the 15 potentially cancer causing types out of over a hundred different types of hpv) if she had got vaccinated at 12 then there is no guarantee she would have been protected and no guarantee that she would have been still been protected in her early 20s so you can't say the vaccine would have saved her. We can't say screening would definitely have saved her either but earlier, more frequent screening would have given her a better chance of catching cell changes early.

You are acting like the vaccine is a risk free option that will prevent an extremely risky virus whereas actually, the risk of actually developing cervical cancer from hpv is very very small and every vaccine carries a risk. Gardisil, the one that protects against genital warts, has had serious side effects in around 1 in 25,000 doses(CDC) Serious is considered hospitalization, permanent disability, life-threatening illness, congenital anomaly or death. I think we use cevarix in the UK which doesn't protect against genital warts.

Re heart disease - a healthy diet and lifestyle would make more sense to prevent it.

I would argue that there is a greater risk of taking a relatively new vaccine with known, serious, potential side effects (and those are only what we know about now) for a virus that in the vast majority of cases will be harmless and in the small percentage of cases that can become potentially life threatening is treatable if caught early using existing screening methods that have been successfully preventing cancer and reducing the number of cases year on year. I think earlier and more frequent screening are needed regardless of whether or not people have been vaccinated because the vaccine offers no guarantees.

Pimsoclock (I love your screen name btw), do you have a reference for the Gardasil claim, and yes, I know about the hepB policy, but policy does not always follow biomedical evidence ;)

HPV may be "harmless" in a large number of cases and yes, many of us do carry it with no ill effects.

However, it is not harmless in all cases. People do die from cervical cancer in spite of the national screening programme. If we can save those people then the vaccination programme is worthwhile. As PIM says, by the time you get an abnormal smear some harm has already been done to your body. It may be treatable, but prevention could have spared you that treatment.

The risk of contracting many diseases is relatively small. However the consequences of those diseases are often so awful that most people think the vaccination is worthwhile. The risk of my house being burnt down is very small but I still have insurance.

Re heart disease/stroke there is plenty of it running in my family which has killed people with a healthy diet and lifestyle before the age of sixty. It is genetic in its nature. As are many other diseases. People do themselves no favours with an unhealthy lifestyle of course. But there are plenty of people who smoke 20 a day and eat fry ups till the age of 90, and plenty of people who do their best to look after their health and die young.

If this vaccine had nothing to do with sex, people would be less up in arms about it.

Yes, people are still dying Kat because the screening program could be improved. If the screening program stays the same people could still be dying of cervical cancer regardless of whether they were vaccinated because it doesn't guarantee protection against all the strains of hpv that can cause cancer, isn't 100% effective and only offers temporary protection.

I'm not sure what you mean 'harm being done to your body'. Minor cell changes can repair themselves without causing any problems (our immune system can fight them off like other viruses) and again, hpv (even the riskier strains) will not necessarily cause cell changes and cell changes will not necessarily develop into cancer.

There are other things that can reduce the risk of cervical cancer too (again no guarantees but a reduction in risk) - using a condom, fewer sexual partners, not taking the contraceptive pill, not smoking - but some people will choose not to take those precautions either. Reducing the age at which screening starts and making it more frequent (maybe every 12-24 months) could save lives and I think that is being overlooked.