Friday, August 22, 2008

HPV Vaccine Caution Still Urged

Charlotte Haug, MD, PhD, from the Journal of the Norwegian Medical Association, in Oslo, writing a commentary in the August 21 issue of the New England Journal of Medicine urges caution regarding large scale programs for HPV vaccination, primarily because there are “too many unanswered questions”.

Dr. Haug says, "The real impact of HPV vaccination on cervical cancer will not be observable for decades. Rational choices about the introduction of medical interventions that might do good in the future but for which evidence is insufficient, especially since we will not know for many years whether the intervention will work or — in the worst case — do harm?"

The editorial accompanies a study published in New England Journal of Medicine, which uses a mathematical model to show the cost effectiveness of disseminating the vaccine in the United States. The study expects that the vaccine will be effective lifelong if highly targeted to girls, age 12. According to the conclusion, “The cost-effectiveness of HPV vaccination will depend on the duration of vaccine immunity and will be optimized by achieving high coverage in preadolescent girls, targeting initial catch-up efforts to women up to 18 or 21 years of age, and revising screening policies.”

Dr. Haug feels the model is “quite optimistic, saying testing trials and follow-up are still needed. One of the major questions that exist is whether the vaccine will last throughout life. If not, screening again becomes more effective than catch up programs.. In addition, studies haven’t proven whether the vaccine has the same effect on older women as pre- adolescents, something that to date is presumed.

The next few years should reveal more, but in the meantime, Dr. Haug is urging more research. She concludes, “We should concentrate on finding more solid answers through research rather than base consequential and costly decisions on yet-unproven assumptions."


Related: HPV Vaccine Causes Public Concern despite FDA/CDC Support