brushing your teeth won't help with this
May 12, 2007 9:45 AM   Subscribe

Damn. I smoke, I drink a lot, and boy howdy do I love giving head. Cancer, here I come.
posted by dirtynumbangelboy at 9:55 AM on May 12, 2007

From the article:

"Although the vaccine, called Gardasil, blocked about 100% of infections by the two human papilloma virus strains it targets, it reduced the incidence of cancer precursors by only 17% overall.

"Part of the reason was that many of the teenage girls and young women in the three-year study had already been exposed to the virus, according to the report in the New England Journal of Medicine."

I've not RTFA but it appears the vaccine is efficacious -- ie it provokes an appropriate immune response to prevent future infection -- but is not effective, ie doesn't work in the real world.

More evidence, it appears to me, for the vaccine to be given as part of the preschool schedule.
posted by docgonzo at 10:15 AM on May 12, 2007

...Part of the reason was that many of the teenage girls and young women in the three-year study had already been exposed to the virus, according to the report in the New England Journal of Medicine. ...
That's why states are now starting to mandate it for preteens. If you give to teens and young women, it might already be too late if they're already infected. As the article says, it's 100% efffective if given to women before they start being sexually active.

Nation: Virginity or Death!

Moonie Times: A Georgia member of Congress yesterday introduced legislation to prohibit federal money from being used by states to make vaccines against the human papillomavirus (HPV) mandatory for school-age children. ...
posted by amberglow at 10:27 AM on May 12, 2007

So how the hell is Paris Hilton still alive?!
posted by Brandon Blatcher at 10:29 AM on May 12, 2007

The 'H' is for "human".
posted by Wolfdog at 10:41 AM on May 12, 2007

They were right ... there's no such thing as a free lunch.
posted by Twang at 10:44 AM on May 12, 2007

"A Georgia member of Congress..."

No offense to gentle Me-Fiers from Georgia, but ... I didn't have to read any farther than that before I knew the rest would be meat-headed.
posted by Twang at 10:47 AM on May 12, 2007 [1 favorite]

In other depressing news, liver cancer can be caused by exposure to hepatitis.
posted by Smart Dalek at 10:58 AM on May 12, 2007

In other depressing news, liver cancer can be caused by exposure to hepatitis.

That's been known for quite a while.
posted by IronLizard at 11:04 AM on May 12, 2007

I heard this correlation between HPV and throat cancer the other day (theGaurdian I think) and it's just - whatareyagonnado?

It's like, try this, try that but at some point - you're gonna fucking die. It's almost like it's inevitable.
posted by From Bklyn at 11:07 AM on May 12, 2007


Oh wait, I read this on another forum...
posted by subaruwrx at 11:08 AM on May 12, 2007

From the second page of the article:

Among women who had not previously been exposed to types 16 and 18, the vaccine reduced the risk of precancerous lesions caused by those two strains by 98%.

"The overall message, in my mind, is that among susceptible young women, the vaccine was highly effective in preventing HPV-16 or -18 precancerous cervical lesions," Koutsky said.

When the researchers included all the women enrolled in the study, the vaccine reduced the risk of lesions caused by types 16 and 18 by 44%.

The number of women who were previously infected by the viruses was not large enough to account for this low rate of protection.

But when Koutsky and her colleagues considered lesions caused by all strains of the virus, the vaccine reduced the risk by only 17%.

Because researchers had previously believed that 50% of all serious precancerous lesions were caused by types 16 and 18, this rate of protection seemed inexplicably low.

Sawaya suggested in the editorial he co-wrote that the small size of the protection could be because other strains of HPV are filling the gap when types 16 and 18 are eliminated.

I don't know... 17% still seems worthwhile. If I were female, I'd still take those odds against the odds without the vaccine.

I guess the takehome message is that you shouldn't stop the pap smears. But that's a good message anyway.
posted by sbutler at 11:16 AM on May 12, 2007

Well, it sounds like the vaccine might still be usefull, if the precancerous lesions caused HPV strains other then 16 or 18 are less likely to turn into cancer.

Indeed, if 50% of the precancerous lesions are from non 16 or 18 HPV, but 90% of the cancer comes from 16 or 18, it seems like the vaccine would reduce cancer risk by more then 17%.
posted by delmoi at 11:21 AM on May 12, 2007

what delmoi said. Also, now that the vaccine exists, it should be pretty easy to make it work for other types too, no?

is HPV like HIV in its virulence, resistance, or mutations, or no?
posted by amberglow at 12:12 PM on May 12, 2007

HPV is a DNA virus, not an RNA virus like HIV-1, so its mutation rate is much lower. This will also effect the rate of resistance mutations.

