When the U.S. introduced the human papillomavirus (HPV) vaccine in 2006, cervical cancer rates had been steadily declining for several decades, in large part due to successful and routinized cervical cancer screening.
A similar trend also was underway in Europe, including in Scandinavia. Within that region, Sweden stood out as having the lowest levels of cervical cancer.
Sweden now appears poised to lose this distinction. Sweden’s Center for Cervical Cancer Prevention reported in 2017 that the incidence of invasive cervical cancer has reversed course and is climbing in nearly all counties.
The increase was particularly steep (20%) over the two-year period from 2013 to 2015. Neither the Center, health authorities nor the media offered any explanation for the turnaround in the country’s long-established cervical cancer trends.
An independent Swedish researcher decided to take a closer look. On April 30, 2018, the researcher proposed in the Indian Journal of Medical Ethics that the HPV vaccine may be causing rather than preventing cervical cancer in some women.
This assertion directly threatens the status quo marketing of HPV vaccines as universally safe and effective.
For this reason, the author chose to publish under a pseudonym—in the belief that “the use of his real name would have invited personal repercussions from those opposed to any questioning of vaccines”—but did not inform the journal that the published name and affiliation were fictitious.
A week later, this omission became known to the journal’s editors, who were affronted and immediately published a correction.
However, the editors also took the unusual and courageous step of keeping the article on the journal’s website because “the issues raised by it are important and discussion on it is in the public interest.”
Young women and the HPV vaccine
As a first step in assessing the unexpected uptick in Sweden’s cervical cancer incidence, the anonymous researcher’s simple analytic strategy was to parse, by age group, the same national data that informed the 2017 report.
When the researcher compared cervical cancer rates in younger women (ages 20-49) to rates for older women (over age 50), he found that age made a big difference: “The increase in the incidence of cervical cancer was shown to be most prominent among women 20–49 years of age while no apparent increase was observed among women above 50” [emphasis added].
When he compared changes in invasive cervical cancer incidence in 2006 versus 2015, he again found that the increase mostly affected younger women—and especially women in their twenties. Why should this be the case, when we are told that HPV-induced cervical cancer “often takes years, even decades, to develop after a person gets HPV”?
As one answer, the Swedish researcher points out that the slow-simmer timeline does not apply to all women who get cervical cancer. In fact, rapid onset characterizes roughly 25% of cases, with “a short interval of less than 3 years from negative…screenings to finding of cancer.” This means that an increase in cervical cancer incidence could very well be discernable within the short period of time observed in Sweden:
- The country approved the Gardasil vaccine in 2006.
- By 2010, about four-fifths (80%) of 12-year-old girls were given the vaccine, and about three-fifths (59%) of 13–18-year-old girls were vaccinated through a “catch-up” program.
- By 2012-2013, “most young girls were vaccinated.”
- By 2015, the oldest girls in the “catch-up” group (ages 15-18) had reached their early twenties and thus were “well within” the 20-29-year-old cohort that displayed the greatest increase in cervical cancer incidence.
Disease enhancement and viral reactivation
The Swedish researcher offers two additional (and potentially overlapping) explanations for the surge in invasive cervical cancer in younger women.
First, he explains that seven in ten cases of cervical cancer are linked to just two “target” HPV strains (HPV 16 and 18), and the vaccine is useless—and even damaging—to individuals who have been exposed to those strains prior to vaccination.
In fact, he shows that the U.S. Food and Drug Administration (FDA) recognized this problem in its clinical review of Gardasil in 2006, which euphemistically described the “potential for disease enhancement” in Gardasil-vaccinated individuals who had been exposed to HPV 16/18 before vaccination compared to individuals with no HPV 16/18 exposure (p. 359). Gardasil vaccination in this subgroup produced “a higher level of premalignant cell changes than did placebo.”
To account for the differential subgroup effects, the researcher points to the phenomenon (well recognized in the peer-reviewed literature) of vaccine-induced viral “reactivation,” whereby a vaccine triggers a latent virus to manifest “severe reactivation symptoms.”
