HPV vaccine study finds zero cases of cervical cancer among women vaccinated <14 | Hacker News Reader

HPV vaccine study finds zero cases of cervical cancer among women vaccinated <14

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215 pointsellingsworth133 comments

It seems a little strange to me that the people interviewed in this article find this is so remarkable. Only 40,000 people belonged to the group that got the vaccine before 14. If the incidence rate were the same as for the unvaccinated (8.4 per 100k) you would have expected roughly 4 in the group to have gotten cancer. If the incidence rate were the same as for those vaccinated after 14 (3.2 per 100k), you would have expected only ~1 to have gotten cancer. Maybe I'm missing something here?

> Maybe I'm missing something here?

Statistical literacy is difficult to develop, statistical intuition even moreso, even among well-intentioned and very intelligent people.

That's why papers get away with making big claims that are unsupported by the data.

As demonstrated by the original comment we're all replying to (see the other replies).

The article says that all participants were eligible for screening, but it doesn't say how many were screened or tested.

Also, this cohort would be age 28-36 years currently. The lowest median age for HPV cancer diagnosis is 50. https://www.cdc.gov/cancer/hpv/statistics/age.htm

I believe that's "8.4 per 100k PER YEAR".

The paper uses the term "person-year". So, the intersection of both.

The incidence rate is per year and the study was over an average of 32 years per patient. At that rate you'd expect around 105 incidents instead of 4, although there are other considerations like age to take into account.

I recently heard a doctor mention that cervical cancer typically crops up around age 40. As a result, a study like this is a bit premature. It's not bad news, of course, but it's also not exactly good news.

Study like this are very good to push government to pay vaccination to all kids as early as possible.

In Québec they did the vaccination to all the kids at 12yo, boys and girls.

$300 per dose * 100,000:1, so about $30 million per cancer cure that has a 70% survival rate.

Up to the voters I guess.

The lifetime risk of ever getting cervical cancer is about 1%. So, $30,000 per prevention if you just count the girls, or $60k if you vaccinate the boys as well.

*Assuming the vaccine has zero risk and don't cause other problems.

0.00001% of the US population dies each year of cervical cancer.

The cost to vaccinate all americans is on the order of $100B.

The HPV vaccine also prevents throat cancer in boys.

A policy simply doing -some- good is not sufficient justification given a finite amount of resources to implement it. You need to compare policies against the alternative uses of the resources.

Neither is the fact that "lives will be saved" a sufficient justification. You need to compare that against the lives saved with the alternative policy options available with the given resources.

Reminder that HPV in men has a similar association to oral/anal cancer, and this vaccine (ideally the quadrivalent version) prevents it too [0]. HPV vaccine campaigns often emphasize vaccinating only girls, but boys should be vaccinated too.

[0] https://academic.oup.com/jnci/advance-article-abstract/doi/1...

Many European nations have started vaccination of boys too.

The incidence of these cancers is much lower than cervical cancer.

I think a more practical benefit to boys is the prevention of many strains of general warts and general herpes.

This vaccine does not prevent herpes.

Yes, you’re right, sorry.

The vaccine prevents against up to 9 HPV, including many genital wart [0] strains.

So I was wrong about herpes but my point was that it protects males against STIs and is just a handy vaccine to protect sexually active men against something they don’t want (some genital warts) and that seems like a greater motivator than reducing transmission to protect women from cervical cancer.

[0] https://en.wikipedia.org/wiki/HPV_vaccine

Males not contracting HPV stymies the transmission to unvaccinated females, if cervical cancer is the only concern for some reason.

5-year survival rate of throat cancer is 82%, 5-year survival rate of cervical cancer is 92%, and incidence of HPV-related throat cancers among men is higher than cervical cancer on it's own and rising (probably due to changes in sexual behavior) [0]. While total incidence of HPV related cancers is higher in women than in men and that's bad enough, there is not a lot of difference. It's a problem on its own.

[0] https://www.cdc.gov/hpv/parents/cancer.html

It’s the incidence that is important here. So while there’s higher survivability for cervical cancer, there are many more deaths. (At least until this vaccine)

So people are concerned with the risk of having throat cancer more than the risk of death if they get it. And this seems reasonable. As I have a very high risk of death in many improbable situations and I care more about lower risk of death in very common situations.

