Pap smear PSA

[justginger]

Specifically for the Australians, but I imagine these new proposed guidelines could/would/will be raised/implemented in the States as well (it's all about saving money, so the insurance companies there will be gung-ho). I really want everyone to understand that having fewer Paps is not the awesome treat that the media is currently making it out to be.

A very serious public service announcement for my female Australiano friends and relatives: the newest recommendations being put forth to the Australian government regarding the guidelines for Pap smear screenings are of great concern. At this point, the official recommendation being made is to move to screening every 5 years, and by HPV testing alone. Only if the HPV test comes back positive will you then be sent for a Pap/colposcopy (depending on the strain of HPV detected). HPV does have a very strong correlation to gynecological squamous cell carcinoma and adenocarcinoma -- but the correlation is not 100%. Around 20% of all gynecological cancers are not caused by HPV. That means 1 in 5 individuals who will develop cancer will NOT test positive for HPV, and will NOT be properly screened until symptoms (such as post-coital or intermenstral bleeding) develop. At that point, it is an advanced disease - treatment is intense, and not as likely to result in a favourable outcome.

TL;DR -- please, please, please continue to ELECTIVELY have your Paps done every 2 years, regardless of the fact that it will likely not be covered by Medicare. The cost is incidental and there is a very real chance it could save your life. Please share this information with your friends and family members.

 

[movie zombie]

actually, I do not believe every 2 years is adequate.
I personally believe that every year is necessary.

many decades ago a gyn made me promise him I'd have it done every year.
why?
his very own daughter who had never had a negative test result was diagnosed with cervical cancer 6 months after her last pap smear.

think about it.

 

[missy]

Ginger, thanks so much for this info. I remember last year I got into a disagreement with my gyn because at that time the US guidelines were to have a pap smear only every 3 years and I wanted one every year because an acquaintance of mine who had been having yearly pap smears developed late stage cervical cancer. My gyn said that was not necessary and that I must have gotten my facts wrong about the person who had late stage cervical cancer.

Now maybe I am being overcautious but I have found the medical community (of which I am a part) sorely lacking in real facts and as you said they/insurance companies specifically do what they can to reduce costs. That is fine when one is just looking at statistics but we are not statistics but individuals. And if you are the one that receives early diagnose and successful treatment because of that well that is worth any amount of money.

It also amazes me how many doctors get their drug facts from the pharmaceutical companies as their main source. Talk about conflicts. Sorry about that tangent but this frustrates me as well.

Anyway I fully anticipate a fight with my gyn this year as well (and I am in no mood for doctors as of late so she better not get my ire up) and my appointment is coming up in less than 3 weeks so we shall see. I appreciate you posting this now and I hope all women listen to their instincts and advocate for themselves and their health.

ETA: Movie Zombie we cross posted. I totally agree and yes I know I did not get my facts wrong about the friend who got late stage cervical cancer despite her yearly pap smears. Thanks for posting your story. I will be using it if I need to at my gyn appt!

 

[justginger]

actually, I do not believe every 2 years is adequate.
I personally believe that every year is necessary.

many decades ago a gyn made me promise him I'd have it done every year.
why?
his very own daughter who had never had a negative test result was diagnosed with cervical cancer 6 months after her last pap smear.

think about it.

Based on the research I have done, statistically speaking every 2 years is sufficient, if your screening is being done PROPERLY. Australia has lower cx ca rates than the States did when the recommendation there was yearly - partially due to the fact that the screens here are completely free, and partially because the screening procedures there were abysmal. Labs were simply expecting their cytologists to screen far too many slides in far too little time - hence missed diagnoses.

The average length of time it takes for a pre-malignant adenocarcinoma (AIS) to develop into invasive adenocarcinoma is 13 years - unfortunately not even Paps are designed to screen for these cells, as their presence is lesser than that of squamous epithelial cells (which ARE being sought out in Paps as squamous cell carcinoma) and they have a multitude of diagnostic pitfalls. Getting Paps regularly greatly increases the likelihood of incidental diagnosis of adenocarcinoma when looking for SCC. However, there is always a chance of causing unnecessary damage and irritation at the delicate transformation zone by taking Paps too often.