With over 200 known strains of the ubiquitous human papillomavirus (and over a dozen that are associated with cervical cancer), it is fully plausible that the HPV vaccine could reactivate cancer-causing HPV strains (both “target” and “non-target”) in previously HPV-infected young women. The Swedish researcher concludes:
“The increased incidence among young females, the possibility of virus reactivation after vaccination, the increase in premalignant cell changes shown by the FDA for women who were already exposed to oncogenic [tumor-inducing] HPV types and the time relationship between the start of vaccination and the increase in cervical cancer in Sweden could support [the] view” that the HPV vaccine is “caus[ing] an increase in invasive cervical cancer instead of preventing it among already infected females.”
An appalling record
From their inception, the two HPV vaccines (Merck’s Gardasil and, outside the U.S., GlaxoSmithKline’s Cervarix) have been aggressively marketed, with their potential benefits oversold and their many risks disguised, particularly through the use of inappropriate placebos. It has been left to independent researchers to critique the regulatory apparatus’s whitewashed evidence. Recent letters published in the British Medical Journal (BMJ) have brought forward some stark numbers that illustrate the vaccine’s appalling record:
- A serious adverse event rate of 1 in 15 (7%) and a death rate among the vaccinated (14 per 10,000) that far exceeds the risk of dying from cervical cancer (.23 per 10,000) (BMJ letter, May 2018).
- Reports to the World Health Organization’s global adverse drug reactions database—conservatively estimated to represent 10% of actual reactions—of over 305,000 adverse reactions where the HPV vaccine “is believed to have been the cause,” including 445 deaths (23 of which were sudden) and over 1,000 cancerous tumors (including 168 cervical cancers), among other serious reactions (BMJ letter, December 2017).
Even in countries where the burden of cervical cancer is far higher, researchers are eyeing the HPV vaccine’s dismal performance and are reaching the conclusion that “proven and cost-effective methods” of cervical cancer screening “remain the most feasible prevention strategies in low resource countries.”
One group of Indian researchers argues that from an individual perspective, “a healthy 16-year-old is at zero immediate risk of dying from cervical cancer but is faced with a small but real risk of death or serious disability from a vaccine that has yet to prevent a single case of cervical cancer.” From a programmatic perspective, they state that “there is no data in the literature to suggest that vaccination can replace cervical cancer screening. For any population coverage, cervical screening will always detect more pre-cancers and cancers than vaccination can prevent. Cost-effectiveness analyses have shown that cervical screening is more cost-effective than either vaccination alone or vaccination with screening.”
Returning to Sweden, researchers at the Uppsala Monitoring Center have described how easy it is for risks to “escape epidemiological detection.” The implications, according to this group, are that “case reports and case series can no longer be discarded simply as ‘anecdotes’ or ‘coincidence,’ and their contribution to the evidence base should not be ‘trumped’ by the findings of an epidemiological study.” The bottom line is that a corrupt vaccine approval process should not be allowed to sacrifice young women on the altar of industry profits.
Articolul originar al Word Mercury Project
May 15, 2018
HPV Vaccine’s Likely Contribution to Sweden’s Spike in Cervical Cancer
By the World Mercury Project Team
When the U.S. introduced the human papillomavirus (HPV) vaccine in 2006, cervical cancer rates had been steadily declining for several decades, in large part due to successful and routinized cervical cancer screening. A similar trend also was underway in Europe, including in Scandinavia. Within that region, Sweden stood out as having the lowest levels of cervical cancer.
Sweden now appears poised to lose this distinction. Sweden’s Center for Cervical Cancer Prevention reported in 2017 that the incidence of invasive cervical cancer has reversed course and is climbing in nearly all counties. The increase was particularly steep (20%) over the two-year period from 2013 to 2015. Neither the Center, health authorities nor the media offered any explanation for the turnaround in the country’s long-established cervical cancer trends.