10k cases of throat cancer in men each year in the US [0]. Although HPV-related cancer, oropharynx, is less than that and harder for me to find a good incident rate. Almost 14k cases of cervical cancer in women each year in the US [1]

[0] https://www.cancer.org/cancer/types/laryngeal-and-hypopharyn...

[1] https://www.cancer.org/cancer/types/cervical-cancer/about/ke...

> It’s the incidence that is important here

But that's my point: the incidence of cervical cancer in women and throat cancer in men is in the same order of magnitude, but the incidence of cervical cancer is stable or even declining due to screenings and HPV vaccination, while the incidence of back of the throat cancer in men is five fold higher than throat cancer in women already. And what's more, it is rising - also five fold over the past decade - due to (unprotected) oral sex becoming more common.

Does it make sense to get a vaccine for older ppl, like 30y, does this still apply for men?

The CDC doesn't recommend it. By that age, you've probably been exposed already.

https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html

> HPV vaccination is not recommended for everyone older than age 26 years. Some adults ages 27 through 45 years who were not already vaccinated might choose to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and possible benefits of vaccination for them. HPV vaccination of adults provides less benefit, because more people in this age range have been exposed to HPV already.

> The CDC recommends against it.

The CDC does not recommend against getting vaccinated for people in their 30s. They don't issue a general recommendation for vaccinating people in their 30s.

That's an extremely important distinction.

I'll update that to "The CDC doesn't recommend it", in that case.

> I'll update that to "The CDC doesn't recommend it", in that case.

As a native speaker, even that language feels as though the CDC discourages vaccination despite the literal meaning not implying that. This is a case where it's probably best to be more verbose and explain in full details.

I don't know why the CDC themselves choose to use this language. It's confusing.

There's a reason I cited the entire paragraph, yes.

Agreed. I’d rather see “doesn’t actively recommend” or “is neutral” or something.

I don't understand why they recommend against it. I guess the monetary costs don't outweigh the benefits, but that's only if you care more about saving money than potentially preventing cancer. It's not like the vaccine going to hurt you. But the HPV vaccine is not particularly cheap, so it sounds like the insurance companies have lobbied against it or something. In my opinion men should also be vaccinated for it since they are often carriers and can be affected too.

Since nearly everyone is infected with HPV, if you've had sex with a few people you're almost certainly already infected and therefore the vaccine will be of no benefit.

I guess if you were 50 and still a virgin, and planning to change that, it might be worth it.

Or you’ve been monogamous but are now getting divorced, or whatever. Not that uncommon.

It’s actually kind of frustrating how expensive that vaccine is (>$1000) as there’s no incentive to reduce cost.

And if you’re 45, then insurance won’t cover. Even if you test negative for hpv.

Ugh, I didn’t realize that. I got in just under the wire at 44—guess I’m glad my ex left when he did?

How can you be sure there would be no benefit? When my mom was diagnosed with stage four HPV-positive cancer, they still gave her the vaccine on the off chance that it would induce an immune response.

Yes, but being infected with one strain isn't the same as being infected with all of them in terms of the risks. You are unlikely to have all the strains known to cause problems already.

-------

Additionally (something I only became aware of from knowing a person dealing with it) - there's a modest body of clinical research suggesting that vaccinating for HPV in someone who already has it and is symptomatic (warts) can significantly lessen or eliminate their symptoms.

It was recommended for the person I know on that basis by their doctor as a thing to try, and they've noticed significant improvement. Anectdata, but mentioning anyway.

These are very small studies and I won't claim that this is definitive (nor that I've put that much effort into a review of all literature), but to provide some support for my claims that this is a thing being suggested/investigated in research:

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541142/

- https://pubmed.ncbi.nlm.nih.gov/38068369/

---------

I believe that it's too early in the research for that to be factoring into the analysis going into current CDC recommendations, but it's an additional possible upside of vaccination (reducing symptoms/likelihood of symptoms, even if already infected) if the research continues to pan out.

