Book Club: The HPV Vaccine Controversy

The HPV Vaccine Controversy: Sex, Cancer, God, and Politics: A Guide for Parents, Women, Men, and Teenagers
by Shobha S. Krishnan, M.D.

Praeger Publishers, 2008

The HPV vaccine, released in 2006, was ripe for controversy, at least in places like the United States. Here there is a strong anti-sex undercurrent from certain segments of society, and fears abound that a vaccine that protects against a common sexually transmitted disease — especially one whose symptoms disproportionately affect females — would encourage sexual promiscuity among our nation’s teenage girls. In addition, there is a segment of society that is deeply suspicious toward vaccines, a fear that is often fueled by misinformation or misunderstanding.

The HPV Vaccine Controversy is an excellent resource for anyone considering vaccination, as well as those who have already been exposed to human papillomavirus.

While Krishnan’s book is an invaluable guide for anyone considering the vaccine for themselves or their child, it covers much wider territory than just the vaccine and its attendant controversies. The first half of the book is devoted not to a discussion of vaccination but to a thorough and accessible description of female anatomy (although apparently her claim about the teenage cervix is controversial), the lifecycle and transmission of human papillomavirus (HPV), cancer screening techniques such as the Pap test, and the slow development of cancer caused by HPV infection. It also has good information on genital warts, which are caused by certain strains of HPV (such as HPV-6 and HPV-11) that often get overlooked in discussions of their cancer-causing cousins (such as HPV-16 and HPV-18). This makes the book an excellent resource for anyone who has had an abnormal Pap test and has questions — the detailed descriptions of the various cervical-cell abnormalities and the different stages of cervical cancer will assist the lay reader in making sense of her diagnosis.

Additionally, this is a useful handbook for anyone who has been diagnosed with a chronic HPV infection. Krishnan empowers her HPV-positive readers with information that can help them reduce the risk of the recurrence of warts or the development of precancerous or cancerous lesions. Tips to minimize symptoms are commonsense yet important, such as the reminder to quit smoking. Krishnan cites a large study showing a strong correlation between smoking and HPV-16-related severe cervical dysplasia (a precursor to cancer). She mentions that cigarette products, such as nicotine, can wend their way into cervical mucus, suggesting a possible mechanism by which smoking can antagonize the development of cellular abnormalities.

While the focus is on cervical cancer — in line with the pervading discourse surrounding HPV — there is plenty of information that pertains to male readers. An entire chapter is devoted to HPV in males, addressing questions such as whether they should be vaccinated to protect their future female partners, or if men who have sex with men would especially benefit from the vaccine’s protection against anal and throat cancers. And, of course, any sexually active person, regardless of gender, is vulnerable to genital warts, against which Gardasil (but not Cervarix) protects.

Krishnan makes a striking point about the potential the HPV vaccine has to curb cancer deaths caused by human papillomavirus. The Pap test is such an effective screening tool that doctors are able to nip most cellular abnormalities in the bud before they progress to invasive cancer. Cervical cancer mostly strikes people who don’t have access to Pap tests — not just uninsured U.S. women who can’t afford health care, but hundreds of millions of women in undeveloped countries. The vaccine could make an enormous impact if it could be delivered to this underserved population — but unfortunately, they are the population least likely to have access to an expensive vaccine such as Gardasil.

However, the efficacy of these vaccines is nothing to sneeze at. Recipients will have fewer precancerous lesions that require treatment, and Gardasil protects from the strains of HPV that cause 90 percent of genital warts. On the balance, this will save recipients a lot of money — every year in the United States, $4 billion is spent on the diagnosis and treatment of HPV infections and associated diseases. The treatment of genital warts alone costs Americans $200 million a year — and while the warts can be treated, they can never be cured and can keep coming back. Furthermore, widespread vaccination in the United States, even if not everyone has access, might build a “herd immunity” that will help protect those who were unable to receive the vaccine.

One problem with the book is that it was published in 2008 — a scant two years after the vaccine’s debut. Some information is outdated — such as the repeated mentions that Cervarix is not yet available in the United States and that Gardasil hasn’t been approved for use in males. The book could also benefit from updates with the latest information about the vaccine’s efficacy. Although we won’t have more definitive information about the vaccine’s efficacy for another 20 to 35 years, we are still learning more information about it as studies are conducted at a furious pace. A book on such a new vaccine demands periodic updates.

As for the subtitle, there is a lot of information here about sex and cancer, but not too much about God or politics. While these issues are touched upon, the book will disappoint those less interested in the science and health aspects of HPV and more interested in the virus’ politicization.

Overall, this is an excellent resource for anyone considering vaccination, as well as those who have already been exposed to HPV. The author crafts a good argument against the claims that Gardasil will make girls go wild when she points out that other STDs as well as pregnancy are still risks of sexual activity. And the evidence-based, no-nonsense presentation of facts should clear up any misunderstandings that someone suspicious about Gardasil might have about the virus, its symptoms, and vaccination in general. Lastly, it provides detailed information about the virus and its ability to induce cellular abnormalities, which is helpful for anyone living with a chronic HPV infection.