It was an alarming headline, all right. “Close to Half of American Adults Infected With Genital HPV, Study Finds”. As New York Times readers would know, HPV is shorthand for the human papillomavirus, certain strains of which can cause cancer of genital organs as well as of the anus and throat. Notoriously, it is associated with cancer of the cervix in women.
Troubling news, then, this month, that about one in four men (25.1 percent) and one in five women (20.4 percent) between the ages of 18 and 59 in the US have these high risk forms of a virus that must be one of the most, if not the most common sexually transmitted infection in the world.
And its commonness is the first thing Federal public health experts who came up with those figures want everyone to understand: “One of the most striking things that we really want people to know is that high-risk HPV is common – common in the general population – these are not people who are marginalised,” said the lead author of the study, Geraldine McQuillan.
In other words, it’s OK to have genital HPV. It doesn’t put you in some underclass with dubious sexual habits; you could be middle or upper class, a college graduate, a white investment banker or a black bus driver. Practically anyone who has sex can get it and nearly everyone will have a brush with it in their lifetime (estimates go as high as 80 percent of the population). No shame, then, but also no reason to think you are safe from this modern epidemic with its potential to give you cancer. This is the first message.
And if that message has put the wind up a good number of people, the second is meant to reassure: we can prevent these types of cancer by vaccinating children before they start having sex.
“If we can get 11- and 12-year-olds to get the vaccine, we’ll make some progress,” Dr McQuillan said [to The Times]. “You need to give it before the kids become sexually active, before they get infected. By the time they are in their mid-twenties, people are infected and it’s too late. This is a vaccine against cancer – that’s the message.”
A message, though, that takes us into the realm of “alternative facts”. The HPV vaccine is, in fact, a vaccine against a sexually transmitted infection; if you don’t get the infection, you don’t get the cancer. But the experts do not want to talk about “kids” becoming sexually active and the diseases they are likely to get by starting sex early and experimenting with a series of partners.
They want to get infection rates down and cancer rates down – not only for the good of individuals but also to reduce the burden on health budgets and the society generally.
Viewed from the Olympian heights of university departments and the US Centers for Disease Control, tackling the cause of infection is simply a waste of precious time. Family doctors, they suggest, should not embarrass themselves or parents by discussing it unnecessarily.
“The infection is sexually transmitted, but that doesn’t need to be part of the conversation,” Dr Joseph A. Bocchini Jr, a paediatric disease specialist who has advised the US government on HPV vaccination, told The Times a year ago. “If a parent is concerned, physicians should be prepared to talk about it. But we don’t really discuss how people became infected with every vaccine-preventable disease.”
But HPV is not just another communicable disease, like those against which pre-teens are currently vaccinated in the US. They can’t pick it up from the soil, like tetanus, or from other kids coughing around them, like diphtheria and whooping cough; it is transmitted by skin to skin contact, typically through sexual intercourse or behaviour leading to or imitating sexual intercourse.
Parents who wish to protect their adolescent children not only from STIs but from the emotional and moral harms of premature sexual activity would no doubt appreciate hearing all the facts about HPV from their doctor before they agree to vaccinating their 11-year-old. And these facts would include:
The best protection against HPV is avoiding sexual contact with an infected person. In a 2005 paper urologist Richard A. Watson wrote: “Research at the CDC confirms that the risk of contracting HPV is directly proportional to the number of one’s sexual partners, and secondarily to the number of partners with whom one’s partner has been in sexual contact.”
According to CDC figures published in 2002, around 46 percent of US teenagers will have had sex by the time they leave high school; college is likely to increase the number of their partners, and risk.
Since a young person is unlikely to know whether the girl he would like to have sex with is infected, the way to reduce his odds dramatically is not to have sex at all until he is ready to marry a woman with a similar history. “No” is the best vaccine and there are still people who protect their physical and emotional health in that way.
In the vast majority of people who contract genital HPV, the virus will go away by itself. The risk of it progressing to cancer is increased by repeat infections.
Hormonal contraception also increases the risk of cervical cancer: a current Australian fact sheet shows that nearly 35 percent of women with this cancer had been using the pill, injectables or implants. (Here we see the cumulative effect of a permissive attitude to sex among unmarried young people, and births controlled by contraception (and abortion).) Smoking is also known to be a risk factor for cervical cancer.
Cervical screening has markedly reduced both the incidence of cervical cancer and deaths from this cause. Regular screening of women from the age or 18 or 20 can detect precancerous lesions which can be treated and cured before they develop into cancer. From being one of the most common cancers affecting women, in Western countries like the US and Australia it now ranks 14th and 13th among female cancers in those countries respectively. (Unfortunately, this is not the case in the developing world, which has 80 percent of the cervical cancer burden.)
It is more common among younger women — in Australia, the 4th most common cancer among women between 15 and 44 years of age – and among women who do not have regular screening tests. However, both incidence rates and death rates for the disease are relatively low. In the US from 2003 through 2007 the incidence rate for cervical cancer was 8.1 cases per 100,000 women per year. The mortality rate was 2.4 deaths per 100,000 women per year.
Both young people and their parents need to have facts like this put before them in order to understand what their options are in the face of an STI epidemic which is not, of course, confined to HPV, and whose effects go beyond the physical to touch the emotional and spiritual health of the person.
Calling HPV vaccines “cancer prevention” short-circuits informed consent by masking several important facts: that cervical cancer is being prevented to a large extent by screening and treatment; that there are increased risk factors, like multiple partners and using hormonal contraceptives that one can choose not to incur; that one infection is usually a warning, not a death sentence.
HPV and its sometimes serious consequences is a behavioural problem and behaviour can change if we really want it to. The smoking trend has been reversed by determined civil society, professional and government action. Both smoking and HPV cause cancer, but only HPV needs a vaccine. Why? Is it because Western society has too big a stake in sexual licence to allow a change of direction?
Vaccination may the best we can offer young people in a post-truth society, but it falls far short of the remedy that human beings really deserve, and are really capable of embracing.
Carolyn Moynihan is deputy editor of MercatorNet.