Should we cure cancer?

Human PapillomavirusSubscribe to podcasts (free):
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Way back in 1907 it was first realized that human warts were transmitted by a virus, although it was not until 1933 that Richard Shope isolated the first papillomavirus from rabbits. In spite of this early start, human papillomaviruses (HPV) remained largely unstudied until the development of molecular virology in the 1970s. This was because there were no good experimental systems for working with human papillomaviruses, since they stubbornly refused to grow in cultured cells. Since we started using DNA as an experimental tool, we have much more knowledge about how these viruses work and what serious pathogens they are.

As viruses go, papillomaviruses are pretty small, only around 55 nanometers in diameter. The particles are simple icosahedral structures containing a short, circular, DNA genome of about 8 kbp in size. Individual papillomavirus isolates are highly species specific, only replicating in their own host species. They like to grow in squamous epithelial cells, found in the skin and other epithelia. The virus infects the basal cells of the dermal layer, and causes them to continue to divide, forming a wart (or papilloma) on the surface of the skin.
Warts may occur almost anywhere in or on the body. Genital warts (sometimes called condylomas) occur in the genital tract and are sexually transmitted. Superficial warts can be treated by topical application of caustic substances or by freezing them with liquid nitrogen, but surgical removal is more reliable, and is needed for internal warts e.g. laryngeal in the throat. Once you’ve got them, warts may persist for many years, but in some cases they disappear spontaneously due to a cytoxic T-cell response. This gives rise to folk tales about wart charmers who have supernatural powers allowing them to cure people of warts. There is a small risk that skin warts exposed to ultraviolet light may develop into invasive squamous cell carcinomas, but this is very rare.
The really bad news about human papillomaviruses is that they are associated with tumours, including >95% of all cervical cancers and probably about 20% of head and neck cancers. Cervical cancer is estimated to kill 275,000 women worldwide every year, including more than 1000 in the UK.
At least 60 different types of HPV have been identified using molecular techniques, but in the last few years, a small number of types have been found to be to be associated with certain tumours, in particular cervical carcinoma. Odd as it may sound, that might turn out to be good news. Because they are quite simple viruses, and because we know that the right kind of immune response can clear people of warts, pharmaceutical companies have been working on vaccines against human papillomaviruses for some time.
Gardasil is a new vaccine made by Merck and Sanofi Pasteur. In clinical trials involving more than 25,000 women, the vaccine was 100% effective in preventing cervical cancer, pre-cancerous lesions, and genital warts caused by human papillomaviruses type 6, 11, 16 and 18. This is an amazing finding, but is explained by the fact that HPV 16 and 18 are responsible for 70% of all cervical cancers, and types 6 and 11 cause about 90% of cases of genital warts. This vaccine was approved for use in the USA in August, and in the EU in September. Other vaccines are in development by other manufactures but have not been approved for general use yet. The question now is, what should we do with it?
These new vaccines have caused controversy over plans to give it to girls as young as nine, before they become sexually active, so protecting them against disease. But in might make more sense to vaccinate both boys and girls in order to reduce the rate of infection more quickly, and in the hope of eventually eradicating HPV. An editorial in the Lancet has called for compulsory vaccination for girls in all EU member states at the age of 11 or 12 (Should HPV vaccines be mandatory for all adolescents? The Lancet 2006 368: 1212). Pretty strong stuff, but ethically speaking, if a vaccine is available which will save over a thousand lives each year in the UK alone, shouldn’t we use it? Or do parents have a right to expose their children to the risk of dying of cancer? You can comment on this issue below.


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6 Responses to Should we cure cancer?

  1. Vincent Chu says:

    Though I agree that it is good to save lives we should not ignore the possibility of such vaccines supporting the unhealthy “trend” of decline of the morality of this country by condoning, encouraging and facilitating unprotected teenage promiscuity which is also linked to various other STIs. As much as humans hate to admit it, the true nature of the problem is the “modern” culture which unshamefully promotes the lust within us. Note that I do not hate promiscuous people but only the actual evil itself which wages war against our own consciences until it eventually devours and enslaves most of us.

