No More Paps!

Parent Cafe
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<p><a href=“http://www.msnbc.msn.com/id/13612899/[/url]”>http://www.msnbc.msn.com/id/13612899/&lt;/a&gt;&lt;/p&gt;

<p>The end is in sight! Actually it will be many years before Pap smears completely become a thing of the past, but if HPV screening is embraced, it may be sooner than the 25 years it will take for today’s 30 year olds to age beyond their highest incidence of cervical cancer.</p>

<p>Paps can pick up other types of cancers - endometrial tumors from the lining of the uterus, rarely a very advanced cancer of the ovary, rarely an advanced colon cancer - but the smear is not really used to screen for any of these conditions.</p>

<p>The series of 3 shots is said to cost $350, I’m going to talk to my daughter about availability at student health (because you probably have to wait a few weeks between shots). I don’t know if she’s already sexually active, I don’t really care, I want her to have the shots anyway.</p>

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<p>Sounds great.</p>

<p>Merck is also testing the vaccine on boys, as HPV can cause certain tumors in them. Also, just from a practical standpoint, the spread of disease slows when there are no carriers.</p>

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<p>Correct Ari - I’m not sure that the cost-benefit ratio will work out for males - certainly in terms of primary prevention, the number of boys vaccinated vs the number of male cancers prevented doesn’t make sense. But, if near eradication of cervical cancer is the goal, reducing the reservoir of infection in men will be important.</p>

<p>Someday, maybe, the cost and accuracy of HPV screening will be such that it is cheaper than a Pap smear. It may be cost-effective now, but I’m not sure the medical community as a whole “trusts” the test enough to replace Pap smears with HPV testing. THere have been some interesting studies done in 3rd World countries where Paps are unavailable, using self collected HPV swabs, that show good results.</p>

<p>This will wipe out a goodly amount of my business, but I will not be sorry to see it go!</p>

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<p>Not so fast. The evidence is that the strains of HPV affected by the vaccine account only for a good percentage of cervical cancer patients. And, without many years of surveillance, we won’t know how many cases of disease the vaccine really prevents. clinical trials only tell so much.</p>

<p>The best intel I’ve seen indicates the recommended frequency of pap smears may decrease, but not go away.</p>

<p>If I were a woman, I’d not play the odds too closely.</p>

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<p>Yes NMD, the vaccine only covers some strains. But I think that broadening the scope of HPV screening is the change that will begin to do away with the Pap smear before the vaccine’s effect becomes noticeable. The vaccine alone won’t make an impact on dysplasia rates for 5-10 years, cancer rates in 20-25 years. When the cost and availability of a comprehensive HPV screening test (not just the high risk HPV test we do routinely now), comes down, then Paps will start to go away, but it is a complex process. I’m predicting 10 years to begin to see a major decline in the number of Paps, but I could be wrong. Women with positive HPV results will get diagnostic Paps for years, but the number of women we need to look at will go down considerably. I’m already hearing rumblings that monogamous women with negative Pap/negative HPV only need a Pap every 5 years.</p>

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<p>Pap smears may still be necessary, but this will be a step in the right direction in terms of reducing cancer. </p>

<p>As stated above, the frequency at which Pap smears are done may decrease, but they’ll still be done - probably kind of like how mammograms start off at every few years, but increase in frequency if you have a family history and as you age.</p>

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<p>…“I’m already hearing rumblings that monogamous women with negative Pap/negative HPV only need a Pap every 5 years…”</p>

<p>And if her partner isn’t??? Then what?? Just wondering…</p>

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<p>I think “monogamous” implies both partners…</p>

<p>…but, as you point out, not everyone knows that. Some 50% of men cheat on their spouses. That, by the way, is why I think it’s important to vaccinate men as well - imagine the woman who doesn’t get vaccinated, thinking she’s okay. Fewer carriers always reduces disease transmission.</p>

<p>Yeah, I’m conservative… but I can’t help but wonder why the “pro-lifers” are against this. It’s like trying to reduce auto accidents by not installing air bags in cars, under the theory that people will drive better. GAH!</p>

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<p>I think that conservative groups are not against recommending and/or offering the vaccine, just making it required for school entry. They just want a choice as to whether it is given at a certain age, ie 11-12 year olds and to have the option for their children of getting it later or not at all.This would also be the young woman’s choice. But to prevent entry to school over this vaccine is what they are objecting to.</p>

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<p>Am I the only one worried about possible side effects? In recommending to our own daughters, surely there is a tradeoff between the likelihood of getting HPV and the likelihood of suffering from whatever side effects there may be from the vaccine.</p>

