Tag: HPV elimination

Are Cervical Cancer Rates Rising?

Why do some folks think that cervical cancer rates are rising?

They don't mention this, but most of the 25- to 29-year-olds seeing a rise in cervical cancer rates in The Independent article likely would have been too old to have had an HPV vaccine, as the UK began their HPV vaccine program in 2008, starting with 12 year olds.
They don’t mention this, but most of the 25- to 29-year-olds seeing a rise in cervical cancer rates in The Independent article likely would have been too old to have had an HPV vaccine, as the UK began their HPV vaccine program in 2008, starting with 12 year olds.

The usual suspects…

Are Cervical Cancer Rates Rising?

The HPV vaccines have been around for well over 10 years, having been approved in 2006.

So why haven’t we eliminated cervical cancer yet?

As you hopefully suspect, it is going to take a little time. For one thing, not everyone was on board with getting their kids vaccinated and protected when the vaccine first came out.

Even Jay Gordon has changed his mind about the HPV vaccine and now recommends it to his patients…

But as more and more kids get vaccinated and protected, we should see much lower rates of HPV infections and then lower rates of cervical cancer.

Is that what we are seeing?

“…the prevalence of HPV16/18 in sexually active 16-18 year-old females who were offered vaccination at age 12-13 years has been less than 2% (compared to over 15% prior to the vaccination programme in 2008). In the most recent year, 2018, 10 years after vaccination was introduced, we detected no HPV16/18 infections in 16-18 year-olds (0% of n=584): this shows the programme has succeeded in delivering both direct and indirect protection.”

Surveillance of type-specific HPV in sexually active young females in England, to end 2018

Yes!

“…the prevalence of HPV6/11 in 16-18 year-olds did not decrease until 2018, from 7-10% during 2010-2017 to 4.1 in 2018.”

Surveillance of type-specific HPV in sexually active young females in England, to end 2018

Yes, we are.

The latest statistics in countries with high HPV immunization rates show that there are little or no HPV infections among 16 to 18 year olds, which means that as they get older, they almost certainly won't develop cervical cancer.
The latest statistics in countries with high HPV immunization rates show that there are little or no HPV infections among 16 to 18 year olds, which means that as they get older, they almost certainly won’t develop cervical cancer.

And following lower rates of HPV infections we will see cervical cancer rates eventually drop.

Are they dropping now?

Would you expect them to be dropping much already?

If you look at the chart above, a lot of teens who were 16 to 24 years old between 2010 to 2013 were infected with HPV…

Now if you are not aware, it takes time for those HPV infections to develop into cervical cancer.

How long?

About 10 to 20 years or longer.

“Cervical cancer has a bimodal age distribution with the majority of cases occurring among women in their 30s and 40s the age at which women are often raising families and ensuring the financial viability of their families and communities.”

Luckett et al on Impact of 2-, 4- and 9-valent HPV vaccines on morbidity and mortality from cervical cancer

That means that we are still going to see cervical cancer because of all of the people who were infected with HPV in the pre-vaccine era.

But rates shouldn’t be rising, should they?

“Routine vaccination of girls aged 12-13 years with the bivalent HPV vaccine in Scotland has led to a dramatic reduction in preinvasive cervical disease. Evidence of clinically relevant herd protection is apparent in unvaccinated women. These data are consistent with the reduced prevalence of high risk HPV in Scotland. The bivalent vaccine is confirmed as being highly effective vaccine and should greatly reduce the incidence of cervical cancer. “

Palmer et al on Prevalence of Cervical Disease at Age 20 After Immunisation With Bivalent HPV Vaccine at Age 12-13 in Scotland: Retrospective Population Study

In most studies, they aren’t.

We haven’t eliminated cervical cancer, but we are hopefully on the road to getting there. Or we will be if folks get vaccinated and protected.

And women should continue to get Pap tests, as the HPV vaccines don’t protect against all types of HPV infections that can cause cervical cancer.

More on Cervical Cancer Rates

Has Gardasil Really Eliminated Cervical Cancer in Australia?

Why do some folks think that Gardasil hasn’t eliminated cervical cancer in Australia yet?

“New research from Cancer Council NSW, being presented this week at the International Papilloma Virus Conference (IPVC 2018) in Sydney and published in The Lancet Public Health, has shown that if vaccination and screening coverage are maintained at their current rates, cervical cancer is likely to be eliminated as a public health issue within 20 years.

The new research predicts that cervical cancer rates will drop to less than 6 in 100,000 by 2022 – meaning that it will soon be considered a rare cancer. Rates will continue to drop further, dropping below 4 in 100,000 by 2035. These findings indicate that Australia is on-track to be the first country in the world to eliminate cervical cancer by successfully implementing a combined approach to vaccination and screening.”

Australia set to eliminate cervical cancer by 2035

Maybe it is because Gardasil really hasn’t yet eliminated cervical cancer in Australia…

Has Gardasil Really Eliminated Cervical Cancer in Australia?

Wait, so why is anyone trying to say that something that hasn’t happened yet isn’t true?