 

[justginger]

Ginger, thanks so much for this info. I remember last year I got into a disagreement with my gyn because at that time the US guidelines were to have a pap smear only every 3 years and I wanted one every year because an acquaintance of mine who had been having yearly pap smears developed late stage cervical cancer. My gyn said that was not necessary and that I must have gotten my facts wrong about the person who had late stage cervical cancer.

Now maybe I am being overcautious but I have found the medical community (of which I am a part) sorely lacking in real facts and as you said they/insurance companies specifically do what they can to reduce costs. That is fine when one is just looking at statistics but we are not statistics but individuals. And if you are the one that receives early diagnose and successful treatment because of that well that is worth any amount of money.

It also amazes me how many doctors get their drug facts from the pharmaceutical companies as their main source. Talk about conflicts. Sorry about that tangent but this frustrates me as well.

Anyway I fully anticipate a fight with my gyn this year as well (and I am in no mood for doctors as of late so she better not get my ire up) and my appointment is coming up in less than 3 weeks so we shall see. I appreciate you posting this now and I hope all women listen to their instincts and advocate for themselves and their health.

ETA: Movie Zombie we cross posted. I totally agree and yes I know I did not get my facts wrong about the friend who got late stage cervical cancer despite her yearly pap smears. Thanks for posting your story. I will be using it if I need to at my gyn appt!

Part of the problem with cervical cancer is what I mentioned in my post to MZ - it is not one kind of cancer. There are two broad classifications (which then have many sub-classifications based on a range of characteristics), that of squamous cells and that of glandular cells. Paps are designed to detect squamous cell cancer and they do it very well. Glandular adenocarcinoma? Not so much. These are the kinds of cancer people are diagnosed with after a lifetime of negative smears. The only thing that can be done to reduce the likelihood of a missed AC diagnosis is to request a liquid-based Pap preparation (ThinPrep or SurePath). These result in less cellular insufficiency and have a significantly increased detection rate of adenocarcinoma.

 

[movie zombie]

no matter where one resides each woman needs to make her own decision as to when and how often she wants a PAP.
it is one thing to talk statistics and another to become a statistic.
personally, I preferred not to be on the losing end of that one.

 

[ruby59]

I am in the US and my GYN instituted the every 2 years policy last year. I hope they do not start doing it with mammograms as well.

 

[amc80]

I will continue with them annually. My OBGYN still recommends it. I wish mammograms were done starting earlier, as well.

 

[smitcompton]

Hi Ginger et al:

Could you please clarify what effect the HPV vaccine has on all this. Should , as an example, Missy get the vaccine as she is in her 40's. I had squamous cell cervical cancer that spread to both lungs, which of course required surgeries and chemo. It was diagnosed stage 2A. The Drs did say they thought it was the HPV virus, and admittedly I had a number of different sex partners which as you know the virus is passed along.

So do you think the vaccine protects more now and thus is one of the reasons for the extended time between paps. I would hope this is the case.



Annette

 

[movie zombie]

I do not believe the vaccine has anything to do with this. from the CDC: http://www.cdc.gov/cancer/cervical/basic_info/screening.htm

the PAP is separate from the HVP testing.......and your dr may recommend waiting 3 years between PAP smears if it is "normal".

additionally, I don't think the vaccine has been used long enough or with an adult population to have effected the statistics that the new "recommendation" is based upon.

personally? I think 3 years is way too long.

the issue here is now that the US has come out with this "recommendation" of 3 years, many insurance companies are refusing to pay for it.

oddly, my insurance will pay for the test itself [lab work] but not for the office visit where the sample was taken in the first place....

yes, cost cutting efficiency trumps health.