> Since nearly everyone is infected with HPV

Not quite, though the messaging on this is muddy. The CDC simultaneously says:

> HPV is so common that nearly all sexually active men and women get the virus at some point in their lives. [1]

and

> During 2013–2014, any genital HPV prevalence among adults aged 18–59, was 42.5% in the total population, 45.2% among men and 39.9% among women; high-risk genital HPV prevalence was 22.7% in the total population, 25.1% among men and 20.4% among women. [2]

1: https://www.cdc.gov/std/hpv/stats.htm

2: https://www.cdc.gov/nchs/products/databriefs/db280.htm

It's not approved above age 45 and thus insurance isn't going to pay. But that's simply a matter of not testing. It was intended to be used before exposure and the pool of people >45 who aren't exposed and might be is pretty low.

However, there is a case where it makes sense: Someone who went into a monogamous relationship early and it has now ended. I'm not a sex-only-in-marriage type but I ended up taking my first partner down the aisle--chances are I was never exposed. I'm still with her, but all relationships end eventually.

I don’t understand either. My doctor recommended I get it despite being older, because it’s possible there are strains of HPV it protects against that I have not yet been exposed to. He also said it could theoretically help clear an existing infection faster.

> I don't understand why they recommend against it. I guess the monetary costs don't outweigh the benefits, but that's only if you care more about saving money than potentially preventing cancer. It's not like the vaccine going to hurt you.

All vaccines have a nonzero risk of adverse outcomes. That can be as simple as the risk of physical injury due to incorrect administration of the needle. That's weighed against the risk of nonvaccination.

In almost all cases, the balance is so extremely skewed that it's safe to issue general recommendations in favor of vaccination. For HPV, the issue is that there's literally zero benefit after exposure, and it's difficult/infeasible to test for exposure, but from epidemiological data we know that most people over the age of 25 have already been exposed.

> In my opinion men should also be vaccinated for it

The recommendation is for all genders, and has been for well over a decade.

Noted in my other comment, but mentioned here as well:

- Exposure to a strain is not the same as exposure to all strains. Few are likely to have been infected with all of the strains that the vaccine protects against, and infection by multiple strains is not a rare event.

- There's research being done on if the vaccine can reduce symptoms to people who already have HPV. Early results seem promising. Certainly nothing large enough for the CDC to be making recommendations on yet (that I know of/could find from a quick search), but worth noting - there may well turn out to be a significant benefit to the vaccine even after exposure, we just seem to be relatively early in that research.

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541142/

- https://pubmed.ncbi.nlm.nih.gov/38068369/

doesn’t recommend ≠ recommends against

It's a bit confusing, but often when a government agency issues a statement about something being "not recommended" it is intended to mean the government is not strongly encouraging people to do [whatever]. This is very different from the government recommending against people doing [whatever]. So here the CDC is basically saying we don't say people over 26 should definitely get an HPV vaccination, but we don't say they shouldn't either.

Talk to your doctor, be honest about your sexual history and current situation. It made sense for me to get the vaccine, but may not make sense for all, or at least not make sense enough to be approved by your insurance.

A note about current sexual situation too: This first came out when I was in college. My (female) roommate wanted to get it immediately, even though she was very open about only having been with the man she was seeing at the time.

When I asked her about it, since it seemed like her risk of contracting HPV would be very low, she mentioned she was doing it to mitigate the risks she faced as a woman who was barely 5 feet tall and didn't weigh 100 pounds soaking wet. She said she already has to keep her head on a swivel against the possibility of assault, and she'd really rather not have to worry about a virus that could cause cancer in addition to that risk.

I had the privilege of not ever having had to pay much attention to the risk that my current sexual situation might change without my consent, but it was sobering to be reminded that was something that she had a reason to have on her radar.

She could also get HPV if the man she was "seeing" at the time was seeing more people than just her (or had seen, ever).

Very true, but at least at that point, she trusted him a lot more than she trusted random other people.

Yes: https://cbuck.substack.com/p/the-freedom-to-choose-medicine-...

Also, HPV causes head and neck cancers in men and women. These are very unpleasant and not recommended: https://jakeseliger.com/2023/09/09/life-swallowing-tasting-a...

Yes, please, even if you've had HPV before, get this vaccine. The medical literature says there are benefits in almost every person, even if your insurer does not.

