By Katia Protsenko
“A cancer that is caused by a virus,” emphasizes a fashionable and sympathetic-faced 30-something in one commercial.
In another, young girls skateboard and jump rope, each proclaiming to be “one less.”
Both ads target women and advise them to get vaccinated against the human papillomavirus (HPV), the most common sexually transmitted virus in the United States. HPV infects approximately 6.2 million Americans each year, and some strains are known to cause cervical cancer, according to the Department of Health and Human Services at the Centers for Disease Control and Prevention (CDC).
But those numbers may soon decrease, as the Food and Drug Administration (FDA) recently approved the vaccine Gardasil to prevent certain strains of HPV. It is the first vaccine that protects against a sexually transmitted disease and, according to the CDC, the vaccine protects against two virus types that cause 70 percent of cervical cancer and two types that cause 90 percent of genital warts.
While pharmaceutical manufacturers boast the effectiveness of their drugs, the message may not be reaching its targeted audience.
Out of a class of 30 high school freshmen in Watsonville, nine had seen advertisements for HPV vaccine.
“The ads were cute, but didn’t inform me about HPV,” said high school senior Noemy Gamboa.
Fellow senior Irma Garcia had just one response to the ads: “Lame.”
Many of the students had suggestions on how to make the ads better reach their age group, such as advertising on MySpace and using popular actors to promote awareness.
“[The ads] should have good music that we’d listen to. They should be funny, like the Comcast commercials,” said freshman Diana Pham-Le, describing ways to make the HPV vaccination advertisements more effective.
Freshman Jacueline Martinez added, “Show someone we could relate to, look up to; someone who experienced getting cervical cancer.”
There may be a large pool to choose from. Over 50 percent of sexually active men and women will be infected with HPV at some time in their lives, according to M’Liss Keesling, immunization coordinator at the Santa Cruz County Health Services Agency.
“HPV is important mainly because it can cause cervical cancer in women,” Keesling told City on a Hill Press via e-mail. “Every year in the United States about 10,000 women get cervical cancer and 3,700 die from it. It is the second leading cause of cancer deaths among women around the world.”
Dr. Ruth Ann Crystal, a privately practicing gynecologist and obstetrician in Palo Alto, considers cervical cancer a “silent cancer.”
“If caught late, cervical cancer erodes through the bladder and the rectum and is very painful,” Crystal said. “Since it affects personal hygiene, it is particularly humiliating for the patient. It is a terrible way to die.”
With regular pap smears, the ability to detect cervical cancer in its earliest stages has become more common.
“Fortunately in this country, cervical cancer is often picked up early when it is treatable with either surgery or radiation therapy,” Crystal said. “Before the pap smear was invented, there were hospital wards full of young women dying of cervical cancer. Now, this is rare in the United States.”
According to a 2006 FDA news release, Gardasil was approved in six months—a relatively short period of time—because it was a product that would provide “significant health benefits.”
Keesling stressed the importance of giving the vaccine to girls at a young age, before they become exposed to HPV.
“It is important to give the HPV vaccine to girls before their first sexual contact,” Keesling said. “If given at this time the vaccine can prevent almost 100 percent of the diseases caused by the four types of HPV [it targets].”
Crystal seconded Keesling’s advice.
“I highly recommend the vaccine to my patients aged nine to 26, as that is the FDA-approved age group,” Crystal said. “If an older woman wants to be vaccinated, I tell her that this is ‘off-label’ use, but I am happy to give her the vaccine as it is very safe and has very little side effects.”
The freshmen interviewed from Watsonville High, however, were surprised by the young age range the CDC and FDA has recommended receive the vaccine.
According to high school freshman Melody Fuentes, her peers are beginning to have their first sexual experiences several years later than what the CDC has suggested.
“Fourteen to 16 should be the target age,” Fuentes said. “That’s just how it is.”
Some states have gone as far as to make HPV vaccination mandatory for young women. On Feb. 2, Texas Governor Rick Perry signed an executive order that will make it mandatory for all girls to be vaccinated against HPV before entering the sixth grade. Similar legislation is being discussed in over 20 other states, including California.
However, some parents are concerned that the legislation is too extreme. Leticia Alan, mother of a 10-year-old girl, was shocked at the young age range that is being targeted by the FDA, legislators and health care providers.
“There are benefits to the vaccine, but I still think it should be a choice,” Alan said. “Offering it to such a young group gives the assumption that they’re sexually active close to that age.”
Alan continued, “Kids that age are too immature to make those decisions. It should be presented in more of an educational format, during the middle school years, when kids are beginning to explore their bodies and each other’s bodies.”
Alan believes that talk about the vaccine should be tied in with parent-child discourse about sexual health and safety.
“Assuming your child will be having unprotected sex is an indication that you should have a discussion with them about values,” Alan said. “My preference would be to wait and make a decision when I can talk to my daughter about it.”
However, some healthcare workers, including Dr. Crystal, stress that while Gardasil works to prevent against a sexually transmitted disease, it should be handled like any other vaccine that is designed to protect people. The vaccine should not be stigmatized for that reason.
“Some mothers are bringing in their teenage daughters, which I think is admirable,” Crystal said.
For some, however, getting the vaccine is easier said than done: The cost of the vaccination has to be taken into account as well.
Diane Lamotte, RPh, the acting clinic manager of the UCSC Health Center, discussed the cost of getting vaccinated for HPV.
“It’s not cheap,” Lamotte said. “It’s between $400 and $500 for the series.”
According to Lamotte, the University Health Coverage Plan pays for $250 of the vaccination, but the student has to cover the rest of the cost.
Many public health agencies, like the Santa Cruz County Health Services Agency, choose not to get involved in advertising new vaccines. Keesling, however, personally believed that Gardasil was an important vaccination for young girls to receive.
“Because we are public health, we are a safety net for the community. Our job is to encourage individuals to have a relationship with a health care provider,” Keesling said.
The majority of publicity and awareness regarding the HPV vaccine is focused toward women, but men are often unknowingly carriers of the infection.
“Yeah, I know about the HPV vaccine,” said UC Irvine alumnus Carl Johnson, whose girlfriend was diagnosed with a strain of HPV. “They were doing test trials for that when I was in college, and I signed up because not getting diseases is super rad, and [the pharmaceutical companies] paying me for it makes it even better.”
Johnson added, “I don’t think most men are aware of HPV because HPV really does not affect a man in any way, but it sure can mess with a girl’s body.”
According to Johnson, the type of HPV his girlfriend has will prevent her from ever having children.
In the near future, the producers of both Gardasil and Cervarix—another vaccine against HPV currently in development—will make the vaccine available to men.
However, there is currently very little medical knowledge regarding men and HPV.
“Unfortunately, there is no test to detect HPV in a man, and there is no treatment for him,” Crystal said.
Crystal emphasized the need to practice safer-sex methods, regardless of what vaccines may be available.
“Condoms are the best protection against STDs, including HPV,” Crystal said. “If a man’s partner tells him that she has HPV, he should go back and alert his previous sex partners so that they can get tested as well.”
_For more information about HPV and Gardasil, contact the UCSC health center, or the Centers for Disease Control and Prevention, call 1-800-CDC-INFO or check them out online at http://www.cdc.gov/std/hpv. The Family Health Unit, a part of the Santa Cruz County Health Services Agency, will be staffing a table at UCSC’s Health Fair coming up on Feb 14, 12-4pm, and will plan on having information on the HPV vaccine._
