Dear VaccineSmarts,

I received an email asking for me to sign an online petition known as Sophie’s Choice.

If the goal of the petition is cervical cancer prevention, wouldn’t it be better if the advocates of earlier Pap smears put their efforts into Human Papillomavirus (HPV) vaccination?

Beth

Jamaica Beach


Dear Beth,

We found this question quite surprising. It is the first question we received pertaining to an issue in another country.

We had to look into it because we were unfamiliar with the story.

First, a little bit about online petitions in the United Kingdom. Parliament set up the program to allow the public to have more say about government decisions.

Any citizen or resident of the United Kingdom may post or sign a petition.

Petitions that get 100,000 electronic signatures within one year are considered for debate in the House of Commons.

We assume you must be a British citizen to participate in this process.

Sophie Jones died at age 19 from cervical cancer.

She suffered from severe abdominal pain and was misdiagnosed with a gastrointestinal disorder called Crohn’s disease.

Her physicians reportedly failed to consider cervical cancer because the minimum age for routine Pap smear screening is 25 in the United Kingdom.

The Sophie’s Choice petition requests that the age be decreased to 16.

In the United States, the recommended age for routine cervical cancer screening is 21 years.

In the not-too-distant past, we screened teens.

Those with abnormal Pap smears were followed and treated.

All too often, the treatment resulted in damage to the young woman’s cervix that could lead to preterm deliveries and other complications.

Now we know that most all of the abnormal Pap smears in this age group resolve without treatment.

The current recommendation makes good sense for the U.S.

It takes into consideration that cervical cancer is extremely rare in teens and that treating Pap smears did more harm than good.

This recommendation applies only to healthy women. Young women with problems with their immune system or other risk factors may need screening at a younger age.

You are right. Vaccination is a much better route to go.

It is easier and more cost effective to prevent HPV disease than to treat.

The vaccine protects against the two HPV types that cause 70 percent of cervical cancers.

Vaccination decreases the chance of abnormal Pap smears, resulting in less anxiety and discomfort in relation to treatment.

Additionally, the vaccine prevents a significant portion of vulvar, vaginal, penile and anal cancers.

Although not yet demonstrated, it also is likely to prevent a sizable portion of oral cancers as well.

We did not find any information indicating that there were rules or regulations that kept Sophie’s physicians from checking her for cervical cancer.

Instead, it appears that they did not pursue the diagnosis because it was unlikely because cervical cancer occurs in less than two in 100,000 19-year-old women each year.

Cervical cancer usually takes decades to develop.

Recognizing unusual cases like Sophie’s before it is too late is extremely difficult.

There is no way of determining whether Sophie would have chosen to be screened if it had been available for someone her age.

What we do know is that vaccination of a younger Sophie would have reduced her chance of cervical cancer by 70 percent.

Advocates of the online petition could have a bigger impact encouraging vaccination of 11- to 12-year-old girls and boys.

As Sophie’s case illustrates, even young people suffer the ill effects of HPV.

Dr. Richard Rupp is a pediatrician and member of UTMB’s Sealy Center for Vaccine Development. Bridget Hawkins, Ph.D., is the assistant director of the Sealy Center for Vaccine Development. This column is supported by a UTMB President’s Cabinet Award to provide information about vaccines. Visit www.utmb.edu/scvd/vaccinesmarts for more information.

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