Why a vaccine… instead of more cytologies?

The human papilloma virus is transmitted by contact (not by fluids) during sexual intercourses.

The use of condom lowers the contagion, but it doesn’t eliminate it.

Some types of human papilloma virus have oncogenic capacity, and provoke uncontrolled mitosis, dysplasia, carcinoma in situ and uterine neck cancer.

Having the virus is a necessary but not sufficient condition to develop a cancer. Poverty, addiction to tobacco and other unknown factors are key factors for the development of the illness.

Women are infected when beginning to have sexual intercourses.

What matters is the infection kept for decades. Many times a woman can get the infection and eliminate it by natural means, complementary medicines or even spontaneously.

The permanent infection is slow, since it takes 10 years to produce precancerous lesions and other 10 years to produce cancer.

Spain is among the countries worldwide with lowest mortality for Uterine Neck Cancer. 175.000 women die per year. Approximately 600 of them because of Neck Cancer and out of the 600, 30% have never had a cytology done.

Women who have cytologies done are in general the ones who less need them, (healthy, young and educated…). However, a “popular” program to allow precocious diagnosis within women with higher risks hasn’t been organized yet.

Tetravalent vaccine currently authorized, has proved to be efficient to prevent the contagion (not the cancer…) of the strains type 16 and 18, which are attributed a 70% of Uterine Neck Cancer, and what is even more important to reduce the pre-cancerous lesions originated by persistent chronic infection in many infected women whose cancer will be developed after 10 or 20 years.

It would be reasonable to expect this positive effect…but we can’t forget how short the period of research has been compared to the time the illness takes to develop.

The tested effect of the vaccine lasts 5 years and the development of cancer takes decades. Besides, we know that the virus is a necessary but not sufficient condition to develop neck cancer.

We also know that the vaccine is neither active against all the viral types which produce cancer, nor in women already suffering from a persistent infection.
Therefore, it is not the vaccine against Neck Cancer, as it is advertised.

Taking this into account, we shouldn’t arrogate cancer to every candylomatous lesion of the uterine neck.

What matters is the infection kept for decades. Many times a woman can get the infection and eliminate it by natural means, complementary medicines or even spontaneously.

70% of women sexually active may have had an infection provoked by the papilloma virus during their lives, it is said that only 1% will develop a Cancer in situ, a lesion that can be precociously discovered by cytology and healed.

75% of women in Spain have a cytology done at least every 3 years. Among a population of women between the age of 30 and 65 with three consecutive normal cytologies, the incidence of uterus cancer is lowered to cero.

It is proposed the vaccination of girls between the ages of 9 to 12, with quite a flexible calendar for 3 doses.

The vaccine generates antibodies which will eliminate the virus; but its efficiency hasn’t been proved among the age group receiving the vaccine, in this case only its immunological capacity has been demonstrated.

The demonstrated period of efficiency is 5 years.

Leave our girls in peace and protect their bodies from not clear options and interventions such as this vaccination.

We know that most women suffering from neck cancer have never had a previous cytology done, neither once nor periodical. I believe this is what brings the topic into light…the necessity to make a greater effort regarding the cytologies.

Neck Cancer used to be one of the main reasons for death in the USA, until the introduction of cytologies during the fortieth decade. Nowadays, those deaths have been reduced in more than 80%.

In the USA where Neck cancer is even much more frequent…they have already started the vaccination and demonstrated complications derived from it such as polyneuritis of Guillain-Barré and other polyneuritis in very low proportions of vaccination.

I believe we are facing again the creation of a new “epidemic” to sell a product of the pharmaceutical industry.

If in Spain there isn’t a real epidemic of Neck Cancer, if the benefits of vaccination are not that clear (at least by now), if in a couple of years we will possibly have more conclusive information to help us decide…why not to delay the decision and take advantage of this time to improve popular programs to help us detect this cancer precociously in high risk women such as immigrant, prostitutes, outsiders, etc.?

As far as I know, promoting the practice of cytologies once a year among the before mentioned groups instead of doing it every three years, as it has been established without taking into account the differences among the feminine population, should be the first step to take instead of the excessive expense not only economical but also for the girls this vaccination implies.

This is the first vaccine which refers to a personal sexual behavior.

We don’t know yet how, but it will for sure have an influence on the different human sexual spheres.

Last but not least…don’t stop reading between lines the message that neither virgin women nor the ones with a “perfect” monogamous couple will ever get infected.

 Dr. Mónica Puga

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