Vaccination against human papillomavirus
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* Jeff Nisker, MD PhD

*   © 2007 Canadian Medical Association or its licensors

The commentary by Abby Lippman and colleagues on the planned vaccination of Canadian girls aged 9–13 years with the HPV vaccine raises “questions and cautions”1 for physicians, parents and citizens of Canada. As a physician who trained in the late 1970s with gynecologic-oncologist Hugh Allen, I have witnessed both the devastating effects of advanced cervical carcinoma2 and the dramatic reduction in the incidence of this disease with Pap smear screening.3 As a parent, I would worry that if I had a daughter aged 9–13 years (I have sons) she could not give informed consent to HPV vaccination by herself.4 Predicated on my expectation that she could be educated about the importance of Pap smear screening and safe sexual practices and would comply at least with Pap smear screening, I would advise her that HPV vaccination was not necessarily in her best interest. As a citizen, I believe that funding for women's health promotion should be directed to improving educational initiatives about Pap smear screening and safe sexual practices and to starting a public education campaign concerning the largely preventable breast and ovarian cancers related to the *BRCA* gene mutations,5 which are much more common killers of women than cervical cancer.

As a physician, parent and citizen, I support vaccination for herd immunity;6 however, my obligation to my daughter would supersede my obligation to others. When one of my patients asks, “What would you do if I (or my daughter) was your daughter?” I usually respond, “But you are not my daughter (or wife or sister).” In this case, however, I would respond, “I would be uncomfortable with you being vaccinated against HPV at this time.”

## Footnotes

*   **Competing interests:** None declared.

## REFERENCES

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4.  4. Nisker, J. Philip. CMAJ 2003;168:746-7.
    
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5.  5. Nisker J. The need for public education: “surveillance and risk reduction strategies” for women at risk for carrying BRCA gene mutations. J Obstet Gynaecol Can 2007;29:510-1.
    
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6.  6. Colgrove J. The ethics and politics of compulsory HPV vaccination. N Engl J Med 2006;355:2389-91.
    
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