The Gardisil vaccine is essentially just the empty shell of the virions without the internal genetic material. This primes an immune response without causing an infection. I don't know how the capsid protein (the outer shell) varies by subtype, ie whether new vaccines targetting other subtypes could be developed from the current template.
posted by docgonzo at 1:28 PM on May 12, 2007 [1 favorite]

ah, that's what i thought, doc--thanks.
posted by amberglow at 1:51 PM on May 12, 2007

More evidence, it appears to me, for the vaccine to be given as part of the preschool schedule.

More evidence, I agree, docgonzo, but perhaps not sufficient-- yet.

There are many reports of vaccines, even completely killed or synthetic vaccines, causing mild, symptomatic versions of the illnesses they prevent (I think this may be at the root of the troubles of the polio vaccine program in Africa, by the way). This could very well be the result of antigenic mimicry, where the virus or organism has surface molecules which are enough like those of tissues in the body that the immune system cannot attack the pathogen without also attacking the body. This tends to limit the ferocity of the immune response and promote the propagation of the pathogen.

In the case of HPV, which is transmitted sexually and infects sex organs, I would look for mimicry of important tissues which become active, after a along dormancy, right at puberty. Vaccinating prepubescents against HPV could conceivably result in an immune system which is primed to attack the reproductive system right when it is at its most vulnerable, when a small population of cells is just beginning to multiply toward a much larger final population.

I think the losses from such a program would probably outweigh the gains if that were to turn out to be the case, and I don't think we should proceed with universal or even large-scale vaccination against HPV until we know that it isn't.
posted by jamjam at 2:11 PM on May 12, 2007

posted by sbutler at 2:24 PM on May 12, 2007 [1 favorite]

I think everybody ought to be forced to be celibate or masturbate, and anyone caught having any sexual contact of any kind (even with their hetero spouse) should be tried as a GERM SPREADER and then duly hung.
posted by davy at 2:51 PM on May 12, 2007

*slobbers and drools all over davy* ; P
posted by amberglow at 5:22 PM on May 12, 2007

are the states planning on testing the kids for exposure before vaccinating? I hope so.
posted by amberglow at 5:24 PM on May 12, 2007

ah, so maybe it's not cigarette smoke and smoking that causes cancer afterall.
posted by brandz at 6:06 PM on May 12, 2007

The NEJM paper being discussed.
posted by kisch mokusch at 7:53 PM on May 12, 2007

Oh holy crap why are you telling me about this now? My throat's been hurting for weeks now
and my boyfriend recently visited for three months...

and I have religious guilt that probably has something to do with the fact that I was told as a child that oral sex would make my eyes fall out.

though cancer doesn't sound much better.

posted by po at 8:17 PM on May 12, 2007

Dan Savage on the shift to come, now that men are at risk: The HPV Vaccine: Watch How Fast the Debate “Shifts”
posted by amberglow at 8:19 PM on May 12, 2007

"boy howdy do I love giving head"

Do you visit Louisville KY often?
posted by davy at 9:49 PM on May 12, 2007 [1 favorite]

Wait, where is Dan Savage's "debate shift" supposed to originate? Maybe I'm naive but I find it hard to believe that your average misogynist anti-sex religious zealot goes down on their partners and that they would therefore classify themselves as at-risk. I mean, they'll take oral alright, but if they believed in reciprocity on the personal level, they'd probably believe in reciprocity on the political level.

Well, except there's the possible transmission by kissing. But I still say the anti-sex zealots won't fight their cognitive dissonance enough for this info to make much of a splash either way. The truth of the matter is that their ideas aren't reality-based enough to be particularly predictable. Anti-sex zealots do a good enough job of being hypocrites without Dan's help as it is.
posted by Skwirl at 2:43 AM on May 13, 2007

jamjam: That's an interesting point; I'm not up enough on immunology to be able to declare either way.

However, I am an epidemiologist(-in-training) and one of our truisms is that interventions are rarely, if ever, risk free and thus are evaluated on the balance of probabilities. Right now, the benefits of reducing infections with oncogenic strains of HPV appear clear: a substantial and significant drop in incidence of reproductive cancers. While the scenario you sketch might be a risk, we know this vaccine would have substantial public health benefits if delivered before initial challenge with HPV.
posted by docgonzo at 10:24 AM on May 13, 2007

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