A Necessary Vaccine

[timotheos]

It a plain fact that we have a limited amount of resources and we have to allocate those resources as best we can.

I think this is a very valid point.

Fact: HPV is fairly common.

Fact: HPV infections and dysplasia are detected by Pap and treated very effectively, before the occasional cancer can develop.

Fact: Cervical cancer risk is highest in those not screened by Pap tests, or do not get adequate follow-up for abnormal Paps.

Fact: Vaccination at this time is not considered a substitute for Pap testing.

So, what do you want to do? Throw a ton more money at the problem in the form of universal vaccination? Or try to get adequate screening to the population that is at highest risk, that is, the women who do not get regular Pap tests? I say we are best served by the latter approach, as the Pap detects HPV lesions of ALL HPV types, not just 6, 11, 16, 18. In my experience, this would be the most effective and least costly plan, until the vaccine covers more of the oncogenic HPV types, and we know more about the long term effectiveness.

Peace, Timotheos

 

[magician]

I think this is a very valid point.

Fact: HPV is fairly common.

Fact: HPV infections and dysplasia are detected by Pap and treated very effectively, before the occasional cancer can develop.

Fact: Cervical cancer risk is highest in those not screened by Pap tests, or do not get adequate follow-up for abnormal Paps.

Fact: Vaccination at this time is not considered a substitute for Pap testing.

So, what do you want to do? Throw a ton more money at the problem in the form of universal vaccination? Or try to get adequate screening to the population that is at highest risk, that is, the women who do not get regular Pap tests? I say we are best served by the latter approach, as the Pap detects HPV lesions of ALL HPV types, not just 6, 11, 16, 18. In my experience, this would be the most effective and least costly plan, until the vaccine covers more of the oncogenic HPV types, and we know more about the long term effectiveness.

Peace, Timotheos

This is an ex post facto approach. Screening serves the purpose of detection. It does nothing for prevention. Pap smears do not detect all HPV strains if the virus has not “bloomed” to the extent that it causes a lesion. And only lesions which produce koilocytotic atypia are detected in pap smears.
Pap smears might be the least costly, but are totally unrelated to prevention.
As regards oncogenic subtypes, the HPV virus, like all viruses, mutates.

Waiting to determine “long term effectiveness” essentially issues a death sentence to those women who are at risk and can avoid the cervical cancer outcome by taking the vaccine.

This is a no-brainer.

 

[magician]

“Fact: HPV infections and dysplasia are detected by Pap and treated very effectively, before the occasional cancer can develop.”

I would appreciate a credible citation for this “Fact”. I’ll pass it on to my colleagues.
The fact is that once the virus has been incorporated into the genome, it will replicate randomly. The “lesion” is a manifestion of cellular infection. It is viewed by colposcopy which is a microscopic examination of the cervix. If a lesion is detected, it can be “burned out” cryogenically or removed by cone biopsy.
The patient, however, remains infected with the virus.

Again, please cite your sources - if you have any.

 

[Margaret33]

" True, the girls being vaccinated today have a moral choice: not to have premarital sex. And, they may grow up and decide they need it when they’re older. But if they don’t, if they decide that sex within marriage will prevent this from happening to them, and it’s uneccessary, they are playing a game of roulette."

That is a very astute analysis. I, too, am in the health care profession as well as being a research scientist.

The issue is a non-starter if you are over the age of 18 simply because you are in control of your own healthcare and can get the vaccine if you so wish.
What we are discussing here is whether parents of underage girls should take the precautionary measure by having their daughters vaccinated. It’s somewhat of a no-brainer, but, as I mentioned before, I am against mandatory vaccination, or mandatory anything with regard to healthcare. Parents have the right to govern their children.
By the same token, there is an element of responsibility. If you do not vaccinate and your daughter becomes infected, who is responsible? If you say the daughter because she engaged in sex prematurely, then she should have had the right to avail herself of the vaccine in the first place.

While I do see the point of those who are against mandatory vaccination, this health issue is not confined to the person who a) decides against having their own child vaccinated, and also b) the person who comes of age and decides against self-vaccination… it has the potential to affect anyone he or she comes in contact with sexually, unbeknownst to either the host or the recipient (or both), and because of that I think it needs to be addressed as a public health issue which can no longer be left in the individual’s hands.

