the state of Texas has just mandated that their seventh grade girls get the shot for human papilloma virus. That’s the good news.

The bad news is that it will cost a bundle.

HPV, or human papilloma virus, is a virus that causes warts. Now, you can get warts all over your body, but some types of the virus tend to like the genital area, and a couple types when the part of the uterus that sticks into the vagina (the cervix) gets infected with one or two strains or varieties of the virus, the woman can end up with cancer of the cervix.

When the vaccine came out, there was a lot in the press about “fundamentalist” parents objecting to it because it sent their daughters a message that they can have sex without consequences. Now, I’m sure someone out there has worried about this, but Focus on the Family, which has a widely listened to program on Christian radio and which covers child training and health concerns of parents, has actually supported the shot, saying in a matter a fact way that it is a sexually associated disease, (i.e. can spread non sexually) and that girls could catch it from their husbands or through rape.

LINK says that 75% of people will get HPV at some time or another, but they are including ordinary warts we see in kids. Luckily, only a few strains of the virus cause cancer, and most warts go away by themselves without treatment.

In the old days, venereal disease was caught through intercourse. Now they have STD and other definitions to cover disease spread through fingers and saliva and other bodily fluids, sometimes in a sexual context but not always. Think Bill Clinton and you know what I mean.

The fact that Cancer of the cervix is an STD has sort of been known for a century, since a doctor noted married Jewish women had a very low rate of this cancer, but prostitutes had a very high rate. It’s statistics. Lots of partners, start sex at a low age, poor hygiene, sex with uncircumcized men, the odds go up. But not everyone gets cancer or even warts.

So, with the sexual revolution, early cases have become more common, especially in girls who were sexually abused or exploited as early adolescents. (I am old fashioned enough to feel a 14 year old cannot consent to intercourse). But these cases are statistical things, and after years of seeing lots of early cases caught on routine pap smears, I lost two older (age 48 and 55) married women in my practice from Cervical cancer: both had weakened immune systems that probably activated the virus.

The vaccine alas is very expensive, over $100 for a shot, and three shots are required.

However, not only will it save lives, it many change the way we screen for cervical cancer.

Every woman knows about a yearly pap smear. And every woman hates it.

Well, now there is a reason to think that with the vaccine this will be eliminated for younger girls, and maybe even replaced with a urine test for HPV virus. Indeed, even now when we pick up abnormal cells that we don’t know what is wrong (ASCUS) we can either keep doing paps, or do an HPV screen. If the HPV is negative, then the cancer risk is low.

Alas, for older women, the news is that it’s probably too late, and we still need the exams.

But the good news is that Paps pick up more than Cancer. We find chlamydia and other STD’s, we screen for family planning etc. and on older women we screen for cancer of the colon. And most docs screen for other things: drug abuse, menopause, stress, heart disease risk factors etc.

Think of it as an oil change in your car, where the mechanic checks and finds your fan belts need replacement or your radiator is dry. An ounce of prevention is better than a pound of cure for both cars and people.


Nancy Reyes is a retired physician living in the rural Philippines with her husband. Her website is Finest Kind Clinic and Fishmarket and she posts medical essays to HeyDoc Xanga site.

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