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HPV testing and vaccines
Unless you've been living under a rock these last few years, you'll be aware that the HPV virus is positively linked with cervical cancer incidence in women. Most women who get HPV don't develop cervical cancer, but it majorly ups your risk of gettting it. 70% of cervical cancer patients test positively to one of two strains of HPV infection. 97% of cervical cancer patients in another study showed the presence of any of a dozen strains of HPV. 4 out of 5 women will have an HPV infection some time in their lives - it's mostly silent, although a few develop genital warts. Interestingly enough, the strains that tend to produce warts (which manifest in about 10% of cases) are not the ones which are associated with later cancer. This article from the EMJA sets out all the implications.
On the good news front, an HPV vaccine has been recently developed, which seems to offergood resistence to HPV infections (of the strain in the vaccine). There have been many calls made recently for girls to get vaccinated routinely, generally before puberty (and sexual activity, presumably). Of course, the "wages of sin are death" crowd are jumping up and down and saying that this would encourage sex before marriage and all kinds of other nasty nasty things. My understanding - possibly limited, I admit - is that marriage is not magic protection against HPV either. Maybe married couples are all engaging in safe sex these days.
That's all well and good, despite the rumptions of the religious right. However, there are two things that are bugging me. One is that the vaccine is naturally only effective if one hasn't already been exposed to the virus. Are they going to test every girl before mass vaccination, because there will be a significant proportion (a small minority, but significant, nonetheless) who will already be infected? It's disgusting to consider, but, if there are negative consequences if the vaccine is given to someone already infected, these need to be thorougly explored before going gung-ho giving it to every girl.
The other is that while an HPV test is available in Australia (of course), it's only offered to women who are already showing cervical abnormalities in a smear. I presume that one could pay the full price for such a test, but I haven't tracked down any pricing information. While 4/5 women have already been infected with HPV, that means 20% have not. Since the only sex I've had with a man as an adult has been safe sex, I think my chances of not having contracted it are good. Yes, lesbians can pass it too, but like many STIs, I'm sure it's harder (I haven't found any comparative statistics tho'). I would like to know whether or not I have been infected. I would also like access to the vaccine if I have not. Obviously, it's early days, but I haven't yet seen any discussion on that.
There would be a cost associated with providing an HPV screening test to all women, and then vaccinating them if they're clear. If there is a latency period between infection and testing positive, that could prove difficult to manage. Assuming not, though, if all goes well, and you get vaccinated, you're presumably at much less risk (3% of the usual risk, going by the above stats, assuming they develop a multi-valent vaccine that will take out the 6 major cancer-associated strains) of developing cervical cancer. If you consider the cost of providing all those 2-3 yearly pap smears to the women who bother to have them, surely it'd cost much less in the long run to vaccinate the fortunate few and then call them in for pap smears at much-reduced intervals? If you say that 5 years is a suitable period for a vaccinated woman to go between smears (and research might show longer is fine), you've just reduced your cervical screening costs by 10%. Over the course of a woman's lifetime, the savings would be much greater. Not to mention the reduced costs of treating women who do go on to develop cancer. I'm fairly confident that the reduced costs of regular smears (and reduced treatment costs) would more than offset the costs of mass HPV screening/vaccination.
So, how long till the Powers That Be start doing the sums? Not too long, I hope. And not too long for us adult women who might have some options. I'm definitely going to try and track down HPV testing via the private route. We'll see what happens after.
ETA: I just realised that my assessment of HPV infection risk was a bit over-optimistic. There has been at least one instance of the "safe sex" I engaged in failing catastrophically. Huh. Well, there's still a 1 in 5 chance of my point applying to me. It certainly still does to women as a group.
On the good news front, an HPV vaccine has been recently developed, which seems to offergood resistence to HPV infections (of the strain in the vaccine). There have been many calls made recently for girls to get vaccinated routinely, generally before puberty (and sexual activity, presumably). Of course, the "wages of sin are death" crowd are jumping up and down and saying that this would encourage sex before marriage and all kinds of other nasty nasty things. My understanding - possibly limited, I admit - is that marriage is not magic protection against HPV either. Maybe married couples are all engaging in safe sex these days.
That's all well and good, despite the rumptions of the religious right. However, there are two things that are bugging me. One is that the vaccine is naturally only effective if one hasn't already been exposed to the virus. Are they going to test every girl before mass vaccination, because there will be a significant proportion (a small minority, but significant, nonetheless) who will already be infected? It's disgusting to consider, but, if there are negative consequences if the vaccine is given to someone already infected, these need to be thorougly explored before going gung-ho giving it to every girl.
The other is that while an HPV test is available in Australia (of course), it's only offered to women who are already showing cervical abnormalities in a smear. I presume that one could pay the full price for such a test, but I haven't tracked down any pricing information. While 4/5 women have already been infected with HPV, that means 20% have not. Since the only sex I've had with a man as an adult has been safe sex, I think my chances of not having contracted it are good. Yes, lesbians can pass it too, but like many STIs, I'm sure it's harder (I haven't found any comparative statistics tho'). I would like to know whether or not I have been infected. I would also like access to the vaccine if I have not. Obviously, it's early days, but I haven't yet seen any discussion on that.
There would be a cost associated with providing an HPV screening test to all women, and then vaccinating them if they're clear. If there is a latency period between infection and testing positive, that could prove difficult to manage. Assuming not, though, if all goes well, and you get vaccinated, you're presumably at much less risk (3% of the usual risk, going by the above stats, assuming they develop a multi-valent vaccine that will take out the 6 major cancer-associated strains) of developing cervical cancer. If you consider the cost of providing all those 2-3 yearly pap smears to the women who bother to have them, surely it'd cost much less in the long run to vaccinate the fortunate few and then call them in for pap smears at much-reduced intervals? If you say that 5 years is a suitable period for a vaccinated woman to go between smears (and research might show longer is fine), you've just reduced your cervical screening costs by 10%. Over the course of a woman's lifetime, the savings would be much greater. Not to mention the reduced costs of treating women who do go on to develop cancer. I'm fairly confident that the reduced costs of regular smears (and reduced treatment costs) would more than offset the costs of mass HPV screening/vaccination.
So, how long till the Powers That Be start doing the sums? Not too long, I hope. And not too long for us adult women who might have some options. I'm definitely going to try and track down HPV testing via the private route. We'll see what happens after.
ETA: I just realised that my assessment of HPV infection risk was a bit over-optimistic. There has been at least one instance of the "safe sex" I engaged in failing catastrophically. Huh. Well, there's still a 1 in 5 chance of my point applying to me. It certainly still does to women as a group.