CMAJ • December 4, 2007; 177 (12). doi:10.1503/cmaj.1070117.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nisker, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nisker, J., MD PhD

Letters

Vaccination against human papillomavirus

Jeff Nisker, MD PhD

Professor, Departments of Obstetrics and Gynecology and Oncology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ont.

The commentary by Abby Lippman and colleagues on the planned vaccination of Canadian girls aged 9–13 years with the HPV vaccine raises "questions and cautions"1 for physicians, parents and citizens of Canada. As a physician who trained in the late 1970s with gynecologic-oncologist Hugh Allen, I have witnessed both the devastating effects of advanced cervical carcinoma2 and the dramatic reduction in the incidence of this disease with Pap smear screening.3 As a parent, I would worry that if I had a daughter aged 9–13 years (I have sons) she could not give informed consent to HPV vaccination by herself.4 Predicated on my expectation that she could be educated about the importance of Pap smear screening and safe sexual practices and would comply at least with Pap smear screening, I would advise her that HPV vaccination was not necessarily in her best interest. As a citizen, I believe that funding for women's health promotion should be directed to improving educational initiatives about Pap smear screening and safe sexual practices and to starting a public education campaign concerning the largely preventable breast and ovarian cancers related to the BRCA gene mutations,5 which are much more common killers of women than cervical cancer.

As a physician, parent and citizen, I support vaccination for herd immunity;6 however, my obligation to my daughter would supersede my obligation to others. When one of my patients asks, "What would you do if I (or my daughter) was your daughter?" I usually respond, "But you are not my daughter (or wife or sister)." In this case, however, I would respond, "I would be uncomfortable with you being vaccinated against HPV at this time."

Footnotes

Competing interests: None declared.


REFERENCES

  1. Lippman A, Melnychuk R, Shimmin C, et al. Human papillomavirus, vaccines and women's health: questions and cautions. CMAJ 2007;177:484-7.[Free Full Text]
  2. Allen HH, Nisker JA, Anderson RJ. Primary surgical treatment in one hundred and ninety-five cases of stage 1B carcinoma of the cervix. Am J Obstet Gynecol 1982;143:581-4.[Medline]
  3. Canadian Cancer Society, National Cancer Institute of Canada. Canadian cancer statistics 2007. Toronto: National Cancer Institute of Canada; 2007. Available: www.ncic.cancer.ca/vgn/images/portal/cit_86751114/21/40/1835950430cw_2007stats_en.pdf (accessed 24 Oct 2007).
  4. Nisker, J. Philip. CMAJ 2003;168:746-7.[Free Full Text]
  5. Nisker J. The need for public education: "surveillance and risk reduction strategies" for women at risk for carrying BRCA gene mutations. J Obstet Gynaecol Can 2007;29:510-1.[Medline]
  6. Colgrove J. The ethics and politics of compulsory HPV vaccination. N Engl J Med 2006;355:2389-91.[Free Full Text]




This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nisker, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nisker, J., MD PhD