An independent Swedish researcher decided to take a closer look. On April 30, 2018, the researcher proposed in the Indian Journal of Medical Ethics that the HPV vaccine may be causing rather than preventing cervical cancer in some women. This assertion directly threatens the status quo marketing of HPV vaccines as universally safe and effective. For this reason, the author chose to publish under a pseudonym—in the belief that “the use of his real name would have invited personal repercussions from those opposed to any questioning of vaccines”—but did not inform the journal that the published name and affiliation were fictitious. A week later, this omission became known to the journal’s editors, who were affronted and immediately published a correction. However, the editors also took the unusual and courageous step of keeping the article on the journal’s website because “the issues raised by it are important and discussion on it is in the public interest.”
Young women and the HPV vaccine
As a first step in assessing the unexpected uptick in Sweden’s cervical cancer incidence, the anonymous researcher’s simple analytic strategy was to parse, by age group, the same national data that informed the 2017 report. When the researcher compared cervical cancer rates in younger women (ages 20-49) to rates for older women (over age 50), he found that age made a big difference: “The increase in the incidence of cervical cancer was shown to be most prominent among women 20–49 years of age while no apparent increase was observed among women above 50” [emphasis added]. When he compared changes in invasive cervical cancer incidence in 2006 versus 2015, he again found that the increase mostly affected younger women—and especially women in their twenties. Why should this be the case, when we are told that HPV-induced cervical cancer “often takes years, even decades, to develop after a person gets HPV”?
As one answer, the Swedish researcher points out that the slow-simmer timeline does not apply to all women who get cervical cancer. In fact, rapid onset characterizes roughly 25% of cases, with “a short interval of less than 3 years from negative…screenings to finding of cancer.” This means that an increase in cervical cancer incidence could very well be discernable within the short period of time observed in Sweden:
- The country approved the Gardasil vaccine in 2006.
- By 2010, about four-fifths (80%) of 12-year-old girls were given the vaccine, and about three-fifths (59%) of 13–18-year-old girls were vaccinated through a “catch-up” program.
- By 2012-2013, “most young girls were vaccinated.”
- By 2015, the oldest girls in the “catch-up” group (ages 15-18) had reached their early twenties and thus were “well within” the 20-29-year-old cohort that displayed the greatest increase in cervical cancer incidence.
Disease enhancement and viral reactivation
The Swedish researcher offers two additional (and potentially overlapping) explanations for the surge in invasive cervical cancer in younger women. First, he explains that seven in ten cases of cervical cancer are linked to just two “target” HPV strains (HPV 16 and 18), and the vaccine is useless—and even damaging—to individuals who have been exposed to those strains prior to vaccination. In fact, he shows that the U.S. Food and Drug Administration (FDA) recognized this problem in its clinical review of Gardasil in 2006, which euphemistically described the “potential for disease enhancement” in Gardasil-vaccinated individuals who had been exposed to HPV 16/18 before vaccination compared to individuals with no HPV 16/18 exposure (p. 359). Gardasil vaccination in this subgroup produced “a higher level of premalignant cell changes than did placebo.”
To account for the differential subgroup effects, the researcher points to the phenomenon (well recognized in the peer-reviewed literature) of vaccine-induced viral “reactivation,” whereby a vaccine triggers a latent virus to manifest “severe reactivation symptoms.” With over 200 known strains of the ubiquitous human papillomavirus (and over a dozen that are associated with cervical cancer), it is fully plausible that the HPV vaccine could reactivate cancer-causing HPV strains (both “target” and “non-target”) in previously HPV-infected young women. The Swedish researcher concludes:
“The increased incidence among young females, the possibility of virus reactivation after vaccination, the increase in premalignant cell changes shown by the FDA for women who were already exposed to oncogenic [tumor-inducing] HPV types and the time relationship between the start of vaccination and the increase in cervical cancer in Sweden could support [the] view” that the HPV vaccine is “caus[ing] an increase in invasive cervical cancer instead of preventing it among already infected females.”
