If there were a vaccine that could prevent cancer, would you get it?
That's the question families and health care professionals have struggled with ever since a shot that can prevent cervical cancer caused by a sexually transmitted virus was approved by federal agencies.
The vaccine -- Gardasil -- was overwhelmed by controversy last year when Texas Gov. Rick Perry mandated that all girls entering sixth grade receive the vaccine.
His order brought a public outcry from groups that said Gardasil hadn't been sufficiently tested and would encourage young girls to become sexually active.
Although the Legislature nullified Perry's order soon afterward, a spokesman for Perry's office said last week that his action had at least part of the desired effect: It got people talking about the human papillomavirus, or HPV.
Even so, a year after Perry's mandate, health officials said teenagers in Bryan-College Station are often not aware of the cancer-causing virus, despite the fact that many of them become sexually active before graduating high school.
Worth a shot
When Gardasil was approved by the FDA in 2006, it was seen as a medical breakthrough that could save thousands of lives each year.
That's the reason Perry moved so quickly to require the vaccine, a spokeswoman from the governor's office said last week.
"For the first time in history, we had the chance to prevent cancer with a vaccine," Krista Piferrer said. "The governor very strongly believes this is a life-saving tool, and he was very disappointed with the Legislature's decision."
Piferrer said Perry didn't see it as a "conservative vs. liberal" political issue.
"Saving a life is the most pro-life stance you can take," she said.
A federal panel that recommended the vaccine reviewed thousands of test cases for years before approving Gardasil, according to Ciro Sumaya, who served on that panel and is dean of the Texas A&M Health Science Center School of Rural Public Health.
"It is being very carefully monitored for safety, efficacy and side effects," he said.
Cervical cancer can be deadly, Sumaya said, because people often don't realize they have it until it's too late. It's especially a risk for women who don't get regular medical checkups.
Although some strains of HPV cause genital warts, it's possible for both men and women to have HPV without symptoms. Both men and women can pass it to their sex partners without knowing they have it.
Besides reports that the injection is painful, the vaccine has shown no unusual or dangerous side effects, Sumaya said, although Gardasil and its effects are being closely monitored by private and public-sector groups.
A woman can get the set of three shots after she's had sex, Sumaya said.
Research shows Gardasil can minimize the virus' ability to produce cancer cells, he explained, even if a woman has already been infected with HPV.
"It has a protective effect that's being studied now," he said. "Even after someone already has strains of the virus, its ability to produce a cancer is minimized."
But the vaccine remains the most effective if it's administered before a person is exposed to the virus, Sumaya said, which is why it's important for parents to have their kids vaccinated when they are young.
And that's where experts said the situation becomes more complicated.
Controversy
Opponents of Gardasil say vaccinating young girls against a virus that's sexually transmitted will encourage them to have sex at a younger age.
Coalition for Life Executive Director Shawn Carney said he is against anyone getting the vaccine at any age.
"If you have to get a vaccine to have sex, you shouldn't be having sex," he said this week.
Carney said Coalition for Life, a local conservative anti-abortion group, has no official stance on the vaccine. But for Carney, the issue is clear.
All STDs can be prevented through abstinence, he said, so there's no reason to take a risk by having sex. Getting a vaccine might decrease the risk of harm, but it's treating the symptom, not the problem.
It's not the government's job to mandate vaccines like this, Carney said, adding that parents often don't opt out of vaccines for their kids even though they can.
"It assumes the worst of our young girls," he said. "It assumes parents are idiots and can't make a decision for their own children."
It's normal for a new vaccine to be met with hostility, Sumaya said. Vaccines against polio and the measles, which seem like good science to people now, had to be introduced slowly.
But Perry's intent was good, Sumaya said, adding that health professionals would eventually like to see the vaccine be required across the U.S.
That issue won't come up in Texas again until 2011, due to a legislative order that bans bringing it up for discussion until then.
Still, the mandate brought Gardasil and HPV to the forefront of the discussion about teen health. That's at least part of what it was intended to do, Piferrer said.
"One of [Perry's] goals was to generate discussion," she said. "If the governor's executive order did anything, it got parents talking."
Awareness of HPV has definitely increased in Bryan-College Station, a spokeswoman for Planned Parenthood's regional office said. But, she said, there's still a lot of misinformation about the vaccine.
She said the governor's mandate scared parents away from Gardasil.
"This vaccine is not promoting sexual activity any more than taking out an umbrella will make rain come from the sky," said Rochelle Tafolla, spokeswoman for Planned Parenthood of Houston and Southeast Texas.
Tafolla has kids, she said, and it's scary to think about them having sex. But because HPV is so common, it's hard to justify not vaccinating them.