 

[ame]

I have HAD a gynecological cancer related to HPV, and I get Paps every 3 months to make sure it's not coming back. There's no damn way I would elect to less than once a year even if I was sure I was fine and I know my Dr office wouldn't either, for me or anyone else.

 

[amc80]

To anyone in the know- now that the official recommendation is every 3 years, does that mean insurance will only cover it that often?

 

[missy]

To anyone in the know- now that the official recommendation is every 3 years, does that mean insurance will only cover it that often?

I think it depends on your insurance. Last year they paid for my annual pap smear though the gyn said it was not necessary to get every year and the official rec was for every 3 years I believe. However, now that healthcare is changing (in the US at least) I think insurance companies will cover less because they need to cut costs even mores now and you might be forced to pay for pap smears if you want them more frequently than the official recommendation.

 

[movie zombie]

amc, not all insurance companies are the same: call yours to find out.

like I said earlier, my insurance will not cover the office visit for the sample collection but will cover the lab work to process it.

sigh.

 

[amc80]

Okay, I decided to not be lazy and take 5 minutes to look it up. They are covered as preventative medicine every three years. I can get them annually, but then they are subject to my deductible/copay. That works for me.

 

[TooPatient]

I discussed this with my dr a year or so ago. She said the insurance company wants them to do every three years if track record of normal but that she was skeptical and would be looking into the facts further. She has decided that she will continue doing yearly paps for all of het patients as she feels it best to check often and catch early. There was more to her reasoning, but I don't remember the specific rates and stuff she mentioned.

Thankfully our insurance covers the full exam and all tests. I think I would do at least once every two years even if I had to pay out of pocket.


It is sad that so many decisions come down to cost cutting...

 

[movie zombie]

and a clarification for justginger: this was implemented last year in the US or the year before......

 

[Asscherhalo_lover]

My Dr. still requests that I come in for annual PAPS and will not renew my BC unless I get one. As far as I know for the vaccine it is most effective if you have it done before the age of 26. I personally had the full series at around 25.

 

[justginger]

and a clarification for justginger: this was implemented last year in the US or the year before......

It sounds as if what I am referring to has not been implemented at all - if Paps every three years is the current recommendation, as I am understanding from previous posts. What is being put forth here is every 5 year a molecular test for HPV is done. Only if that is positive, would you receive a Pap. So NO Paps would be used for general screening purposes.

I agree one should decide for themselves how often to be screened. But over-screening IS a possibility. The squamocolumnar junction is delicate. You can get those cells stirred up, angry, and cause reactive changes that may mimic actual abnormality, leading to emotional stress, plus the financial and physical drama of getting a colposcopy and biopsy. I think a more on-point concern in the States appears to be the overloading of cytologists. There is little help in doing the right thing, having regular Paps, and then not having them screened properly. Again, done properly, screening every 2 years is statistically (yes, I operate on population statistics, I am a scientist) producing BETTER screening results and lower cervical cancer rates than yearly.

 

[momhappy]

Here is a chart I found (from 2012) on guidelines:
http://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf

 

[justginger]

Hi Ginger et al:

Could you please clarify what effect the HPV vaccine has on all this. Should , as an example, Missy get the vaccine as she is in her 40's. I had squamous cell cervical cancer that spread to both lungs, which of course required surgeries and chemo. It was diagnosed stage 2A. The Drs did say they thought it was the HPV virus, and admittedly I had a number of different sex partners which as you know the virus is passed along.

So do you think the vaccine protects more now and thus is one of the reasons for the extended time between paps. I would hope this is the case.