> In a retrospective analysis of data from two qHPV vaccine efficacy studies in young women who underwent cervical surgery or were diagnosed with genital warts or vulvar/vaginal disease related to infection present before vaccination (Figure 1), prior qHPV vaccination was associated with a significant reduction (46.2−64.9% for those who underwent cervical surgery; 35.2% for those diagnosed with infection-related disease) in any subsequent HPV-related disease, including high-grade disease.6 Other studies demonstrated that HPV vaccination before and after surgical treatment for cervical lesions reduced the risk of subsequent cervical intraepithelial neoplasia (CIN) grade 2 or higher, related to HPV16/18 (88.2% efficacy 60 days or more post-surgery),8 and the risk of recurrent CIN 2–3 post-surgery was higher in qHPV vaccine non-recipients compared with recipients (hazard ratio [HR] 2.840).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10038021/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580486/

Seems to say that for a subset of people HPV infection is latent. But current vaccines aren't useful against latent infections. Quick skimming says therapeutic vaccines are an area of research. "Numerous DNA-based vaccines have been developed to target persistent HPV infection and are currently in various stages of clinical study"

My thought is watch this space.

Yes absolutely. Even if you have already been exposed, the vaccine has been shown to prevent manifestations and/or recurrence of HPV-induced pathologies. It's not necessarily in standard of care, but the literature is pretty overwhelming here.

thanks for replies, will get one with my gf, even if we have a strain, looks like vaccine could be beneficial anyway

It's funny how people who are afraid to click a link with a unknown domain will take any vaccine they're offered. A computer can be fixed or discarded if it's damaged by software, not an option with your body.

The USA has the most aggressive vaccine schedule for children in the world. If Vaccines are so effective we should see either lower per capita health care costs and/or superior aggregate health statistics. However US pee capita health cost are substantially higher than any other country and the health indicators are poor.

If you regressed health level on vaccination it would likely come out a non-factor. The mania around Vaccines is profit driven; greedy pharma bullies and scares everyone into buying their product, because it's the only class they have that doesn't require waiting for someone to get sick.

This is one of the many reasons that "parental rights" people are dead wrong. People as young as 12 should have the absolute right to seek and get, in confidence, this vaccine and other health care. Nobody should give any weight to whether their parents want them to not have this vaccine.

> as young as 12

Why the arbitrary line at 12?

Probably because they felt the need to draw the line somewhere to prevent hypothetical five year olds from demanding a dangerous cocktail of innoculants from every pharmacy in town, and probably the sense that at 12 you've developed enough for your sense of agency to be respected.

Why does 12 sound arbitrary to you?

> Why does 12 sound arbitrary to you?

Because it is?

> they felt the need to draw the line somewhere to prevent hypothetical five year olds

> probably the sense that at 12

I think you get the point. 12 is entirely arbitrary. Some children might well be able to make sound choices like this at that age. Some definitely will not. You're advocating for a line at which parents lose their right to be parents while maintaining the rest of the responsibility for raising the child. You want to put the government in control. I think you need more than a sense before taking that step.

This is one of those ideas that sounds good mostly to people who don't have the responsibility of being parents.

Yes, I get the point that you couldn't muster an actual argument so resorted to an overly broad question that intentionally ignored context.

And I'm not advocating for anything, I just hate the insincerity that comes from people asking questions like that. Its also a little whiffy that you're trotting out the 'some kids will make good choices' bit with regards to this age range and the ability to ask a doctor for a vaccination - we normally reserve that line of reasoning where making a bad decision is attractive and an adult might also not behave responsibly.

Also point of order - what are you talking about, 'government control'? The topic at hand was literally whether 12 was an appropriate age to start respecting a persons wishes when it came to seeking a vaccination. It is troubling that you see that as government control, and troubling that you see this as 'losing your right as a parent'

> Yes, I get the point that you couldn't muster an actual argument

Don't be a dick. It was a legitimate question. And no amount of insinuations or insults on your part changes that. Your points are very weak for someone advocating for getting the gov't more deeply involved in everyone's affairs.

And if you don't think some 12 year olds are wildly incapable of making good medical choices, I don't know what to say.

I don't get it - the government is what gives you your current legal authority over your offspring, and someone suggests less of that power, and you're saying the government is getting more involved? It makes it difficult to take you seriously.

I picked 12 because that is the age of medical privacy in my state. It is consistent with the grade level at which schools teach comprehensive sexual health.

Children have rights. Parents have responsibilities.

