The Nov. 29 editorial "Recommend Pap smears, not vaccines, to prevent cervical cancer" completely missed the mark with regard to HPV vaccines. We are researchers and clinicians at the University of Iowa who study and treat HPV and other infectious diseases. It is disturbing to think that the article might dissuade individuals from getting a safe and effective vaccine that can prevent cancer.

First of all, it has been conclusively demonstrated that the vaccines are effective at preventing HPV infection. Cervical cancer is caused by HPV. Additionally, cancers of the head and neck are linked to HPV, including cancers in males. It has been clearly shown that the vaccines prevent the development of precursors to cervical cancer. In the editorial, Dr. Diane Harper was quoted as saying, "If doctors tell patients that this vaccination will prevent cancer, they’re telling them a lie." This statement from Dr. Harper is simply misleading.

In the vaccine studies, non-treatment of precursor lesions in the placebo group in the context of a clinical trial was considered unethical, and therefore, any precursor lesions were treated. Subsequent development of cancer in the placebo group was prevented by the required ethical treatment. Thus, the trials could not evaluate prevention of advanced cancer, per se. Because it takes cervical cancer a long time to develop, it will take about 15 more years to have data on incidence rates of cervical cancer from a large vaccinated general population. Because the vaccines prevent HPV infection and HPV-associated precursor lesions, they will prevent cancer.

The statement that the vaccines offer only five to seven years of protection is also misleading. The vaccine trials were initiated only five to seven years ago, and while we know that protection has been good for that period of time, there is no evidence that protection is waning. Only time will tell if protection is longer-term but this should in no way deter individuals from getting vaccinated. The earlier vaccinated populations are being carefully followed and, over time, it will be known if booster vaccinations are required. It is known with some other vaccines, such as the diphtheria vaccine, day-to-day potential encounter with the causative microbe stimulates additional protection in a significant part of the previously vaccinated population, reducing the need for re-vaccination.

Both vaccination and Pap smears are two important tools to prevent cervical cancer. It is not a question of "either/or." The editorial failed to mention that Dr. Harper advocates vaccination for both sexes in several of her published articles. However, Pap smears are still critical. The HPV vaccines do not cure HPV infections once they have occurred, and most women do not know whether they have been infected or not. In addition, the current vaccines only protect against two cancer-causing HPV types which account for more than 70 percent of cervical cancers. Other cancer-causing types exist, so vaccinated individuals should not feel a false sense of security. In other words, women need to continue to get Pap smears even if they have been vaccinated.

The side effects and safety concerns of the vaccine are also greatly misrepresented in the editorial. The article fails to mention that the CDC and FDA have been closely monitoring the safety of HPV vaccines and have deemed them safe. The statement that 73 percent of those who received the vaccine reported new medical conditions gives a wrong impression regarding safety. The editorial fails to mention that almost all (more than 90 percent) of the reported "medical conditions" were considered minor (e.g. pain and swelling at the site of injection), common events in all vaccination protocols. While severe reactions to the vaccine have been encountered, these could not be directly tied to the vaccine, no specific patterns were observed in these events, and those that were reported were consistent with events that occur in healthy adolescent and adult populations of similar size. It should be mentioned that there were slightly elevated risks of fainting and anaphylaxis that occurred within 15 minutes of vaccination, which led to the recommendation that those who are vaccinated be monitored for 15 minutes after vaccination. This is true of all vaccinations. The CDC continues to closely monitor the safety of the vaccines and makes recommendations based on the data.

It is too easy to think of HPV cancers as preventable by Pap smears alone. Furthermore, it is too easy to understate the importance of both vaccination and Pap smears. It needs to be emphasized that not all HPV-associated cancers can be detected by Pap smears. Consider this: A male developed HPV-associated head and neck cancer six months ago. This was discovered in the male during shaving, simply as a swollen neck lymph node. The downstream consequence of this finding was the male received radiation and chemotherapy for months that had to be stopped prematurely since the patient was near death because of treatment. Three months later, the male is still being fed by tubes, does not have a sense of taste, cannot speak clearly, has radiation burns on his face, and has significant anxiety because he remains susceptible to recurrence of cancer. His cancer is linked to one of the HPVs that is in the vaccine, and to think, this could have been prevented with vaccination prior to his initial infection with HPV. It is too late now for him to have vaccine protection.

In the summary of the editorial it is stated "not enough is known about HPV vaccinations to be recommended to the general population by medical professionals." This statement is false. The CDC, which does not take these things lightly, has recommended vaccination for prevention of cervical cancer and also more recently for anal cancer. The recommendation was based on sound medical and scientific findings. The editorial did not follow these same principles.

This opintion piece was signed by five University of Iowa professors: Al Klingelhutz, Ph.D., Pat Schlievert, Ph.D., Stanley Perlman, M.D., Marty Stoltzfus, Ph.D., and Colleen Kennedy Stockdale M.D., M.S.