Sep 1, 2008
Organic NZ magazine - September/October 2008.Sue Claridge, researcher and science writer, presents essential information for all women and parents.
In New Zealand in 2004, 154 women were diagnosed with cervical cancer and 71 women died.1 Between 1988 and 2004 the incidence of cervical cancer in New Zealand fell by 60% and the death rate by 52%. This fall in both morbidity and mortality can largely be attributed to the cervical cancer screening programme. Through the detection of abnormal cervical cells (using a pap smear) precancerous conditions can be detected and treated before the development of cervical cancer, thus reducing the incidence of, and mortality from cervical cancer.
The lifetime risk of cervical cancer is very low, and in New Zealand cervical cancer is one of the least common cancers in women; in 2004 cervical cancer represented only 1.7% of new cancer registrations in women. It was the 13th most common cancer in women, behind breast, colorectal, skin and lung cancer, among others.
It was long believed that cervical cancer was associated with sexual intercourse, because it is rare in women who have never had sex (e.g. celibate women such as nuns). It is now widely believed that the human papilloma virus (HPV) is responsible, in part, for the development of cervical cancer. Dr Harry Haverkos, from the US FDA Center for Drug Evaluation and Research, writes that HPV plays at least a major if not a necessary role in the development of cervical cancer.2 He goes on to say that “many investigators acknowledge that HPV is not sufficient to induce cervical cancer” and one or more other factors are also likely in order to initiate the cancer.
It is estimated that 75% of sexually active men and women have been exposed to HPV at some point in their lives.3 However, it is extremely important to note that some other factor is required to trigger the development of cervical cancer, and the medical community doesn’t seem to know quite what that is. When you consider that as many as 75% of women are exposed to HPV at some point in their lives, yet as few as 1% of them go on to develop cervical cancer, it is very, very clear the HPV infection alone is not the problem.
An HPV vaccine has been licensed in New Zealand and, from September this year, will be available free to girls from 12 to 18 years of age. Despite claims that this vaccine can prevent cervical cancer, scientists simply do not know if this is the case. Cervical cancer takes 20 to 30 or more years to develop and this vaccine has only been licenced since 2006. In addition, there have been numerous reports of serious adverse reactions to the vaccine where it has been introduced in Australia, the UK and the US.
For parents wishing to reduce the risk of their daughters developing cervical cancer in adulthood there are a number of things they need to consider when making a decision about the HPV vaccine.
Options for preventing cervical cancer A vaccine should not be considered an optimal way of preventing disease. They are never 100% effective and never 100% safe, and many of the alternative disease prevention measures offer much broader health benefi ts than the reduction in risk from a single disease.
A study published in June 2006 found that the consistent use of condoms offered considerable protection against HPV.4 Dr Rachel Winer and colleagues found that women whose partners always wore a condom during sex were 70% less likely to become infected with HPV than those whose partners used protection less than 5% of the time. In addition, the study found that after eight months, in women reporting 100% condom use by their partners, no pre-cancerous cervical lesions were detected, whereas 14 such lesions were detected among women whose partners did not use condoms or used them less consistently.
Condoms also have other health benefi ts such as protecting against other sexually transmitted diseases and pregnancy.
Research published in 2003 concluded that selenium and zinc deficiency may be risk factors. The results of the study “showed that the tissue contents of zinc, selenium, and calcium were signifi cantly lower and the copper and iron concentrations and copper/zinc ratio were significantly higher in cervical cancer tissue than that for paired nonlesion tissue.” In addition the blood levels “of zinc, selenium, calcium, and iron were lower, and copper and manganese levels and copper/zinc ratio were higher in patients with cervical cancer, than in healthy subjects.”5
Another study, from 2003, obtained the same results: that signifi cantly lower selenium and zinc levels and higher copper/zinc ratios were found in both CIN [Cervical Intraepithelial Neoplasia] and cancer patients compared with the controls.”6
In addition, a 1993 paper reported that among a cohort of 15,161 women, low serum levels of total carotenoids, alphacarotene and beta-carotene were a signifi cant risk factor for cervical cancer. Smoking was also strongly associated with cervical cancer in this study.7
Clearly not every woman gets cervical cancer. In fact, more than 99% of women don’t develop cervical cancer. Like many other chronic diseases, dietary defi ciencies are implicated as causal factors.
Problems with the HPV Vaccine
One of the first concerns with the vaccine is that it contains only four of the more than 100 known human papilloma viruses, and only two of the 30 that have been associated with the development of cervical cancer.New strains of the virus are being found all the time, and Dr Thomas Broker told a 1999 workshop on vaccine development that “instead of 80 HPV genotypes or 150 that have been offi cially named, that there probably are millions of variants, virtually a continuum.”8 Women who have had the vaccine will still need to have pap smears and this is acknowledged by the Ministry of Health.
