Maurie Markman, MD
The impact of staggering increases in the cost of individual antineoplastic agents for patients and the overall healthcare system cannot be overstated, and there appears to be no realistic solution to the current dilemma that is acceptable to the parties involved in this ongoing debate. The stakeholders include patients and their families, governmental and third-party payers, healthcare regulators and economists, local and national political leaders, investors, individual providers and hospitals, medical organizations, healthcare systems, and manufacturers and developers of products and devices.
Figure 1. HPV Vaccination Rates in the United States2
The foundational role of HPV in the development of essentially all cases of cervix cancer, other squamous cell gynecologic malignancies, and an increasing percentage of head and neck cancers is well established and not open to rational scientific debate (FIGURE 2).3,4
Further, evidence supporting the clinical utility of HPV vaccination in preventing persistent HPV infection and reducing HPVassociated precancerous gynecologic abnormalities is extremely solid, and reports of meaningful short-term or long-term adverse effects are preciously limited.
Figure 2. Annual Incidence of HPV-Associated Cancers4
What remains absent from the current discussion are definitive data demonstrating a reduction in cancer-related morbidity and mortality resulting from the introduction of a population-based HPV vaccine strategy. Of course, this is a critical issue with all cancer prevention strategies. Since clinically evident malignancies develop years, perhaps decades, following exposure to recognized carcinogens (eg, cigarette smoke), if one mandates definitive proof of this ultimate outcome before establishing the strategy, the desired state may never occur, would be seriously delayed, or would result in countless unnecessary deaths before the evidence is finally accepted.
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