 

[Margaret33]

Fact: HPV infections and dysplasia are detected by Pap and treated very effectively, before the occasional cancer can develop.

Not factual at all. HPV is not always detected. And sometimes by the time it does become detectable, it has progressed to a more severe form of dysplasia. It is also not treated ‘very effectively’ in my experience. The virus does not simply ‘go away’ with treatment. Women have to return again and again to have it’s reoccurrence or progression checked, and sometimes treated many times, and even then, not always successfully.

 

[didymus]

First, I apologise to everyone I offended with my previous post. I did not intend to make light of the suffering or deaths of women due to HPV and cervical cancer.

But, sadly, when dealing with public health issues one must still take an “actuarial” or “cost/benefit” approach. If I were in a policy position I would certainly mandate that insurance and Medicaid (or other public programs) pay for the vaccine for adult women who want it. But give me $360 per student for health and I’d look for something other than making mandatory a vaccine that a large number of parents object to.

 

[jman507]

That’s a valid point, but as a researcher, I can tell you that no one knows ahead of time what will turn out to be the “least cost to the greatest need”. That’s the nature of research. You just don’t know.

Of course. To make this mandatory is not cheap. No one is going to knock out the strands that cause cancer out of existence in a natural environment, like with the small pox vaccine. Right now there will be men acting as reservoirs, plus if it can escape detection and remain latent, it’ll be hard to know who are carriers. From what I hear the long term effects of the vaccine are not known yet. What are the chances that the strand could have an antigen shift? What are the chances another strand could pick up the genes that cause cancer? Given that it takes a long time to generate into cancer, it’s going to take a long time to know for sure. What are the safety risks with the vaccine? Is there substances in it that we know a population could have a high chance of having an allergic reaction to? Are the countraindications well stated, so accidents don’t occur? How does the vaccine work? Is there a risk that it could cause an infection of a strand that could cause cancer or have a carcenogen in it?

To bring a vaccine to be an option to the public is one thing, but it is another to make it mandatory. If the estimated cost of the vaccine is $380 and try to figure that out to the cost of making it mandatory, is not something to take lightly. Taken from the figure of 4000 deaths from the cancer that was in this thread and compare it to the 63,000 estimated deaths due to the flu (well more likely secondary infections from the flu) is something to keep in perspective when figuring priorities. Another thing to figure is costs due to side-effects of the vaccine.

I myself am mostly dealing with the question on the table fairly abstractly. I haven’t actually gotten too much into the specifics, and I doubt I will. I have very little influence of the matter. I must say, I will be a bit skeptical due to a fancy liking of the principle, be wary of something that sounds too good to be true. I want to know the problems with it, if it’s going to get the mandatory stamp on it.

My defualt stance on the issue is since what we are trying to avoid is a long term effect and it can avoid being detected and I doubt there is little hope of killing it off, let’s wait and see to study it more to be sure the money could be better spent somewhere else and to see if there are long term safety risks. I have no problem with funding programs to make it available to low income groups. I have a problem with making it mandatory right now.

 

[magician]

Of course. To make this mandatory is not cheap. No one is going to knock out the strands that cause cancer out of existence in a natural environment, like with the small pox vaccine. Right now there will be men acting as reservoirs, plus if it can escape detection and remain latent, it’ll be hard to know who are carriers. From what I hear the long term effects of the vaccine are not known yet. What are the chances that the strand could have an antigen shift? What are the chances another strand could pick up the genes that cause cancer? Given that it takes a long time to generate into cancer, it’s going to take a long time to know for sure. What are the safety risks with the vaccine? Is there substances in it that we know a population could have a high chance of having an allergic reaction to? Are the countraindications well stated, so accidents don’t occur? How does the vaccine work? Is there a risk that it could cause an infection of a strand that could cause cancer or have a carcenogen in it?