An appalling record
From their inception, the two HPV vaccines (Merck’s Gardasil and, outside the U.S., GlaxoSmithKline’s Cervarix) have been aggressively marketed, with their potential benefits oversold and their many risks disguised, particularly through the use of inappropriate placebos. It has been left to independent researchers to critique the regulatory apparatus’s whitewashed evidence. Recent letters published in the British Medical Journal (BMJ) have brought forward some stark numbers that illustrate the vaccine’s appalling record:
- A serious adverse event rate of 1 in 15 (7%) and a death rate among the vaccinated (14 per 10,000) that far exceeds the risk of dying from cervical cancer (.23 per 10,000) (BMJ letter, May 2018).
- Reports to the World Health Organization’s global adverse drug reactions database—conservatively estimated to represent 10% of actual reactions—of over 305,000 adverse reactions where the HPV vaccine “is believed to have been the cause,” including 445 deaths (23 of which were sudden) and over 1,000 cancerous tumors (including 168 cervical cancers), among other serious reactions (BMJ letter, December 2017).
Even in countries where the burden of cervical cancer is far higher, researchers are eyeing the HPV vaccine’s dismal performance and are reaching the conclusion that “proven and cost effective methods” of cervical cancer screening “remain the most feasible prevention strategies in low resource countries.”
One group of Indian researchers argues that from an individual perspective, “a healthy 16-year-old is at zero immediate risk of dying from cervical cancer but is faced with a small but real risk of death or serious disability from a vaccine that has yet to prevent a single case of cervical cancer.” From a programmatic perspective, they state that “there is no data in the literature to suggest that vaccination can replace cervical cancer screening. For any population coverage, cervical screening will always detect more pre-cancers and cancers than vaccination can prevent. Cost-effectiveness analyses have shown that cervical screening is more cost-effective than either vaccination alone or vaccination with screening.”
Returning to Sweden, researchers at the Uppsala Monitoring Center have described how easy it is for risks to “escape epidemiological detection.” The implications, according to this group, are that “case reports and case series can no longer be discarded simply as ‘anecdotes’ or ‘coincidence,’ and their contribution to the evidence base should not be ‘trumped’ by the findings of an epidemiological study.” The bottom line is that a corrupt vaccine approval process should not be allowed to sacrifice young women on the altar of industry profits.
Increased incidence of cervical cancer in Sweden: Possible link with HPV vaccination
Lars Andersson
Published online: April 30, 2018
Abstract
The Centre for Cervical Cancer Prevention in Sweden has noted in its annual report a substantial increase in the incidence of invasive cervical cancer, especially during the two years 2014 and 2015. I have sub-grouped the data according to age, using the same statistical database of the National Board of Health and Welfare as used by the authors of the above-mentioned report. The increase in the incidence of cervical cancer was shown to be most prominent among women 20–49 years of age while no apparent increase was observed among women above 50. The FDA has noted in the clinical trials referred to it for marketing approval that women exposed to the human papilloma virus (HPV) prior to vaccination had an increase in premalignant cell changes compared with placebo controls. I discuss the possibility that HPV vaccination could play a role in the increase in the incidence of cervical cancer by causing instead of preventing cervical cancer disease in women previously exposed to HPV. A time relationship exists between the start of vaccination and the increase in the incidence of cervical cancer. The HPV vaccines were approved in 2006 and 2007, respectively and most young girls started to be vaccinated during 2012–2013.
Introduction
The Centre for Cervical Cancer Prevention (NKCx) in Sweden has noted in its annual report of 2017 (1), which includes data up to 2016, a substantial increase in the incidence of invasive cervical cancer, especially during the years 2014 and 2015. An English translation of the increase in the incidence of cervical cancer is given in Table 1 (1: p 45).
