Doctor not sure vaccine is wise investment

The human papilloma virus vaccine that will be offered to Nova Scotia girls in Grade 7 this fall isn’t a sure way to prevent cervical cancer and might not even be a wise investment of health-care funds, a Cape Breton pediatrician said Friday.

The province announced Wednesday it would use $2.8 million in federal funds to vaccinate about 6,000 girls against two strains of the virus, which are known to be responsible for about 70 per cent of cases of cervical cancer.

Sydney pediatrician Dr. Andrew Lynk said the vaccine is safe and he would certainly want his daughter to get it to reduce her odds of developing cervical cancer.

But he said unanswered questions about the vaccine lead him to wonder whether such an investment might better be directed toward measures such as cancer screening.

Of the 55 Nova Scotia women who will develop cervical cancer this year, half to two-thirds will not have had a recent Pap smear — or any at all, Dr. Lynk said.

Elderly, low-income, aboriginal and immigrant women have especially low rates of participating in cervical cancer screening, he said.

"Is that money not better spent trying to figure out how to get all women or most women to have regular Pap smear testing?" Dr. Lynk asked of the funding for the vaccine campaign.

The $2.8 million is the province’s share of a federal fund for human papilloma virus vaccination. It’s available for three years, but the province expects to continue the program after that.

The entire childhood immunization schedule has been retooled around the new vaccine. Even if that money were available, it would be unlikely that more women seek Pap smears than do so now, said Dr. Robert Grimshaw, medical director of Cancer Care Nova Scotia’s gynecological cancer screening program.

He said at one point people with the program wrote to every woman in Cape Breton who had not had a Pap smear in the previous four years. The best results were with women aged 40 to 50, but only seven of 100 went for screening in response to the letters.

"Short of hiring nurses and putting guns in their hand or some coercive method, I don’t know that that’s going to be successful," Dr. Grimshaw said.

About one-third of women who develop cervical cancer do have regular Pap smears, but the disease develops so rapidly it is not caught by screening.

Dr. Grimshaw said the provincial campaign will offer an opportunity to study some of the outstanding questions about the vaccine.

It’s yet to be determined how long the vaccine remains effective, if there’s a need for a second round of shots later in life and what role other strains of human papilloma virus have in causing cervical cancer. Data from Nova Scotia, where three doses of the vaccine will be provided, will be compared to data from Quebec and British Columbia to determine its effectiveness versus a two-dose regimen. Dr. Grimshaw said it is crucial that even women who are vaccinated continue to have regular Pap smears.

Dr. Lynk said the vaccine may not have a big impact on cancer rates if it proves to wear off over time.

"You vaccinate the girls in Grade 7 when they’re 12. Let’s say it’s gone in 10 years time when they’re 22 and at the height of their sexual activity: What happens then?" he asked.

He also said there’s evidence from the use of other vaccines that when you successfully protect against some disease-causing strains, others become more prominent. Dr. Grimshaw said there’s no indication that is happening with human papilloma virus, and new vaccines now in development aim to protect against more strains of the virus.

source: thechronicleherald.ca