To bring a vaccine to be an option to the public is one thing, but it is another to make it mandatory. If the estimated cost of the vaccine is $380 and try to figure that out to the cost of making it mandatory, is not something to take lightly. Taken from the figure of 4000 deaths from the cancer that was in this thread and compare it to the 63,000 estimated deaths due to the flu (well more likely secondary infections from the flu) is something to keep in perspective when figuring priorities. Another thing to figure is costs due to side-effects of the vaccine.

I myself am mostly dealing with the question on the table fairly abstractly. I haven’t actually gotten too much into the specifics, and I doubt I will. I have very little influence of the matter. I must say, I will be a bit skeptical due to a fancy liking of the principle, be wary of something that sounds too good to be true. I want to know the problems with it, if it’s going to get the mandatory stamp on it.

My defualt stance on the issue is since what we are trying to avoid is a long term effect and it can avoid being detected and I doubt there is little hope of killing it off, let’s wait and see to study it more to be sure the money could be better spent somewhere else and to see if there are long term safety risks. I have no problem with funding programs to make it available to low income groups. I have a problem with making it mandatory right now.

If we waited to see the outcome of every medical therapy, no one would even be taking an aspirin!
The statistical data and research studies have been duplicated by independent scientific laboratories, corroborating the evidence that the vaccine works.
All the questions posed in the first part of your post of course have been addressed or else the vaccine would never have been approved by the FDA. You may not be familiar with the FDA process, but it is a very thorough, well thought out set of criteria.

I would say in closing this thread (at least my participation) that if the subject vaccine were for any other cancer like childhood leukemia, there would not be a discussion. But because this vaccine has sex as a correlated issue, it has generated all sorts of twisted, convoluted, and specious arguments against it (this is a general comment, not directed to anyone who has posted on this thread).

 

[jman507]

If we waited to see the outcome of every medical therapy, no one would even be taking an aspirin!
The statistical data and research studies have been duplicated by independent scientific laboratories, corroborating the evidence that the vaccine works.
All the questions posed in the first part of your post of course have been addressed or else the vaccine would never have been approved by the FDA. You may not be familiar with the FDA process, but it is a very thorough, well thought out set of criteria.

I would say in closing this thread (at least my participation) that if the subject vaccine were for any other cancer like childhood leukemia, there would not be a discussion. But because this vaccine has sex as a correlated issue, it has generated all sorts of twisted, convoluted, and specious arguments against it (this is a general comment, not directed to anyone who has posted on this thread).

Well, I am sure the vaccine works, otherwise it wouldn’t come to market. I’m sure the vaccine is relatively awfully safe, otherwise it wouldn’t have come to market either.

Did I say that the vaccine should be banned and taken off the market? No. But when it comes down to money, everyone has their pet project. I would say, let’s do this, give more funding to CPR training, increase the number of AEDs, and more funding to make every 9-1-1 an enhanced 9-1-1. Early CPR and early AED is often a weak link when it comes to saving lives after cardiac arrest, it will increase the number of surviors. I am sure many others can come up with other public health plans. I am sure many others can come up with important needs in health and human services. I am sure many others can come up with other great plans in all types of other areas, including education and infastructer. If you can increase the capacity of output by building up capital and infastructor, there will be more goods and services to go around. If you let people keep their tax money they can put that to good use too. In my opinion public policy works best, if you actually take a plan and present it as a business proposal to a business.

I say it is prudent to wait, becuase, you have a hard time of actually visualizing the effects, because the cancer is a long term effect and the ability of the virus to stay latent. Plus since the vaccine is not yet approved for men, you cannot treat all possible carriers. It is not that effective if the person all ready has the virus. The ability to eliminate the strain isn’t really there, so I don’t see time very much being of essence. Now say if the bird flu comes along, you might say, hey we need to cut down numbers as quick as possible, there you might want to say, nevermind the side-effects or if we are wasting money, the need is too great.

As far as asprin, I know a lot of ambulances carry it. If anyone is thought to have heart trouble, it’s pretty standard to see if it is counterindicated, double check with the medical director and give a dose. Now if instead of a bottle costing oh about $2, and a dose cost $360, I don’t think it’d be handed out so quickly. I don’t even know if it’d even be used.