Annette

Yes, the benefits of Gardasil are definitely being very seriously backed by the proposal here (with the basis of it the result of Ian Frazer's effort, it is strongly supported within Australia). ~85-90% of SCC and ~75-80% of adenocarcinomas are directly linked to HPV infection, an extremely strong correlation (causation, really). However large those numbers are, that still leaves 10-15% of SCC patients without HPV, and 20-25% of AC patients without HPV. Cancer arises from the accumulation of numerous genetic errors, which can be caused by any number of elements. It is definitely the case that if you eliminate HPV infections from the greater population, you will see a decrease of cervical cancer. The issue with backing Gardasil so heavily is the fact that it only provides protection (if you seroconvert it properly) against HPV strains 6, 11, 16, and 18 (16 being the prime culprit of SCC and 18 the prime culprit of AC). That leaves nearly 150 strains NOT protected against, of which ~40 can infect the genital tract, and of which 11 are known to be associated with cervical cancer. They account for ~30% of Cx Ca, with 16/18 linked to the 70% majority.

For a normal 40 year old woman, there's no reason NOT to get Gardasil. You cannot guarantee the fidelity of a partner, and it does protect you from the 2 strains most likely to cause warts and the 2 strains most likely to cause cancer. If used in addition to Paps, cervical cancer rates would bottom out. Sadly, we appear to be ok with 'low-ish' rates and are happy to put all of our eggs in the Gardasil basket.

I do know researchers here are working on adding some of the other HPV strains to a new vax - 35 and 41, I think. Again, beneficial. Again, 20% of cervical cancers arise independently of HPV infection.

 

[justginger]

Here is a chart I found (from 2012) on guidelines:
http://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf

So current recommendation is simultaneous Pap and HPV testing every 3 years (well, the HPV test is only FDA-approved in women >30yo). If this were every 2 years, I'd be supportive. It beats the hell out of every 5 years, HPV-only, Paps if HPV-positive. I'm hoping against hope that someone with some sense sorts this out before it is government approved.

 

[manderz]

Hi Ginger et al:

Could you please clarify what effect the HPV vaccine has on all this. Should , as an example, Missy get the vaccine as she is in her 40's. I had squamous cell cervical cancer that spread to both lungs, which of course required surgeries and chemo. It was diagnosed stage 2A. The Drs did say they thought it was the HPV virus, and admittedly I had a number of different sex partners which as you know the virus is passed along.

So do you think the vaccine protects more now and thus is one of the reasons for the extended time between paps. I would hope this is the case.



Annette

Yes, the benefits of Gardasil are definitely being very seriously backed by the proposal here (with the basis of it the result of Ian Frazer's effort, it is strongly supported within Australia). ~85-90% of SCC and ~75-80% of adenocarcinomas are directly linked to HPV infection, an extremely strong correlation (causation, really). However large those numbers are, that still leaves 10-15% of SCC patients without HPV, and 20-25% of AC patients without HPV. Cancer arises from the accumulation of numerous genetic errors, which can be caused by any number of elements. It is definitely the case that if you eliminate HPV infections from the greater population, you will see a decrease of cervical cancer. The issue with backing Gardasil so heavily is the fact that it only provides protection (if you seroconvert it properly) against HPV strains 6, 11, 16, and 18 (16 being the prime culprit of SCC and 18 the prime culprit of AC). That leaves nearly 150 strains NOT protected against, of which ~40 can infect the genital tract, and of which 11 are known to be associated with cervical cancer. They account for ~30% of Cx Ca, with 16/18 linked to the 70% majority.

For a normal 40 year old woman, there's no reason NOT to get Gardasil. You cannot guarantee the fidelity of a partner, and it does protect you from the 2 strains most likely to cause warts and the 2 strains most likely to cause cancer. If used in addition to Paps, cervical cancer rates would bottom out. Sadly, we appear to be ok with 'low-ish' rates and are happy to put all of our eggs in the Gardasil basket.

I do know researchers here are working on adding some of the other HPV strains to a new vax - 35 and 41, I think. Again, beneficial. Again, 20% of cervical cancers arise independently of HPV infection.

I was under the impression that Gardasil was only being given to women 26 or under. Per their website, as listed below.

http://www.gardasil.com/are-you-18-to-26/considering-gardasil/

 

[justginger]

Hi Ginger et al:

Could you please clarify what effect the HPV vaccine has on all this. Should , as an example, Missy get the vaccine as she is in her 40's. I had squamous cell cervical cancer that spread to both lungs, which of course required surgeries and chemo. It was diagnosed stage 2A. The Drs did say they thought it was the HPV virus, and admittedly I had a number of different sex partners which as you know the virus is passed along.