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<p>Yes, monogamous implies both partners. There are still a few of us out here, dutifully getting Pap smears every year, even though the datareally don’t support it.</p>

<p>No, Aparent, you aren’t the on;y one worried about side effects, although history says that vaccine side effects in general, are way overblown compared to the good they do - a little different than a drug.</p>

<p>Your daughter’s risk of getting HPV is about 70-80% - almost everyone gets infected. My understanding (and I will check this) is that it is much more contagious than typical STDs (that’s why we resisted publicizing that it is an STD for many years). Her cervical cancer risk is much, much lower - hopefully, the vaccine will save the lives of women who can’t or won’t get regular medical care, those are mostly the ones we see now with cervical cancer.</p>

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<p>Not all strains of HPV cause cervical cancer. The ones that DO, however, cause a particularly nasty and rapid cancer. </p>

<p><a href=“http://www.cancer.gov/cancertopics/factsheet/Risk/HPV[/url]”>http://www.cancer.gov/cancertopics/factsheet/Risk/HPV&lt;/a&gt;&lt;/p&gt;

<p>This fact sheet from the National Cancer Institute is full of fun facts, like HPV causing anal cancers too… </p>

<p>My D and I have already discussed the vaccine and decided in its favor. But me, I’m big on vaccines in general.</p>

<p>Speaking of vaccines–have you all had your 10-year tetanus booster?</p>

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<p>But to prevent entry to school over this vaccine is what they are objecting to.</p>

<p>Funny how I don’t hear the vast majority of the objectors raising objections to the numerous other vaccines required for entry to school. Do they really think that their daughters are going to go out and start having sex at age 11 because they’ve been vaccinated? For that matter, do they think that preventing their teenage daughters from getting this vaccine is a good way to encourage them to wait to have sex?</p>

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<p>How is this a different issue from requiring Hepatitis B vaccinations? I may be wrong, but I thought that Hep B was a STD and is a required vaccination for most schools now. If I had a daughter, I’d definitely look into the HPV vaccine.</p>

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<p>Very similar to Hep B, although I think that HepB can be transmitted through other means… rarely. </p>

<p>Given that not all sex is consensual (sadly), I don’t understand the wailing, hue, and cry. If something were to happen to your little girl, would you then really want to worry that she could get cancer, too?</p>

<p>Furthermore, even if your little girl waits for marriage, there are no guarantees that her husband will have - or is being completely honest with her. I am always stunned at those who decry birth control because it “contributes to pre-marital sex,” when it can be used (and often is used) inside of a healthy, stable, monogamous marriage. Same issue here.</p>

<p>Finally, we often “sacrifice” individuals to the greater good. Polio is a good example - some children have had adverse reactions to the drug. However, the great benefit of the polio vaccine is not the the individual, but that it’s almost impossible for it to spread at all when everyone is vaccinated. Whooping cough is one example: 30-40% of the vaccines fail; however, the number of people who contract the illness is much lower. (Yours truly got it in 8th grade, by the way!) Since enough people are still immune to it, it barely spreads. </p>

<p>Do you even need to tell your daughter the nuances of STDs when she gets the vaccine? I mean, I don’t think my parents told me all about tetanus when I was vaccinated as a kid… and I don’t think they thought it would encourage me to find rusty nails.</p>

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<p>Actually, Dmd, just to correct, most cervical cancers are squamous and the vast majority are associated with HPV infection, usually the high risk types. Cervical cancers are bad, but the typical cervical squamous cell cancer develops slowly over a period of 10-20 years from first HPV infection, through gradual worsening of dysplasia to non-invasive squamous carcinoma to invasion with the risk of metastasis and death. The slow, orderly progression of the great majority of cervical cancers through the multiple stages of worsening dysplasia, is the reason why screening by pap smear works as a preventative strategy - you get lots of chances to find and treat the “pre-cancer” if a woman is screened regularly.</p>

<p>A few cervical squamous cancers, ?<5%?, progress rapidly, bypassing or “zooming” through the stages of dysplasia, over a period of 8-18 months - these are a disproportionate share of the cases that were missed on Pap smear and led to lawsuits.</p>

<p>I’m not keeping up on this as well as I should, but some low risk HPVs have been found in cervical cancers, and the last I read about the research (admittedly a few years ago), researchers were trying to figure out if the low risk HPVs were innocent bystanders (the majority viewpoint, based on other data) or were actually the cause of the cancer (the minority viewpoint) - I need to try to look that up.</p>