Is Bobby Kennedy trying to get in the way of work to eliminate cervical cancer?
Who is Dr. Robert Reichert?

Perhaps “Dr. Reichert” just misspoke and did say that Australia had already eliminated cervical cancer instead of that they were on their way to eliminating cervical cancer

It is true, after all. Australia is really on their way to eliminating cervical cancer thanks to the HPV vaccine!

What about all of the slides and tables that Bobby Kennedy included with his post?

Does Slide 1 really show a terrifying increased risk of cervical cancer?

Anti-vax folks like to misrepresent the results of this study.
Anti-vax folks like to misrepresent the results of this study.

Of course not.

It actually shows how thoroughly vaccines are tested before they are approved!

In this case, they were evaluating “the potential of Gardasil to enhance cervical disease in subjects who had evidence of persistent infection with vaccine-relevant HPV types prior to vaccination.”

And although Bobby Kennedy is claiming that is what they found, the women in the Gardasil group (6.5%) were much more likely to have a Pap test with HSIL (high grade squamous intraepithelial lesion) as those in the placebo group (3.7%) at the start of the trial! That’s before they were vaccinated and that’s why they were more likely to have cervical cancer. Remember, the HPV vaccines prevent cervical cancer. They do not treat cervical cancer.

Bobby Kennedy left this out, but during these trials, when they looked at other subgroups, they “did not raise a concern about enhancement of cervical disease due to HPV.”

And Bobby Kennedy‘s other slides?

In Slide 2, just after telling you to look at the vaccine insert, he claims that “nearly half of all women have had prior exposure to HPV – with 38% being exposed before age 10.”

Is that in the vaccine insert?

Nope, it comes from a small study he found, Genital HPV in Children and Adolescents: Does Sexual Activity Make a Difference?, which says that “sexual activity was associated with increased risk for genital high-risk HPV infection.”

Most studies find that prepubertal girls are negative for HPV.
Most studies find that prepubertal girls are negative for HPV.

Surprisingly, the study did find that some girls somehow had exposure to HPV even though they were not sexually active and some, even while they were prepubertal.

“The finding of asymptomatic HPV DNA in children, and correlation with live virus, infectivity, or disease is unclear.”

Jayasinghe et al on Genital warts in children: what do they mean?

Again, Bobby Kennedy leaves out the fact that almost all other studies have found that prepubertal kids and those who are not sexually active are negative for HPV.

And Bobby Kennedy‘s other slides?

The UK doesn't have vaccine mandates and rates of stage II or worse cancers were lower than ever.
The UK doesn’t have vaccine mandates and rates of stage II or worse cancers were lower than ever.

Did rates of cervical cancer increase “in the vaccinated group (20-24)” just after the start of a school vaccination campaign?

“Screening from age 20 yrs, rather than from age 25 yrs, would not prevent any more cancers from spreading beyond the cervix (stage II or worse) by age 27 yrs. The substantial increase in stage I cervical cancers in 24 and 25 year old women, corresponds to changes whereby a high proportion of women are now screened for the first time between ages 24.5 and 25.5 yrs. Previously some of these early stage screen detected cancers would have been prevented by treatment of high-grade cervical intraepithelial neoplasia following earlier screening and a few would have been screen-detected later – at age 26 or 27 yrs. Others may be slow-growing cancers, some of which could be argued to be over-diagnosed.”

Castanon et al on Is the recent increase in cervical cancer in women aged 20–24 years in England a cause for concern?

It kind of did, but only in the lowest grades and because they changed the ages for when these women were screened!

“Reassuringly no increase in stage II or worse cancers was observed in women under age 27 yrs. In fact, numbers of stage II or worse cancers diagnosed at age 24.5–25.0 yrs in 2014 are lower than in any other year since 2007.”

Castanon et al on Is the recent increase in cervical cancer in women aged 20–24 years in England a cause for concern?

And that’s not all they found!

Wait, Bobby Kennedy doesn’t mention that rates of cervical cancer are getting lower since 2007…

“Amidst these changes HPV vaccination was introduced in 2008 for girls aged 12–13 with catch-up for those aged 14–18.”

Castanon et al on Is the recent increase in cervical cancer in women aged 20–24 years in England a cause for concern?

What else happened since 2007?

That’s right. That’s about when we started vaccinating girls with the HPV vaccine.

A vaccine that has been very well studied since to see it’s effects on cervical cancer, including a large meta-analysis of 65 studies in 14 countries.

“More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination.”

Brisson et al on Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis.

What did they find?

They found “compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men.”

“In countries like the UK, Australia, and Canada there has been dramatic reduction in HPV related infections and diseases, while in countries with very low coverage there has been very little impact.”

Marc Brisson on HPV vaccine: high coverage could eradicate cervical cancer within decades, say researchers

HPV vaccines are safe and effective and they prevent cancer!

Why are some folks still trying to scare parents away from vaccinating and protecting their kids with these necessary vaccines?

More on Gardasil Eliminating Cervical Cancer in Australia