Vaccine tackles virus, but sparks controversy

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Cathie Rossignol wants the best for her two girls but won't vaccinate them against a virus that causes cervical cancer when the shots become widely available this fall.

The vaccine targets the sexually transmitted disease responsible for most of the cancer cases, making the lifelong Catholic from Brooklin feel like she would be "giving the OK" to premarital sex if her daughters were inoculated.

Twenty-two-year-old Ashley Mowatt, who contracted human papillomavirus, or HPV, wishes the vaccine had been around when she was younger.

"If this were a vaccine for boys, people would be on top of that and say, 'We need to distribute it,' " said Mowatt, who is studying to be a teacher at Thomas College in Waterville.

New vaccines usually raise questions about effectiveness and side effects. But this one is also prompting debate over the message it sends about sex.

Nationally, conservative groups are arguing against making the vaccine required for public school attendance. Women's groups and abortion-rights organizations want otherwise.

The political fault lines are similar to those drawn over Plan B, the emergency contraception that critics say promotes promiscuous behavior among women; and before that, birth control.

Setting the stage for controversy: The new vaccine is currently available just for women and involves the most common sexually transmitted infection.

HPV has infected more than half of sexually active men and women at some point in their lives. Some infections cause genital warts, but most cases clear up with no symptoms, so some people never realize they even had it.

But some infections in women can lead to cervical cancer, often 10 to 15 years later. While cervical cancer screening has reduced the number of cases by 74 percent from 1955 to 1992, according to the American Cancer Society, about 3,700 women die from it in the United States each year.

The vaccine, Merck's Gardasil, minimizes the risk by protecting against two strains of HPV that cause 70 percent of cervical cancer cases. The vaccine also guards against other types of HPV that cause 90 percent of genital warts.

These findings led a federal panel in May to recommend the vaccine for all 11- and 12-year-old girls - it is most effective when administered before girls become sexually active - and for females as young as 9 or as old as 26. But it's doubtful that the vaccine, approved by the federal Food and Drug Administration in June, will be immediately integrated into the routine schedule of shots that children get.

The vaccine is not required for entering school in Maine, unlike shots for the measles and the mumps. And the age at which the vaccine is recommended comes at a time when some parents think they're done vaccinating their children.

Supporters of the vaccine, however, describe it as the first cancer vaccine and urge parents to have their young daughters inoculated as insurance for the future.

A woman could stay abstinent until marriage, and still contract HPV from her husband, said Dr. Kristina Parisien, a family practice physician at Mercy Primary Care in Westbrook.

"This isn't about premarital sex," Parisien said. "This is about who's going to have sex, period. It's outside of the whole moral debate."

Her practice plans to begin providing the vaccine within a month. The three-shot series is administered over six months.

At $360, the vaccine is not cheap, but major insurers in Maine such as Anthem Blue Cross Blue Shield, Aetna and Cigna will offer coverage for the medication.

Those who receive the vaccine must still get cervical cancer screenings known as Pap smears, however, to pick up the 30 percent of cervical cancer cases not caused by HPV.

OB-GYN nurse practitioner Marcelle Pick says she questions the need for the new vaccine for everybody because Pap smears have been so effective at detecting HPV and cervical cancer early enough for successful treatment.

While trials with the vaccine have shown no serious side effects, Pick worries about problems that may present themselves 10 years down the line.

"We're so quick to say everybody get the HPV vaccine," said Pick, co-founder of Women to Women in Yarmouth, which combines alternative and conventional medicine.

Instead of a vaccine, women can reduce the risk of HPV-related cervical cancer through condom use, abstinence, diet and healthy behavior, Pick said. Studies suggest smoking by young women with HPV makes them more vulnerable to cervical cancer.

Pick and groups such as the The National Vaccine Information Center, a nonprofit agency that warns parents about the risk of vaccines, are suspicious that Merck has produced more hype than good medicine.

Industry analysts say that mandating the HPV vaccine would make Gardasil the blockbuster the company needs since it was forced to withdraw top-selling arthritis medicine Vioxx because of cardiovascular complications.

However effective the vaccine might be, it offers no guarantee, Rossignol said, that her two daughters, 12 and 17, will never get cervical cancer. So she prefers to advocate abstinence.

"My daughter still plays with dolls," Rossignol said. "I want her to be 12, I don't want her to be a 12-year-old acting like an adult."

National conservative groups feel similarly, and are joining anti-vaccine groups to oppose making the vaccine mandatory for school. Taking the opposite position is the Planned Parenthood Federation of America and the National Organization for Women, which call the vaccine a public health priority.

Mowatt said it is unrealistic for parents to think their daughters will wait until marriage to have sex, noting that sexual contact outside of intercourse is sufficient to pass the virus.

Mowatt has learned a great deal about the subject since she got the virus at 16, and makes sure to get screenings regularly so she can detect any cancer early.

"I've been scared of getting cancer since I was 16," Mowatt said. "So it's me being careful, keeping myself happy and taking care of myself."

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