Vaccines are a medical miracle. Never except that being an anti-vaxxer (or a "vaccine skeptic", which is the sanitized name for the same thing) as being on equal footing. Vaccines are evidence-based. Anti-vaxxers are vibes-based.

The continuing focus on cervical cancer and women’s sexual health in the context of HPV (vaccination) is my biggest pet peeve ever.

HPV causes penile, anal, mouth-throat and cervical cancer.

I‘d argue that all of those cancers are much, much worse than cervical cancer. After all, they can cause permanent disfigurement, chronic pain, inability to ever speak again and loss of the penis. Infertility? Woe is me!

Anyone who is not celibate should really get the HPV vaccines. Tell a teenager he‘s risking to lose his dick and he‘s gonna get vaccinated tomorrow.

Many, many women have died from cervical cancer.

They are offering the HPV vaccine for boy too. Hell my doctor suggested it, and I got it, a couple of years ago as a late 20s male.

10 to 20 years ago, you got a lot of pushback if you wanted this vaccine as a male, with some insinuations about gayness, or it being "too late" if you wanted it in your early 20s when you heard about this benefit. To this day I don't have it as a result.

Maybe today that has been fixed.

> Infertility? Woe is me!

Well, and a couple hundred thousand deaths annually worldwide. https://www.who.int/news-room/fact-sheets/detail/cervical-ca...

I agree it should be more broadly recognized as not being only for women but cervical cancer causes something like 340k deaths vs. the other ones being 1-2 orders of magnitude lower so it’s not surprising that attention has been focused there.

https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac...

Here in Ontario the vaccine is given by default to everyone, male or female.

When my kids were in school that was certainly not the case. It must have changed recently.

>Infertility? Woe is me!

Even if this was the only issue cervical cancer potentially caused (it’s not, you forgot death, among others), this is a really insensitive comment.

Awareness of other cancers doesn’t need to come at the cost of reducing cervical cancer awareness. Seems like a really immature thing to have a pet peeve about.

Cervical cancer kills. I don’t think you mean “it’s worse for a man to lose his penis than for a woman to die” but that’s how it’s coming across. And that’s unfortunate because your point is entirely valid: men are not nearly terrified enough of HPV.

I saw it as more along the lines of "this is why men should get it" - the context is already established that HPV should scare men and here's why...

100% of all cervical cancer patients already don't have a penis. There are about 10 times the number of deaths each year from cervical cancer as there are from penile cancer, and scooping out parts of your innards is not just infertility but is far more invasive and liable to complications than just slicing off your dangly bits. Sounds a bit like an argument from misogyny.

> Woe is me!

Do you think infertility is the only consequence of cervical cancer? Do you mock children with with leukemia saying, "Oh, you feel a little tired? Get over yourself?"

For many people treatment goes smoothly and the can get on with their lives. For some they get treatment, it comes back, they get more treatment, it comes back, and they die, and there is a range of options in between. Maybe they don't die but they can no longer have intercourse. Maybe the financial strain of many rounds of treatment puts them in life-changing debt.

Don't be so glib with the misfortune of other people.

My partner died of cervical cancer at 30 years old. I'm now raising a toddler by myself.

Is this the place where I can tell you to fuck off?

As somebody who lost a dear friend from hpv associated cervical cancer, this is such good news.

It's so crazy/impressive to me that some vaccines are actually "prefect".

Never seen vaccines employed as prefects. Well, I've hears about cat prefects in Japan, but not vaccines.

Ahh you're really missing out then they let you get away without a hallpass.

Where is your towel?

Many vaccines become 'perfect' by causing the disease they treat to die out in the local community.

It doesn't need to be perfect at the individual level to cause that - and in fact many vaccines at the individual level actually have pretty bad metrics - like for example only preventing half of cases.

You're seeing this in vivo with polio - POLIO!! - starting to make a reappearance in some of the more extremist Hassidic communes in NYC. Those groups do not get vaccines.

Polio's complicated because of the differences between the vaccines meaning that external vigilance will be needed even with 100% coverage.

This is how vaccines are expected to operate. You don't need perfection, just enough to drive the reproduction rate below 1.

However, note that this is in a population where there will no doubt be leaks. Even if everyone in the area got the jab that doesn't mean they won't have sex with people who didn't. Thus an infection rate of zero is a good showing.

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