<p>Finally, not to open up a discussion of the definition the word “is” ;), but HPV is a lot easier to catch than most other STDs, transmissible by intimate contact that many people would not consider “sex” (although it might create a storm in the context of a presumably faithful marriage). This is one reason the medical community has been very slow to label HPV an STD. Hep B is technically an STD, but the most common mode of transmission worldwide is mother-to-child, either at birth, in utero or in breast milk - so we think of it more as an STD in the context of industrialized countries. HPV is an STD, but it is so common and so easy to catch, and up until now so under the radar screen of the general public, that docs generally didn’t refer to it so directly as such when talking to patients.</p>

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<p>How long was the vaccine tested? Do we know that it has no negative impact on fertility? </p>

<p>I am not coming from a conservative viewpoint. I grew up with several uncles who were aerospace engineers. They refused to fly in a plane that had been in the air for less than 3 years.</p>

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<p>Actually, hepatitis is a lot different from HPV (the virus of the new vacine) as hepatitis can be spread in several ways, including by blood, needles, household transmission, from mother to baby, etc. HPV is from sexual transmission.</p>

<p>From the Wash State Dept of Health:</p>

<p>How is it (Hepatitis B) spread?</p>

<p>The virus is spread by direct contact with the blood, serum, or sexual fluids of an infected person. This can happen by sharing needles or having sex with somebody infected with hepatitis B. Transmission can also occur for people living together for a long time in the same household or institution. Infected women can pass the virus to their babies. Blood is now tested before transfusion to prevent spreading hepatitis B but in the past some cases resulted from blood transfusion. Medical personnel are at risk of exposure due to needle sticks.</p>

<p>From the Australian Hepatitis Council:</p>

<p>Hepatitis is a term that means inflammation of the liver.</p>

<pre><code>Inflammation is a natural reaction of the body to injury and often causes swelling and tenderness.

Alcohol, chemicals, drugs and viruses can all cause hepatitis.

There are several different viruses that cause hepatitis, such as hepatitis A, hepatitis B or hepatitis C. Each of these viruses may produce similar symptoms and they can all infect and inflame the liver. The main difference between the viruses is how they are transmitted, the way they cause liver damage and the effects they have on a person’s health.

Hepatitis is described as either an acute or chronic illness. An acute illness will only last a short time and although it may be severe, most people recover from the illness within a few weeks with no lasting effects. A chronic illness is one that lasts a long time, often for the rest of a person’s life.
</code></pre>

<p>Hepatitis B is found in body fluids including blood, saliva, semen, mucus, vaginal fluid and breast milk. It can be easily transmitted through sexual activity, sharing injecting equipment, sharing toothbrushes or razors, unsterilised tattooing and body piercing equipment and from mother to child at birth. </p>

<p>Ways to reduce hepatitis B transmission are to:</p>

<pre><code>* wash hands after touching blood or body fluids

  • wear disposable gloves if giving someone first aid or cleaning up blood or body fluids
  • avoid sharing toothbrushes, razors, needles, syringes, personal hygiene items and grooming aids or any object that may come into contact with blood or body fluids
  • use new and sterile injecting equipment for each injection
  • cover all cuts and open sores with a bandage
  • wipe up any blood spills and then clean the area with household bleach
  • throw away personal items such as tissues, menstrual pads, tampons and bandages in a sealed plastic bag
  • practice safe sex
    </code></pre>

<p>People who think they have been exposed to hepatitis B and who have not been vaccinated should receive hepatitis B immunoglobulin (HBIG) within 14 days of exposure from their general practitioner.</p>

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<p>aparent5, no you are definitely not the only one concerned about side effects. I queried my D’s physician about HPV vaccine (his specialty is immune system disorders), and he recommended that we wait at least until the vaccine has been more thoroughly tested. Same goes for Hep B and others.</p>

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<p>Good information from cangel & collegialmom. Pro-lifers are not objecting to anyone getting the vaccine. Being pro-life does not necessarily mean one objects to an active sex life for non-monogamous or non-married people. Pro-lifers are passionate about preventing abortions & helping women in crisis get the help they need to bring their babies to term. Those who are against the HPV vaccine are simply objecting to a forced immunization program for a disease that is transmitted through sexual contact. Unlike mumps, measles, whooping cough, etc., it can be avoided with behaioral choices. The other range of diseases we vaccinate against cannot. And non-vaccinated people put others at risk for the air-borne variety. Comparing HPV with MMR or DPT is comparing apples and oranges. HepB is largely a STD, but can be passed through other routes. There was quite a bit of controversy when it was mandated. </p>

<p>You may feel that parents who don’t wish to vaccinate their kids against HPV are foolish or naive. But there are people who live a chaste life and choose to raise their kids in such a manner. That is their right.</p>