The history of medicine is peppered with advances which have transformed the lives of many. The discovery of insulin and penicillin are changes which made the seemingly impossible possible. For the current generation of doctors, we have in our grasp the elimination of cervical cancer worldwide. Gone. Like smallpox or polio.
The discovery by Prof Harold Zur Hausen – that practically all cervical cancers were caused by a virus called the human papillomavirus (HPV) – led to his attainment of a Nobel prize. This discovery has been the basis for major improvements in cervical cancer prevention. Screening programmes have evolved to include tests to detect this virus, to better detect precancerous abnormalities. Even with these improvements however, screening programmes can never hope to prevent all cervical cancers. The game-changer, like smallpox and polio, has been the development of a preventative vaccine targeting the types of the HPV virus which cause 70 per cent of cancers.
For a disease which kills 500,000 women each year worldwide, this seems almost miraculous. However, it is a real scientific possibility, as suggested by the World Health Organisation in recent months. For our Irish population each year, this would mean 90 women staying alive, 320 never getting the life-changing diagnosis and more than 6,000 never having to undergo invasive treatments to prevent a cancer developing
Affordability
In most countries of the world, the debate has been around affordability and equity – how to provide access to the vaccine for the many, not just the few who can pay. The global vaccination alliance GAVI, supported by Bill and Melinda Gates, has committed to delivering this life-saving intervention to 40 million girls in low-resource countries by 2020. Botswana, for example, has launched a publicly funded programme with an uptake of 95 per cent of its 12-year-old girls.
Up until two years ago, Ireland was taking all the right steps. There was a huge welcome when the vaccine became part of the school schedule, and our uptake rates at more than 80 per cent were among the best in the world. In recent years, misleading and false claims have caused doubt, undermined trust and led to parents hesitating about the vaccine. As a result, uptake rates dropped significantly – provisional figures show uptake rates at an average of 50 per cent nationally.
As a mother and a doctor I have no doubt. As a mother, I ensured my daughter got the vaccine. I wanted her to be protected. As a gynaecologist, I know the impact of cervical cancer, and I operate all too frequently on patients whose lives we do not want to lose. In addition I see at first hand the anxiety and worries associated with treatment for pre-cancer. I believe most of these are now preventable.
Erroneous beliefs
The problem is there are some naturally occurring conditions that can make teenage girls unwell. These conditions occurred in girls in the days before the HPV vaccine was ever introduced. Where there has been a previous vaccination it is easy to see how a link could be suspected and believed. These erroneous beliefs have been augmented in our amplified age of social media.
However, repeating an erroneous belief over and over does not make it true. As doctors, we have to look at the evidence. In excess of 80 million girls have been vaccinated worldwide yet scientists have not found a link. Extensive surveillance studies in Sweden, Denmark, Scotland and France have found that these conditions are just as common in unvaccinated girls as vaccinated girls. The World Health Organisation, the Centre for Disease Control in the United States, the EU-funded European Centre for Disease Control and Prevention, the International Federation of Obstetricians and Gynaecologists agree and emphasise that the benefits of the HPV vaccination greatly outweigh the risks.
A future without cancer is still achievable in Ireland. We can turn this around. Around the country in the coming weeks Health Service Executive vaccination teams will be working with secondary schools, parents and girls to protect our young female students, offering them the vaccine. Those who hesitated last year have another chance to reflect and consent. Parents and girls should take the time to get trusted, scientific information by visiting hpv.ie. Let us have no regrets in ensuring maximum protection for future generations.
Prof Grainne Flannelly is a consultant obstetrician/gynaecologist and clinical director of CervicalCheck