So do you think the vaccine protects more now and thus is one of the reasons for the extended time between paps. I would hope this is the case.



Annette

Yes, the benefits of Gardasil are definitely being very seriously backed by the proposal here (with the basis of it the result of Ian Frazer's effort, it is strongly supported within Australia). ~85-90% of SCC and ~75-80% of adenocarcinomas are directly linked to HPV infection, an extremely strong correlation (causation, really). However large those numbers are, that still leaves 10-15% of SCC patients without HPV, and 20-25% of AC patients without HPV. Cancer arises from the accumulation of numerous genetic errors, which can be caused by any number of elements. It is definitely the case that if you eliminate HPV infections from the greater population, you will see a decrease of cervical cancer. The issue with backing Gardasil so heavily is the fact that it only provides protection (if you seroconvert it properly) against HPV strains 6, 11, 16, and 18 (16 being the prime culprit of SCC and 18 the prime culprit of AC). That leaves nearly 150 strains NOT protected against, of which ~40 can infect the genital tract, and of which 11 are known to be associated with cervical cancer. They account for ~30% of Cx Ca, with 16/18 linked to the 70% majority.

For a normal 40 year old woman, there's no reason NOT to get Gardasil. You cannot guarantee the fidelity of a partner, and it does protect you from the 2 strains most likely to cause warts and the 2 strains most likely to cause cancer. If used in addition to Paps, cervical cancer rates would bottom out. Sadly, we appear to be ok with 'low-ish' rates and are happy to put all of our eggs in the Gardasil basket.

I do know researchers here are working on adding some of the other HPV strains to a new vax - 35 and 41, I think. Again, beneficial. Again, 20% of cervical cancers arise independently of HPV infection.

I was under the impression that Gardasil was only being given to women 26 or under. Per their website, as listed below.

http://www.gardasil.com/are-you-18-to-26/considering-gardasil/

Cross-country information. The TGA here has approved Gardasil use in women 9-45, and MEN only up to 26 (here is the Gardasil info sheet: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-CMI-05715-3). Perhaps in the States it is 26 for everyone.

 

[chemgirl]

Ontario is every 3 years if previous tests were clear.

It makes me a bit nervous to be honest.

 

[mjr1]

I am living proof every year is important. In December 2011 I saw my gyn. Eleven years earlier I had a lumpectomy that was not malignant. I was in my 30's. I have been meticulous about my yearly exams. Every single year, all was good. Normal pap, negative HPV. I had diagnostic mammos with ultrasound every year. 2011 rolls around and I go in for my exam and the PA says to me-everything looks great, new recommendation is every 4 years for a pap BUT your insurance will still pay for it-your call. I say-well, since it is still covered, go ahead...... they also order a pelvic ultrasound because they say I have "abs of steel", they can't feel my ovaries and I have gone through menopause so they want to get a baseline. OK, no worries-off I go. Mammo, ultrasound done and then I'm in the next room getting my baseline bone density when the radiologist comes in and tells me I need to see a surgeon for another lumpectomy. Same area, not going to biopsy, it has to go. OK. Not so great news, but not my first rodeo. Three days later my phone rings(its my birthday) and they tell me my Pap was full of abnormal suspicious cells and my pelvic ultrasound was abnormal. I think I need an endometrial biopsy but no, I need a d and c and some other stuff. They schedule it the same day as my lumpectomy-two surgeons,two surgeries, one anesthesia. UGH. In the end, everything came out OK and I am doing fine. However, I was on the 3 month check, now the 6 month check. If I had not been so serious about my follow ups what I had could have become malignant. Thankfully my doctors are wonderful-my gyno actually came in on his day off to do my surgery to spare me an extra anesthesia. That waiting 4 or 5 years because I had never had an abnormal pap could have killed me.