| Table 1: Age-standardised (according to the standard Swedish population in 2000) incidence of invasive cervical cancer (per 100,000 women) | |||||
| County | 2006 – 2009 | 2010 – 2013 | 2014 – 2015 | Average change 2005 – 2015 expressed as percentage | p value for trend |
| Sweden, total | 9.71 | 9.56 | 11.49 | 1.7 | 0.03 |
| Stockholm | 11.59 | 9.87 | 10.59 | -0.8 | 0.51 |
| Uppsala | 11.16 | 14.17 | 16.02 | 3.8 | 0.20 |
| Södermanland | 8.45 | 12.43 | 10.57 | 2.3 | 0.40 |
| Östergötland | 8.87 | 14.47 | 15.04 | 7.3 | <0.05 |
| Jönköping | 5.33 | 8.38 | 11.17 | 6.4 | 0.04 |
| Kronoberg | 8.99 | 6.14 | 13.15 | 1.1 | 0.78 |
| Kalmar | 12.78 | 7.39 | 11.83 | -2.4 | 0.50 |
| Gotland | 8.00 | 6.47 | 14.18 | 6.5 | 0.32 |
| Blekinge | 13.47 | 14.16 | 17.00 | 8.2 | <0.05 |
| Skåne | 9.50 | 9.21 | 9.48 | -1.6 | 0.22 |
| Halland | 8.84 | 10.78 | 11.47 | 7.4 | 0.04 |
| Västra Götaland | 8.96 | 7.98 | 11.04 | 1.4 | 0.55 |
| Värmland | 6.81 | 9.23 | 13.61 | 8.1 | <0.01 |
| Örebro | 8.22 | 9.51 | 12.29 | 8.3 | <0.05 |
| Västmanland | 9.19 | 10.60 | 11.31 | 4.1 | 0.07 |
| Dalarna | 8.08 | 8.70 | 13.93 | 7.8 | 0.01 |
| Gävleborg | 11.68 | 11.04 | 14.28 | 1.9 | 0.24 |
| Västernorrland | 7.61 | 5.57 | 11.59 | -1.9 | 0.66 |
| Jämtland | 9.74 | 9.80 | 9.85 | 0.0 | 0.99 |
| Västerbotten | 7.39 | 9.36 | 8.94 | 4.0 | 0.06 |
| Norrbotten | 13.60 | 8.34 | 14.24 | -0.6 | 0.86 |
The report states (translation):
“The age-standardised incidence of invasive cervical cancer in Sweden has increased substantially in the last two years (20%) and there is a statistically significant increase for the entire period 2005–2015. The incidence in Sweden for 2014–2015 is 11.5 per 100,000 women. The increase in the last two years can be seen in all counties except Södermanland, Skåne, Jämtland and Västerbotten. Substantial and statistically significant increases are seen for Östergötland, Jönköping, Blekinge, Halland, Värmland, Örebro and Dalarna, with an average yearly increase of 7%–8%. Tendencies of substantial increases are also seen for Uppsala, Gotland, Västmanland and Västerbotten with yearly average increases of 4% or more.”
The above information was gathered from the statistical database managed by the National Board of Health and Welfare in Sweden. The author of the report suggested that it is important to track the causes of the increase in the incidence of cervical cancer. However, no explanations were given for the increase in the incidence of cervical cancer by the NKCx in its 2017 annual report (1).
For analysis, I have sub-grouped the data according to age, using the statistical database of the National Board of Health and Welfare (the same database used in reference [1]). In addition, the relevant literature was surveyed to put the current data in perspective.
Results
The increase in the incidence of cervical cancer was shown to be most prominent among women 20–49 years of age while no apparent increase was observed among women above 50 (Figure 1). The number of cases in the 20–49-year group increased from 202 cases in 2006 to 317 cases in 2015 (an increase of 50%). In 2015, there were 1.9 million women in Sweden between 20–49 years of age according to Statistics Sweden (2). The incidence of cervical cancer is therefore 0.17% for women in the 20–49-year group (317 cases per 1.9 million women). Figure 2 shows the relative change between 2006 and 2015 for each 10-year age group cohort, which illustrates the more pronounced increase in the incidence of cancer among the younger age groups.
Fig. 2: The relative change in percentage of invasive cervical cancer incidence in Sweden between 2006 and 2015 in different age groups. The figure is based on data from the statistical database of the National Board of Health and Welfare in Sweden. The incidence of cancer is age-adjusted according to the standard Swedish population in 2000.
Discussion
I discuss below some possible explanations for the increase in the incidence of cervical cancer among young women in Sweden.
