HPV vax: decreased cervical cancer mortality in young women
a recent letter-to-the-editor
documented a dramatic decrease in cervical cancer deaths in US women younger
than 25 years old, over the time period of 1992-2021. This was likely
attributable to the advent of the HPV vaccine (see dec cervical cancer
mortality in young women JAMA2025 in dropbox, or
doi:10.1001/jama.2024.22169)
Details:
-- cervical cancer mortality
trends were obtained from the National Center for Health Statistics
-- main outcome: the changes in
cervical cancer mortality from 1992 to 2021, with specific reference to women
<25yo
Results:
-- 398 cervical cancer deaths were
reported from 1992-2021 in women <25yo
-- between the 3-year cycle of
1992-94 to 2013-15, there was a largely linear gradual decline in the cervical
cancer mortality, at a rate of 3.7%/year (-4.8% to -2.1%)
-- the cervical cancer mortality
rate then decreased from 2016-2021 at 15.2%/year (-21.9% to -7.8%), and with an
overall 62% reduction (see graph on left)
-- this decrease reflected an
absolute decrease of 55 deaths in 1992-1994 to 13 in 2019-2021 (see graph on
right)
-- based on the
prior rate of decrease, an estimated 26 additional cervical cancer deaths would
have been expected
Commentary:
-- HPV vaccine became available in
the US in June 2006 covering 4 serotypes, then the 9-valent one became
available in 2015 (which covered the more oncogenic strains of HPV)
-- in a prior study, they found an
overall decrease in cervical cancer incidence from 12.39/100K women in 2001 to
9.80/100K in 2019: https://jamanetwork.com/journals/jama/fullarticle/2799049
-- the biggest
decline was in women aged 25-29, which went from 5.36/100K in 2016 to 4.01/100K
in 2019, a 7.5% annual decrease of this timeframe (borderline statistical
significance); the overall trend in women at all ages was highly statistically
significant over time, p<0.001)
-- for women
<25yo (the target of the current study), there was a decrease from 0.24/100K
women in 2012 to 0.08/100K women in 2019, a 12.4% annual decline, overall a 65%
reduction, and highly statistically significant at p<0.001; and by
comparison to the 2001-2012 time period (when the HPV vaccinations first
started), there was a 3.1% decline from 0.29/100K in 2001 to 0.24/100K in 2012,
with p=0.02
--
this timing all was consistent with large increases in the protective effect of
HPV vaccine
-- this current study followed the
previous one assessing mortality rates (the earlier one was incidence rates),
finding a pretty dramatic decrease in cervical cancer mortality in women
<25yo who were the first cohort to reap the potential benefits of the HPV
vaccine (though many of them may have only received the less potent 4-valent
vaccine)
-- the initial gradual decrease may well reflect improved screening and evaluations, and perhaps education on the causation of HPV with cervical cancer and use of condoms
-- this current article came out
recently, reinforcing the slew of prior studies showing that HPV vaccination is
not just safe, but is remarkably effective in decreasing cervical cancer and
likely oropharyngeal and other cancers: for the epidemiology and some of the
more recent studies on changes in precancerous cervical pathology associated
with vaccination, see https://gmodestmedblogs.blogspot.com/2024/05/hpv-related-cancers-oropharyngeal-is.html
-- cervical cancer:
cervical cancer is basically an HPV-associated cancer, leading to the CDC’s
strong recommendation for HPV vaccines be given to all teens until age 26, with
the option to continue to age 45 since the vaccine was so effective
-- a
Scottish study found a 92% reduction in high-grade dysplasia from the
pre-immunization to immunization time-period, and a 77% reduction in
moderate-grade dysplasia; this protection extended to non-vaccinated
individuals, suggesting herd immunity (https://gmodestmedblogs.blogspot.com/2019/04/hpv-vaccination-dramatic-decrease-in.html)
-- another study in this blog found a dramatic
(97%) decrease in high-grade cervical, vulvar, and vaginal pathology in those
women randomized to the newer HPV-9 vaccine that covered the more oncogenic HPV
serotypes vs the older 4-serotype one
-- oropharyngeal
cancer: the majority of these cancers are related to HPV infection (>70%),
occur most frequently in men, and are largely (>90%) associated with
HPV-type 16. vaccination dramatically decreases HPV-16 (90-100% developed
HPV-16 specific antibodies). https://pmc.ncbi.nlm.nih.gov/articles/PMC8310210/#sec3-viruses-13-01339 and
https://pmc.ncbi.nlm.nih.gov/articles/PMC4299160/.
