Married to Medicine

Married to Medicine

Tuesday, January 3, 2017

What You NEED to Know About Gardasil (but probably don't)

A lot of people ask me about Gardasil... it's the vaccine I'm asked about the most, by far.  But very few people are are aware of what I consider to be the most important thing about it.

Bear with me because I think giving you my personal perspective along with the facts is the best way I can share this with readers.

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It was 2007, and HPV wasn't on either of our minds at all.  My husband was only 17 when I'd started dating him a decade earlier, and I was the first girl he'd ever really even kissed.  We'd then saved sex for marriage... for 5 years... and gotten married right before starting demanding graduate programs.  So by the time we were 27 we both had very long, well-established histories of pretty much no sex ever.  HPV was not anything we were concerned with.

That year, my husband finished up his academic medical training (meaning, classroom-based years) and was just starting his clinical years - the years of actually seeing patients.  As you can imagine, it's quite an education and it's a very intense time for medical students - the privilege of working with people on their most important situations is not lost on any trainee who has even half a heart.  Everything is new, the learning curve is incredibly steep, and the demands - physical, intellectual, and emotional - are sky high.

During this time, my husband saw many things that made an impression on him, and I was sometimes his sounding board.  One of the things that struck both of us as very scary... and very sad ... was something he noticed when he started his rotation in the head and neck cancer clinic.  The scene there wasn't what one might think would be, based on common knowledge.  About half of it was... about half of the patients there were the typical population of aging and elderly smokers and chewers... the sad situations he'd expected to encounter.  Very sad indeed, because oral and throat cancers are not only very deadly cancers but they bring some of the most excruciating deaths and their treatments carry horrendous and often permanent side-effects, even for survivors.  As a physician friend of mine has noted, "People with head and neck cancers have disfiguring masses in their mouths and throats, which make it hard for them to eat and speak ... I've been the last person to hear them talk before their vocal cords are removed in surgery, and it is a chilling experience."  This, again, was simply to be expected.  But what my husband hadn't expected and what struck us as almost perverse in how strange and wrong it seemed, was that the other half (half!) of the patients were early middle-aged people with no history of smoking or chewing and no histories of any other high-risk lifestyle choices either.  They were, by and large, parents - with young children.  Totally normal parents.  Parents who, along with their young families, were living out complete nightmares.

What was the cause of these truly godforsaken tragedies?  You've probably figured it out by now ... HPV.  As I sit here writing this post, a decade later, Doctors and scientists now widely consider HPV patients to be "The New Face of Head and Neck Cancer," and oncologists, who have nothing to do with administering the vaccine, are "leading the campaign to boost its use."  And here's the thing:  You don't have to have sex to get HPV in your mouth ... open-mouth kissing is currently believed to be enough, and oral sex, which younger generations don't even consider to be "real" sex, will do it for sure.  And here's the other thing:  There's no annual pap smear, or *any* test, to catch pre-cancerous cells in the mouth or throat and scrape them away.  It's tempting to tell oneself that one's children don't need the HPV vaccine because hopefully they won't be promiscuous and even if they are, they'll surely always have annual checkups (lots wrong here already, but that's outside the scope of this blog post).  But even if those things were safe to assume, they're utterly irrelevant to protecting against the risk of HPV-originating oral and throat cancers.

Most people who ask me about the HPV vaccine have no idea HPV can cause any type of cancer other than cervical.  And that's simply because all of this is so new.  Much as our knowledge base continues to grow, there hasn't even been enough time to complete any long-term studies; we can test the cancer cells themselves and see that they came from HPV, but we still don't know exactly the risk of kissing or oral sex - though I once read an article by a Harvard oncologist estimating that having three or more oral sex partners is the new risk-equivalent of long-term smoking (I read that years ago now and cannot find the link - personally I don't think any solid estimation can really be made yet, but that's the only estimation I've ever seen).  So most people making this choice for their children don't even know the half of what they're deciding about.  And as with all the other standard vaccines, there is plenty of misinformation on the internet to scare parents about alleged side-effects.  I'm not going to rehash why that is and where you should look to find legitimate information; you can read my more general vaccine post on all that (and click here or check Snopes if you've heard the debunked myth about Gardasil's "creator" Dr. Diane Harper).  But here's what I think you should consider:  Whether or not the vaccine has any real risk of side-effects, the decision not to get the vaccine absolutely has a risk of side-effects.  If you visit your local hospital, you won't find a single person occupying a bed there because he or she got the vaccine.  But you'll have only to take the elevator to the head and neck cancer clinic to find plenty of people there because they didn't get the vaccine.   

I hope for your own sake that you've never been (and will never be) close to a young family facing the loss of a mom or a dad.  My husband (now an oncologist/researcher focusing on leukemia research at The Dana-Farber Cancer Institute, a Harvard affiliate) says that these are hardest losses he sees (he doesn't do pediatric oncology... says he couldn't).  Whereas other patients weigh the pros and cons of increasingly experimental treatments and often choose to forego treatments that have almost no chance of prolonging their lives more than a few extra weeks, while also carrying brutal side-effects, parents of young children will put themselves through almost anything for even one more day before they have to say goodbye. Believe me when I tell you - if there was anything you could do to prevent your child and his or her future family from facing this... you would do it in a heartbeat.  And there is.  It won't protect against all types of cancer, obviously.  But the HPV vaccine will protect against various cervical, vaginal, vulvar, penile, anal, rectal, and oropharyngeal cancers.  My kids will both be getting it as soon as they're eligible - in spite of the fairly chaste lifestyles my husband and I lived and hope they will also live.  I hope so strongly that your children will get the vaccine too.