  2. Alexander Davenport says:

    This article poses a difficult ethical question and leads on to ask at what age are you able to have complete control over your self on health related issues. For example, if society does not deem that we are able to vote until 18 because we are not mentally mature enough and that if we are not able to get married without parents consent before 18 and not engage in a sexual relationship before 16, equally because we are not mentally mature enough, how can it be argued that we are mentally mature enough to understand the concept of the risk of pappilomavirus infection and cervical cancer. Therefore it should be the parents choice (hopefully while being discussed with the patient in question)
    To be honest i think this should be a socially mandatory vaccination (not by legislation but just something that is “done”) to help stem the risk and yes both males and females should be vaccinated. Let us not forget that we live in a society of freedom of speech and expression (to an extent) and therefore the choice should ALWAYS be given, but it should be made clear to the legal guardians that the choice of NOT havng the vaccination is frowned upon. A bit like not recieving the MMR vaccine (or equivalent) or the BCG.
    Vince, this post doesnt have a lot to do with modern society. The fact is, society is the way it is whether or not you like it so why not give people the option? actually…people SHOULD be given the option, as that is the nature of freedom of choice. I am concerned that you are of the opinion that these vaccines allow what you call:

    “the unhealthy “trend” of decline of the morality of this country by condoning, encouraging and facilitating unprotected teenage promiscuity which is also linked to various other STIs.”

    Now it may be fair to say that society has changed over the years (for example we enjoy far more politcal,social and religous freedom than ever before), but to argue against vaccinations for more Promiscuious members of society seems to be almost ludicrous and ultra Conservistism (not the party but the political/social Ideal) that we have strived to move away from. I would argue that although yes Yobbish culture is reported more in the news and seems to be a far more emotive topic, it really isnt the norm. Do you think we should go back to victorian values and ideas of covering table legs to stop males being arroused? You use the word “evil” which also conerns me somewhat because this gives the impression that there is a malicous act behind it, and unless one party has not invited such an act how can it be evil? Surely it is an act of Love, just because you do not agree does not mean it should ot happen.
    Now this is not to say i agree with “encouraging and facilitating unprotected teenage promiscuity” as you call it, but rather than calling it evil and trying to stamp it out, surely better education is the answer and failing that…protecting adolecents as best we can is a better answer?

    So to Summerise:
    Yes the vaccination should be made avalailable but it should be made mandatory it should be made socially unexceptable to NOT have it for both males and females.

  3. ajcann says:

    I agree completely that the vaccine should be used for both males and females. This is the only sensible scientific strategy. In the UK, we got ourselves into a mess once before with rubella vaccination by only vaccinating girls. It took us 10 years to figure out that we needed to vaccinate both males and females to make a real impact on rubella. Sadly, in the case of Gardasil, the decision has been made on cost grounds, even though in the long term it would be more economic to eliminate cervical and penile cancer. But how many governments indulge in that sort of long term health planning?

  4. Alexander Davenport says:

    woops sorry i meant to say in the summary that it should NOT be mandatory but it should be available for BOTH males and females

  5. It’s important to use this vaccine for cervical cancer because it can save many women from certain death.We should think also for a vaccine which can be implied on males because after all the disease is coming from them.

  6. Early Genital warts are considered very contagious since they affect the moist tissues and are spread by direct skin to skin contact with an infected person. Contraction of the genital warts mostly happens during sexual intercourse that involves, the mouth, the anus, the penis and of course the vagina. Be warned though, that a person will also re-infect themselves on other parts of their body when they don’t remember to wash off their hands after coming into contact with the warts. The best thing to do is not to keep quiet about the early signs of genital warts. As much as one would feel so embarrassed to open up to their doctor about the problem, just take a step of courage and you could be saving yourself from further damage of a precious part of your body.

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