A change in the routine or other technical or methodological changes during the study period may affect the reported incidence of cervical cancer due to changes in the sensitivity of the diagnostic tools. The reported change in the incidence among younger women and the fact that the increase was noted in most counties in Sweden argue against this explanation. Neither was such an explanation given by the NKCx in its annual report of 2017, with data up to 2016 (1). Recently, when the Swedish media discussed the increase in the incidence of cervical cancer, the health authorities were unable to explain the increase.
Another possibility is that HPV vaccination could play a role in the increase in the incidence of cervical cancer. About 25% of cervical cancers have a rapid onset of about 3 years including progression from normal cells to cancer (3, 4). Therefore, an increase may be seen within a short period of time. Gardasil was approved in Sweden in 2006. In 2010, the vaccination of a substantial number of girls started. In 2010, about 80% of the 12-year-old girls were vaccinated. Combined with 59% of the 13–18-year-old girls vaccinated through the catch-up programme in the same period, one can say that most girls were vaccinated. Thus, the oldest girls in the programme were 23 years old in 2015; and this is well within the younger age group shown in Fig. 1. For the older age group represented in Fig. 1, data on exposure to vaccinations is not available. In 2012–2013, most young girls were vaccinated.
The vaccine does not need to initiate the cancer process. There is a possibility of the vaccine acting as a facilitator in an ongoing cancer process. I discuss below some possible mechanisms of how the vaccine might influence the incidence of cervical cancer.
The efficacy of HPV-vaccines has been evaluated by studying premalignant cell changes in the cervix called CIN2/3 and cervical adenocarcinoma in situ or worse (5). The efficacy was calculated for individuals who have not been exposed to HPV 16 and 18. These individuals are called naïve. The vaccine is efficacious only in individuals not previously exposed to HPV 16 and 18 (naïve individuals). If an individual has already been exposed to HPV 16 and 18, no new antibodies are made. Therefore, the vaccine will not work for non-naïve individuals. HPV 16 and 18 are responsible for about 70% of all cervical cancers (5). It is therefore crucial to give the vaccine to naïve individuals. During their review of Gardasil by the FDA, the efficacy of the vaccine was also evaluated on individuals who were exposed to the oncogenic HPV strains before vaccination since individuals who are non-naïve will also receive the vaccination. A concern was raised for disease enhancement (increase in CIN 2/3, cervical adenocarcinoma in situ or worse) in this subgroup (5). In these individuals, the efficacy was -25.8% (95% CI: -76.4, 10.1%) (5). Thus, vaccination with Gardasil of non-naïve individuals who had HPV 16/18 oncogenes before vaccination showed a higher level of premalignant cell changes than did placebo. The FDA statisticians could not draw any firm conclusions. In their analysis, the FDA included only cases with HPV 16/18. If cases with oncogenes other than HPV 16/18 had been included in the analysis, the efficacy of data could have been even more unfavourable.
The increase in premalignant cell changes in non-naïve individuals, as suggested by the FDA, is consistent with the knowledge that vaccination can cause reactivation of both target and non-target viruses (6, 7, 8, 9, 10, 11, 12). For Gardasil, the HPV types 16 and 18 are called target HPVs since the vaccine contains antigens for these two HPV types. Other HPV types for which the vaccine does not contain any antigens are called non-target HPVs. For individuals exposed to Gardasil, evidence of a selective and significant reactivation of the oncogenic non-target HPV types 52 and 56 was reported in the genital tract for all women (13). This article studied women 13–22 and 23–40 years of age from 2008 to 2013. The target HPVs 16 and 18 decreased only in the younger age group but oncogenic non-target HPVs increased in both the groups, 20%–40% and 8%–30%, respectively. The increase in the total burden of non-target oncogenic HPVs for vaccinated individuals may be consistent with the findings in the FDA report where the efficacy of the HPV vaccine was less favourable for non-naïve women compared with those on placebo. A possible mechanism to explain the increased incidence of cervical cancer may therefore be virus reactivation as described above.