"This is a very preventable cancer," she said. "If this was about breast cancer, we wouldn't even be having this discussion."
Virus causes cancer
There's no cure for HPV, which is linked to most cases of cervical cancer.
It's also the most common type of STD in the U.S., according to a recent study.
One in four girls between 14 and 19 years old tested positive for HPV in a 2007 study by the American Medical Association. Among women 20 to 24 years old, the number of HPV cases increased to almost half of those tested by the study.
Gardasil, which is made by Merck, guards against at least four strains of HPV that cause most cervical cancer cases. The Food and Drug Administration recommends the vaccine for women between 9 and 26 years old, when infection is most common.
The vaccine is already being used across the U.S. Merck had distributed about 13 million doses of the vaccine by December, a company spokeswoman said last week.
Despite its prevalence, most people don't know much about HPV, according to Susan Philliber of Philliber Research Associates, which studies sexual activity and trends in teenagers.
"People don't realize the connection between HPV and cancer," she said.
Lauren Robinson, a 19-year-old sophomore at Texas A&M University, said last week she had never heard of HPV or Gardasil.
An A&M Consolidated High School graduate, Robinson opted out of taking a complete sex education course by taking a health class over the summer.
It didn't matter at the time, Robinson said, because she wasn't sexually active.
Robinson said she has no plans to get Gardasil. When she decides to have sex, she said, she might reconsider getting the shot.
'Younger and younger'
The number of teens having sex before they graduate high school isn't increasing, Philliber said, which doesn't mean it isn't happening.
Around 50 percent of teens say they have had sex by the time they graduate high school, according to the Centers for Disease Control and Prevention's Youth Risk Behavior Study.
Philliber said the rate of pregnancy among teens has increased for the first time in a decade, but that doesn't seem to be the result of an increase in sexual activity.
Instead, she said, there's a growing complacency among young people about condom use.
An awareness of HIV in the 1980s brought on an increased use of condoms, which can protect against contracting STDs as well as pregnancy.
As the fear of HIV has subsided, she said, so has the rate of condom use.
Of the three most common STDs that health officials are required to report -- chlamydia, gonorrhea and syphilis -- CDC reports state 349 Brazos Valley teens between 15 and 19 years old tested positive in 2006, compared to 188 teens in 1998.
Health officials are quick to note that those numbers are underreported because many people don't get tested for STDs. State and local health agencies do not keep track of HPV, a virus that's harder to track because there are often no symptoms.
There were 148 pregnancies among 4,463 Brazos County girls between 13 and 17 years old in 2005, the most recent year for which such data is available, according to reports from the Department of State Health Services. That number is higher than the state average for that year.
Strong relationships and communication about sex between parents and their kids have been shown in some studies to decrease the number of sex partners and delay teen sex, Philliber said.
"But ultimately, kids are going to decide. Parents don't have a say in [when a kid decides to have sex]," she said.
Still, experts said, a misconception that the vaccine isn't necessary unless a girl has many sex partners keeps girls from getting the vaccine.
Bryan schools director of health services Patti Willems oversees the district's sexuality curriculum, which teaches an "abstinence-based" approach to safe sex.
Willems said kids are embarrassed to talk to adults about sex.
"These kids don't want to tell us they're sexually active," she said. "But it's happening younger and younger -- that's the reality."
Both College Station and Bryan schools teach about HPV and Gardasil as part of the state-required sex education course, officials said.
College Station high school health teacher Debe Shafer said the awareness among kids about HPV has increased through commercials and media coverage of Gardasil.
"Kids are more aware of HPV than they were two years ago," she said.
But Shafer said she thinks most high schoolers are still confused about HPV, and many don't understand its link to cancer.
Benefits and cost
Although Gardasil is readily available from clinics, hospitals and private doctors in the Brazos Valley, the cost and fears about pain from the injection keep women from getting it, officials said.
Planned Parenthood in Bryan sees about 7,000 unduplicated clients per year, but, Tafolla said, only 33 women have gotten Gardasil vaccines from the clinic since it was approved in summer 2006.
Although it's covered by some private insurance and by Medicaid, Gardasil is still expensive.
Merck spokeswoman Jennifer Allen said the company sells the vaccine to providers for $125.29 per dose. It takes three doses to be fully immunized.
But at the Brazos County Health Department, spokeswoman Sarah Mendez said the vaccine only costs about $12 thanks to government aid. The agency charges on a sliding fee scale.
There have also been reports of pain at the site of the injection. Pain is a personal thing, Sumaya said, but it's clear that the benefits outweigh the costs of short-term discomfort.
That's the bottom line, he said.
"It's a very safe type of vaccine and very effective," he said.
• Janet Phelps' e-mail address is janet.phelps@theeagle.com.
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