 

[Saoirse2]

I am living proof every year is important. In December 2011 I saw my gyn. Eleven years earlier I had a lumpectomy that was not malignant. I was in my 30's. I have been meticulous about my yearly exams. Every single year, all was good. Normal pap, negative HPV. I had diagnostic mammos with ultrasound every year. 2011 rolls around and I go in for my exam and the PA says to me-everything looks great, new recommendation is every 4 years for a pap BUT your insurance will still pay for it-your call. I say-well, since it is still covered, go ahead...... they also order a pelvic ultrasound because they say I have "abs of steel", they can't feel my ovaries and I have gone through menopause so they want to get a baseline. OK, no worries-off I go. Mammo, ultrasound done and then I'm in the next room getting my baseline bone density when the radiologist comes in and tells me I need to see a surgeon for another lumpectomy. Same area, not going to biopsy, it has to go. OK. Not so great news, but not my first rodeo. Three days later my phone rings(its my birthday) and they tell me my Pap was full of abnormal suspicious cells and my pelvic ultrasound was abnormal. I think I need an endometrial biopsy but no, I need a d and c and some other stuff. They schedule it the same day as my lumpectomy-two surgeons,two surgeries, one anesthesia. UGH. In the end, everything came out OK and I am doing fine. However, I was on the 3 month check, now the 6 month check. If I had not been so serious about my follow ups what I had could have become malignant. Thankfully my doctors are wonderful-my gyno actually came in on his day off to do my surgery to spare me an extra anesthesia. That waiting 4 or 5 years because I had never had an abnormal pap could have killed me.

Thank you for posting that mjr1. Gardasil is for boys and girls. This year, every lady in my family paid out of pocket to get a pap. Best $124 spent.

 

[manderz]

Hi Ginger et al:

Could you please clarify what effect the HPV vaccine has on all this. Should , as an example, Missy get the vaccine as she is in her 40's. I had squamous cell cervical cancer that spread to both lungs, which of course required surgeries and chemo. It was diagnosed stage 2A. The Drs did say they thought it was the HPV virus, and admittedly I had a number of different sex partners which as you know the virus is passed along.

So do you think the vaccine protects more now and thus is one of the reasons for the extended time between paps. I would hope this is the case.



Annette

Yes, the benefits of Gardasil are definitely being very seriously backed by the proposal here (with the basis of it the result of Ian Frazer's effort, it is strongly supported within Australia). ~85-90% of SCC and ~75-80% of adenocarcinomas are directly linked to HPV infection, an extremely strong correlation (causation, really). However large those numbers are, that still leaves 10-15% of SCC patients without HPV, and 20-25% of AC patients without HPV. Cancer arises from the accumulation of numerous genetic errors, which can be caused by any number of elements. It is definitely the case that if you eliminate HPV infections from the greater population, you will see a decrease of cervical cancer. The issue with backing Gardasil so heavily is the fact that it only provides protection (if you seroconvert it properly) against HPV strains 6, 11, 16, and 18 (16 being the prime culprit of SCC and 18 the prime culprit of AC). That leaves nearly 150 strains NOT protected against, of which ~40 can infect the genital tract, and of which 11 are known to be associated with cervical cancer. They account for ~30% of Cx Ca, with 16/18 linked to the 70% majority.

For a normal 40 year old woman, there's no reason NOT to get Gardasil. You cannot guarantee the fidelity of a partner, and it does protect you from the 2 strains most likely to cause warts and the 2 strains most likely to cause cancer. If used in addition to Paps, cervical cancer rates would bottom out. Sadly, we appear to be ok with 'low-ish' rates and are happy to put all of our eggs in the Gardasil basket.

I do know researchers here are working on adding some of the other HPV strains to a new vax - 35 and 41, I think. Again, beneficial. Again, 20% of cervical cancers arise independently of HPV infection.

