FDA advocates that all girls should be vaccinated when they are 8 to 10 years old. Now boys are asked to be vaccinated too. Given the potential risk of a new vaccine and reports of GB Syndrome associated with it, would the risks outweigh the benefits?
Regular cervical smears with a follow up colposcopy, is the gold standard that has reduced the incidence and mortality from invasive cervical cancer. Those given the HPV vaccine are advised to continue the gold standard cervical cancer screening. Hence why add the vaccine with the unknown risk?
HPV vaccine will prevent 70% of cervical cancers and also some other anogenital cancers. The quadrivalent vaccine will also prevent genital warts.
It offers long term protection however, screening with cervical smears / HPV testing should continue. The risks of HPV vaccine are comparable to other vaccines and there is no proof that serious adverse events reported are causally related to the vaccine.
From a public health perspective, HPV vaccine makes sense but if an individual's perception of risk / benefit makes them choose screening as against vaccination, this is also a reasonable strategy. However, screening has to be done every 3 years while the vaccine works for a very long time.
The trials of the vaccines, and more important the follow up studies in field use in various countries show that risk of harm is very small (unless you know of studies that I am unaware of). However, so far the outcome studies of cancer reduction are not long enough to be confident about how effective the vaccine will be: 70%? 90%? 98%? At what level would you say we can stop cervical screening? In particular, the trials and population cohort studies cannot yet show the long term effect in the peak age group for the cancer: 40-60. Until we know that, it is difficult to recommend cutting down on cervical screening: a preventive activity that we know works. Further, if the vaccine reduces minor abnormalities, LSIL, HSIL ASCUS that are found on screening but mostly resolve without treatment, it will reduce the harms that arise when colposcopists feel obliged to treat these, and thereby cause cervical damage that may lead to pregnancy complications. We already know that the vaccine reduces these abnormalities in the younger age groups, so gives us greater confidence not to screen young women under 25. Thus at present, the vaccine should reduce the harms of screening, and in the distant future we will know how well it reduces cancer.
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