it is too soon now to know the actual changes in clinical oropharyngeal cancers
(which occurs later in life), but this current information is pretty
suggestive. see https://gmodestmedblogs.blogspot.com/2024/05/hpv-related-cancers-oropharyngeal-is.html for
recent data
-- anal and penile
cancers: about 2/3 of penile cancers and >90% of anal cancers are associated
with HPV: https://gmodestmedblogs.blogspot.com/2017/02/understated-cervical-cancer-mortality.html,
Limitations:
-- there is a quite evident
association between the initiation of HPV vaccinations and both the incidence
and mortality of cervical cancer in those women <25yo, but:
-- we do not
have enough granular data in either of these studies to assess whether this
reduction, on an individual level, occurred specifically to those individuals
who had received the vaccine
-- if the vaccine
were very effective, the decreased incidence of cervical cancer attributable to
vaccination would likely be much higher than what was found in this study
(though i have not seen applicable studies reflecting the cutpoints for
effective herd immunity, since the vaccine seems to be protective of
non-vaccinated women as well)
-- it should be noted that the 9-valent vaccine (which covers the most
important oncogenic strains of HPV) was not released until 2015, so the results
on cervical cancer mortality will likely improve dramatically over time, when
immunization with this much better vaccine will be more widespread
-- we do not have any information
about other potential risk factors, including multiple sexual partners, sex at
an early age, smoking, family history of cervical cancer, immunodeficiency (eg
HIV), etc. or other psychosocial risk factors that might have played a role,
limiting the generalizability of the results
-- as expected, there were few
mortality events in the young cohort evaluated in this study. There was no
specific statistical analysis in this article, though the prior study on
declining incidence of cervical cancer did find a highly statistically
significant decline (p<0.001). and in this current mortality study, the
confidence intervals were consistent with a statistically significant decline
so,
--as we know, after the current US
elections there will likely be upcoming huge changes in the public health
approach to vaccinations:
-- the rates of HPV
vaccine have been lower in males than females (in 2022, 34.6% of boys 9-17
had received at least one dose of vaccine vs 42.9% of girls); overall 38.6% of
children aged 9-17 had at least one HPV vaccination dose, increasing with age
such that in those aged 15-17 it was in 56.9% overall: https://www.cdc.gov/nchs/data/databriefs/db495.pdf
-- this issue of HPV vaccination
has been distorted, with evident prevarication (ie lying) by RFK Jr, the quite
likely upcoming head of Health and Human Services, who is trying to present
himself as not-really-so-opposed to vaccines despite his many antivaccine
diatribes:
-- he clearly has
stated that HPV vaccine is unsafe, despite loads of data to the contrary: https://www.ascp.org/news/external-news/industry-news/2025/01/31/HPV-Vaccine-Is-Safe-Despite-RFK-Jr-s-Claims-CDC-Says?srsltid=AfmBOoowvaLuVFCcTqocpc0GusFm6EJmfHE0xf07oC0QT4yBOTT1le0l
-- an Australian study of 11 years with the HPV-4 vaccine and
9 million doses found a low incidence of syncope in those 12-13yo (29.6 per
100K doses of vaccine in females and 7.1/100K in males, with higher rates in
the younger adolescents); and 0.32/100K for anaphylaxis. There were low rates
but no expected increase from the vaccine for autoimmune disease, postural
orthostatic tachycardia syndrome, primary ovarian insufficiency, Guillan-Barre
syndrome, complex regional pain syndrome and venous thromboembolism: https://www.sciencedirect.com/science/article/pii/S0264410X20308252
-- RFK Jr is
involved in a lawsuit against Merck, the HPV vaccine Gardasil developer, citing
erroneously that there are "many hundreds of cases" of adverse
effects, reimbursing him directly to 10% of the fees from the law firm pursuing
this issue and $856,559 in 2023: https://www.statnews.com/2025/01/31/rfk-jr-hhs-gardasil-litigation-fees-divest-son-wisner-baum/;
https://abcnews.go.com/Politics/major-reversal-kennedy-tells-senators-money-vaccine-lawsuit/story?id=118321043
-- he recently
reported that if he is confirmed, he will divest from the lawsuit, but will
give his share of the proceeds of the lawsuit to his son Conor, who just so
happens to be a lawyer in that law firm pursuing the lawsuit..... https://www.nytimes.com/2025/01/31/health/rfk-jr-gardasil-hpv-lawsuits-confirmation.html
-- and there is no
assurances that he will not personally profit from subsequent lawsuits
against other products
-- RFK Jr also came
out strongly against both the polio and measles vaccines, also very highly
protective with potentially disastrous effects if these are curtailed: https://gmodestmedblogs.blogspot.com/2024/12/getting-rid-of-vaccines.html
-- one concern about HPV vaccine
is that there has clearly been a backlash against all vaccines in our current
era (error?), leading to decreases of many vaccines, eg flu vaccine declined
especially in white children and adults <65yo: https://www.cdc.gov/fluvaxview/coverage-by-season/2023-2024.html).
In fact HPV coverage, though previously increasing, has actually had a declined
since the beginning of the COVID-19 pandemic from 79.3% in 2022 to 75.9% in
2024 among US adolescents
-- so, the current beat of
anti-science, anti-public health, pro-conspiracy theories, remarkably unethical
positions and outright lying (eg, that RFK is not anti-vaccination and is open
to his reviewing "the science" (as the blatantly non-scientist that
he is) are likely to intensify if RFK, Jr is confirmed)
-- not only will there likely be a
rollback of proven and critically important public health measures, but there
will likely be a dramatic skew of future research support bent towards his
anti-science proclivities
-- the anticipated pending
anti-vaccine agenda will likely be implemented, and will likely be associated
with severely undercutting the federal ability to maintain a vigorous public
health system, making it harder to identify public health issues (there will
likely to be more health problems from lots of industry deregulation, exposure
to carcinogenic chemicals in the atmosphere, less research into the spread of
new deadly microbes or potential vaccines/therapies, etc). As before, trump
effectively dissolved the National Security Council unit dealing with future
pandemics. Likely more coming...
as i concluded the last blog on
polio and measles, "indeed, we are now in for a roller-coaster ride, one
with a rickety frame and without guardrails". it now seems that there are
no seatbelts or even seats as well...
geoff
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