However, it is the more immediate impact of the vaccine that has many parents concerned. There have been numerous reports in Australia, the UK and the US of serious adverse reactions, including paralysis, Bell’s palsy, Guillain-Barré syndrome, and several deaths.9
A US Obstetrician Gynecologist, Dr Clayton Young, opposes the HPV vaccine and points out that “the vast majority of women clear or suppress the virus to levels not associated with [cancer precursor lesions]” and this occurs rapidly, particularly in young women. He argues that “vaccinating children against HPV with a vaccine that is of unknown duration of effi cacy will only postpone their exposure to an age when they are less likely to clear the infection on their own and be subject to more severe disease.”10
Dr Young also points out that the vaccine was not well studied in children and adolescents saying that “there is absolutely no evidence that the vaccine prevents anything when administered at this young age. Merck expects you to extrapolate their adult data to the immune response in children. If they were really interested in vaccine efficacy in children, should it not be studied properly in children?”
One of the most surprising advocates of caution when it comes to this vaccine is Dr Dianne Harper, one of the world’s top experts on the human papilloma virus, and someone who was involved with the clinical trials for Gardasil.
Dr Harper expressed concerns over what she considers a rush to recommend and mandate the vaccination of very young girls with the vaccine. “It went too fast, it went too fast without any breaks,” she said.11
She believes the vaccine is safe but cautions that time is needed to study potential side effects in larger numbers of young girls before any consideration should be given to mandating such a vaccine.
According to Dr. Harper, “the vaccine has not been out long enough for us to have post marketing surveillance to really understand what all the potential side effects are going to be… We don’t know yet what’s going to happen when millions of doses of the vaccine have been given, and to put in place a process that says you must have this vaccine, it means you must be part of a big public experiment. So we can’t do that until we have more data.”
Dr Harper’s is a rare voice of reason and caution from within the medical establishment. One of the striking things about vaccination programmes is that, rather than admit that vaccines are not perfect, those who promote them act like they will solve everyone’s health problems. No one bothers to tell parents what else they can do to protect their children, or tell the truth about the potential for adverse reactions.
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Sue Claridge is a researcher and science writer, editor of the Breast Cancer Network newsletter and Managing Director of Papawai Press.
Sue is also the author of "Investigate before you vaccinate - Making an informed decision about vaccination in New Zealand", published by the Immunisation Awareness Society of New Zealand. This book can be purchased though the Soil & Health Assn.
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References
1. New Zealand Health Information Service, 2007: Cancer: New Registrations and Deaths 2004, New Zealand Ministry of Health, 2004, Wellington.
2. Haverkos, H., 2005: Multifactorial Etiology of Cervical Cancer: A Hypothesis, Medscape General Medicine, 2005;7(4):56, accessed at http://www.medscape.com/viewarticle/515768 in December 2005.
3. Mayeaux, E.J. and Spitzer, M., 2005: Preventing Cervical Cancer and Other HPV-Related Diseases, Medscape, The Postgraduate Institute for Medicine, Accessed at www.medscape.com in August 2005 (webpage no longer available)
4. Winer, R.L., Hughes, J.P., Feng, Q., O’Reilly, S., Kiviat, N.B., Holmes, K.K. and Koutsky,L.A., 2006: Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women, New England Jouranl of Medicine, June 22, 2006, Volume 354: Number 25: 2645-2654.
5. Cunzhi, H., Jiexian. J., Xianwen. Z., Jingang. G., Shumin. Z. and Lili, D., 2003: Serum and tissue levels of six trace elements and copper/zinc ratio in patients with cervical cancer and uterine myoma, Biol Trace Elem Res. 2003 Aug;94(2):113-22.
6. Kim, S.Y., Kim, J.W., Ko, Y.S., Koo, J.E., Chung, H.Y. and Lee-Kim, Y.C., 2003: Changes in lipid peroxidation and antioxidant trace elements in serum of women with cervical intraepithelial neoplasia and invasive cancer, Nutr Cancer. 2003;47(2):126-30.
7. Batieha, A.M., Armenian, H.K., Norkus, E.P., Morris, J.S., Spate, V.E. and Comstock, G.W., 1993: Serum micronutrients and the subsequent risk of cervical cancer in a population-based nested case-control study, Cancer Epidemiol Biomarkers Prev. 1993 Jul-Aug;2(4):335-9.
8. CBER, 1999: Evolving Scientifi c And Regulatory Perspectives On Cell Substrates For Vaccine Development Workshop Proceedings, 10 September 1999, Center For Biologics Evaluation And Research, US FDA, accessed at http://www.fda.gov/cber/minutes/0910evolv.txt in June 2006.
9. Hopkins Tanne, J., 2007: Questions over human papillomavirus vaccine in the US and Australia, British Medical Journal, 334: 1182-1183.
10. Young, C., 2006: Letter to the The American College of Obstetricians and Gynecologists, accessed at http://www.vaccineinfo.net/immunization/vaccine/hpv/doc_against_HPV.shtml 4 August 2008.
11. Gillen, M., 2008: HPV Scientist Speaks Out, CBS broadcasting, accessed at http://cbs4.com/health/Gardisil.Girls.Vaccine.2.718592.html on 4 August 2008.