I was under the impression that Gardasil was only being given to women 26 or under. Per their website, as listed below.

http://www.gardasil.com/are-you-18-to-26/considering-gardasil/

Cross-country information. The TGA here has approved Gardasil use in women 9-45, and MEN only up to 26 (here is the Gardasil info sheet: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-CMI-05715-3). Perhaps in the States it is 26 for everyone.

Ah, must just be US then. I had been unaware that it was offered to men, but when I got it, it was only being offered to age 26, and I had a friend who was a smidge older who was unable to get it.

 

[smitcompton]

Hi,

Thank you Ginger and MZ for your replies. I am glad to learn they give the vaccine to men as well as women. There was a test for men to see if they were carriers of the HPV, but no-one bothered to test for it.

Here is a story that was told to me . A wife developed C.C and ended up dying from it. The husband remarried and the second wife developed cervical cancer, It turned out the husband was the carrier and he passed it along to two wives. My understanding is that they could treat the man, even before the vaccine was developed, but the medical community never pushed it.

During my 20's and early 30s I had only a few sex partners. It was after age 35 that this increased and where I picked up, what I call an STD. I think women of all ages should get the vaccine. It would have helped me.


Annette

PS I think this is a good conversation.

 

[msop04]

Hi Ginger et al:

Could you please clarify what effect the HPV vaccine has on all this. Should , as an example, Missy get the vaccine as she is in her 40's. I had squamous cell cervical cancer that spread to both lungs, which of course required surgeries and chemo. It was diagnosed stage 2A. The Drs did say they thought it was the HPV virus, and admittedly I had a number of different sex partners which as you know the virus is passed along.

So do you think the vaccine protects more now and thus is one of the reasons for the extended time between paps. I would hope this is the case.



Annette

Yes, the benefits of Gardasil are definitely being very seriously backed by the proposal here (with the basis of it the result of Ian Frazer's effort, it is strongly supported within Australia). ~85-90% of SCC and ~75-80% of adenocarcinomas are directly linked to HPV infection, an extremely strong correlation (causation, really). However large those numbers are, that still leaves 10-15% of SCC patients without HPV, and 20-25% of AC patients without HPV. Cancer arises from the accumulation of numerous genetic errors, which can be caused by any number of elements. It is definitely the case that if you eliminate HPV infections from the greater population, you will see a decrease of cervical cancer. The issue with backing Gardasil so heavily is the fact that it only provides protection (if you seroconvert it properly) against HPV strains 6, 11, 16, and 18 (16 being the prime culprit of SCC and 18 the prime culprit of AC). That leaves nearly 150 strains NOT protected against, of which ~40 can infect the genital tract, and of which 11 are known to be associated with cervical cancer. They account for ~30% of Cx Ca, with 16/18 linked to the 70% majority.

For a normal 40 year old woman, there's no reason NOT to get Gardasil. You cannot guarantee the fidelity of a partner, and it does protect you from the 2 strains most likely to cause warts and the 2 strains most likely to cause cancer. If used in addition to Paps, cervical cancer rates would bottom out. Sadly, we appear to be ok with 'low-ish' rates and are happy to put all of our eggs in the Gardasil basket.

I do know researchers here are working on adding some of the other HPV strains to a new vax - 35 and 41, I think. Again, beneficial. Again, 20% of cervical cancers arise independently of HPV infection.

I was under the impression that Gardasil was only being given to women 26 or under. Per their website, as listed below.

http://www.gardasil.com/are-you-18-to-26/considering-gardasil/

Cross-country information. The TGA here has approved Gardasil use in women 9-45, and MEN only up to 26 (here is the Gardasil info sheet: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-CMI-05715-3). Perhaps in the States it is 26 for everyone.

Ah, must just be US then. I had been unaware that it was offered to men, but when I got it, it was only being offered to age 26, and I had a friend who was a smidge older who was unable to get it.

This is correct -- Gardasil approved in the US for 26 and under. I was 28 when it came out... I was upset.