In the evaluation of Gardasil by the FDA, it was found that about 25% of all individuals were non-naïve in the pivotal trial (5). There are more than 200 types of HPVs, of which 12 are currently classified as high-risk cancer types (14). HPV may be found in non-sexually active girls (15). It may be transmitted through non-sexual means, either by way of mother to child, from contact with infected items, from self-inoculation or hospital-acquired infection (16), or via blood (17, 18). The virus can lie latent in any tissue and escape detection by standard techniques (19). It can also be redistributed systemically during the lytic cycle into previous virus-free tissues (auto-inoculation), for example infecting an earlier virus-free cervix.
Recently, it was shown that previously HPV-positive women with normal cytology remained at increased risk of pre-neoplasia (CIN3) despite two follow-up HPV-negative tests (20). “Proving that HPV is absolutely gone is, of course, impossible,” state Brown and Weaver in an editorial in 2013 (21). Therefore, non-naïve-individuals can be seen among females at all ages. Sometimes these individuals have measurable HPV and sometimes not. When taking these results into account, the proportion of non-naïve individuals may be underestimated in the studies.
Since the vaccine is recommended for up to 45 years in the European Economic Area, it is possible that the vaccination has facilitated the development of new or existing cervical cancer among women who were non-naïve at the time of vaccination. Vaccination against HPV has started in Sweden during the study period. Gardasil, the vaccine mostly used in Sweden, was approved in September 2006. There are no statistics for the overall use of Gardasil in Sweden. For young girls (12–13 years of age) there are special programmes for vaccination. About 75%–80% of all girls are vaccinated in this age group (22). For older girls there are catch-up programmes. For older girls/women who will be vaccinated on-demand, data on frequency of vaccination are missing. The increase in the incidence of cervical cancer between 2006 and 2015 was 50% (corresponding to 115 absolute cases). Therefore, the vaccination coverage of the Swedish population does not need to be very high to explain a role for the vaccine. The findings could be consistent with on-demand vaccination of women above 18. In Sweden there were 702,946 cervical cell screenings performed on women aged 23–60 years in 2016 (1).
Could the HPV vaccination cause an increase in invasive cervical cancer instead of preventing it among already infected females and thereby explain the increase in the incidence of cancer reported by the NKCx in Sweden? The increased incidence among young females, the possibility of virus reactivation after vaccination, the increase in premalignant cell changes shown by the FDA for women who were already exposed to oncogenic HPV types and the time relationship between the start of vaccination and the increase in cervical cancer in Sweden could support this view. The answer to this question is vital for correctly estimating the benefit-risk of this vaccine. More studies focused on already HPV-infected individuals are needed to solve this question.
Conflict of interest: None declared.
References
- Nationellt Kvalitetsregister for Cervixcancerprevention (NKCx), Center for Cervixcancerprevention [cited 2018 Mar 22]. Available from: http://nkcx.se/ templates /_rsrapport_2017.pdf [Swedish]
- Statistics Sweden [cited 2018 Mar 22]. Available from: http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/ START__BE__BE0101__BE0101A/ BefolkningR1860/ ?rxid=f45f90b6-7345-4877-ba25-9b43e6c6e299
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- FDA Gardasil Clinical Review 2006 [cited 2018 Mar 22]. Available from: http://www.impfkritik.de /download/ gardasil_fda_464_pages.pdf (pp. 359-360)
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- Bodaghi S, Wood LV, Roby G, Ryder C, Steinberg SM, Zheng ZM. Could human papillomaviruses be spread through blood? J Clin Microbiol. 2005;43(11):5428-34.
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- Freitas AC, Mariz FC, Silva MA, Jesus AL. Human papillomavirus vertical transmission: review of current data. Clin Infect Dis. 2013 May;56(10):1451-6. doi: 10.1093/cid/cit066. Epub 2013 Feb 7.
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About the Authors
Lars Andersson
Medical Scientist
Under the current circumstances where publication of any information critical of vaccines can have serious personal repercussions, the author has chosen to publish under this pseudonym.
Manuscript Editor: Sandhya Srinivasan
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