Jade Goody, the HPV vaccine and yet another example of why our health care system is broken
Regular Pap tests can find precancerous cells early enough before they turn lethal. Since the Pap test was introduced more than 50 years ago, it has led to a 70 percent decline in rates of cervical cancer in the U.S., once the leading cause of cancers deaths among women. Even now, nearly 12,000 women are diagnosed with cervical cancer and 4,000 die of the disease each year, according to the CDC.
Goody's death could also lead to wider acceptance of a new weapon in the fight against cervical cancer. It's called Gardasil and it's a groundbreaking vaccine for HPV, a sexually transmitted infection that lies at the root of most cervical cancers. Actually, let me amend that: the TV series could lead to a wider acceptance of Gardisal in Britain. Even with the buzz that has followed the show across the pond, any such positive change in attitudes about preventive health measures in this country still tend to run smack dab into the economics of our antiquated health care system.
Penny wise and Pap foolish
Gardasil was approved by the FDA in 2006, and the CDC has since recommended that all 11- and 12-year-old girls get the vaccine, as well as any female age 13 to 26 who hasn't yet been vaccinated. The hope is that widespread use of Gardasil could drastically reduce the death rate from cervical cancer even more. In a recent study Gardasil reduced the percentage of women with abnormal Pap tests by 43 percent. Yet the CDC's public health recommendation has sparked controversy. Back in 2007, Merck launched an aggressive campaign to encourage states to mandate that preteens get the vaccine. That didn't go over so well. Two years later, the vaccine still hasn't been embraced even though no ill effects have been found in clinical studies.
According to an article in the Yale Alumni magazine, fewer than 25 percent of eligible women and girls have received the first of three required doses. Yale epidemiologist Alison Galvani surveyed 326 parents of eligible preteens and 286 college students about the risks and benefits of Gardasil. While both groups believed that the vaccine is effective at preventing cancer and genital warts, a majority of parents and students thought that getting vaccinated would lead to promiscuity. (Despite the fact, Galvani reports, there is no evidence this is actually true.) The cost -- $181 for the three shots -- was also a crucial concern.
In my practice, a mother will occasionally ask my advice about whether to vaccinate her daughter. Interestingly, few if any have expressed concern about the vaccine prompting premature sexual activity. More commonly, parents question the safety of vaccines in general.
The majority of patients I counsel about Gardasil are 18 to 26 years old, all of whom I recommend getting the vaccine. I'd estimate that about 40 take my advice. I wish the percentage were higher, and can't say for sure why it's not. It may simply be for the same reason patients don't get mammograms, Pap tests or cholesterol screenings as often they should: They recognize the value, but they're busy, and inevitably it gets relegated to the back burner. (The Gardisal vaccince, let's remember, requires three office visits.) This is true especially now when everyone, it seems, is looking to cut back on expenses.
Most insurance covers Gardasil, but patients still need to pay the co-pay. And since many insurers require people to meet a high deductible before coverage kicks in, for a lot of my patients that $181 cost of Gardisal would come straight out of their pockets.
It's yet another reason why I've been arguing so strongly for meaningful health care reform that makes the necessary investment in patient education and preventive care. The Society of Gynecologic Oncologists has tallied the annual cost of screening and treating cervical abnormalities -- and the bill? About $4 billion, almost all which could eventually be saved by a properly funded and executed Gardisal vaccination program. Just add it to the list.