Before the issue of the ethics of making it mandatory is on the table, I want to know the effectivenss of the plan of how to go about a wide spread vaccination against the pathogen and the primary illness. The nature of how this works, to me says, it’s no smallpox, let’s wait and see. The threshhold to say this is good for market is lower than, yes let’s make this mandatory. I say yes because it is related to sex does make the arguement in general of a different tone, but that does not mean that every objection is exclusivly due to it being a sexual transmitted infection. I’d be a tough sale on any mandatory vaccine, espcially when the illness doesn’t present itself quickly after the infection.

 

[timotheos]

Not factual at all. HPV is not always detected. And sometimes by the time it does become detectable, it has progressed to a more severe form of dysplasia. It is also not treated ‘very effectively’ in my experience. The virus does not simply ‘go away’ with treatment.

True, you can’t treat HPV infection easily, but that’s not the point of treatment. The goal of treatment of Pap-detected abnormalities is not to eliminate the virus, but to treat dysplasia, which is the more direct potential precursor for cervical cancer. George Papanicolau developed this approach long before anyone knew anything about HPV, and it works. You cannot equate HPV infection with dysplasia. HPV is widespread, dysplasia caused by HPV is less common, and cervical cancer is relatively very uncommon. This is partly due to the natural history of HPV infections and dysplasia, and partly due to Pap screening and treatment of dysplasia.

Pap smears do not detect all HPV strains if the virus has not “bloomed” to the extent that it causes a lesion. And only lesions which produce koilocytotic atypia are detected in pap smears.

Only lesions that produce koilocytic atypia and dysplasia are detectable, but fortunately cancers do not arise de novo following HPV infection alone. Cancers develop after passing through increasing degrees of dysplasia over many years time. Thus trying to detect and treat dysplasia, not HPV infection, is most efficacious.

I know personal experience is no substitute for a well-controlled study, but in 10+ years I have not seen cervical cancer in a woman who has had regular Paps. I have seen lots of cervical cancer in women who have never had a Pap, or did not get adequate treatment for an abnormal Pap. I believe this latter group makes up the great majority of the cervical cancer patients in the US.

 

[timotheos]

Pap smears might be the least costly, but are totally unrelated to prevention.

Waiting to determine “long term effectiveness” essentially issues a death sentence to those women who are at risk and can avoid the cervical cancer outcome by taking the vaccine.

This is a no-brainer.

Magician, we are both after the same result, and I think a good well-tested vaccine is a worthwhile goal. I just don’t have the confidence in the vaccine yet from a public heath perspective, even from a scientific perspective. Did you know the FDA has mandated Merck to follow the prevalence of the other non-6,11,16,18 HPV types in their study populations? There is so much we don’t know yet.

If individuals want the vaccine, I have no objection. But the public is entrusting us to be good stewards with public heath monies. I could not look the women in our community in the eye and say, “Just get the vaccine, and let’s forget about Paps anymore.”

“Fact: HPV infections and dysplasia are detected by Pap and treated very effectively, before the occasional cancer can develop.”

I would appreciate a credible citation for this “Fact”. I’ll pass it on to my colleagues.

OK, I should have limited the statement to dysplasia only. But as I said in my previous post, it is fortunate that cancers do not arise de novo following HPV infection alone, they develop after passing through increasing degrees of dysplasia over many years time. Thus trying to detect and treat dysplasia, not HPV infection, is most efficacious.

 

[magician]

Magician, we are both after the same result, and I think a good well-tested vaccine is a worthwhile goal. I just don’t have the confidence in the vaccine yet from a public heath perspective, even from a scientific perspective. Did you know the FDA has mandated Merck to follow the prevalence of the other non-6,11,16,18 HPV types in their study populations? There is so much we don’t know yet.

If individuals want the vaccine, I have no objection. But the public is entrusting us to be good stewards with public heath monies. I could not look the women in our community in the eye and say, “Just get the vaccine, and let’s forget about Paps anymore.”

OK, I should have limited the statement to dysplasia only. But as I said in my previous post, it is fortunate that cancers do not arise de novo following HPV infection alone, they develop after passing through increasing degrees of dysplasia over many years time. Thus trying to detect and treat dysplasia, not HPV infection, is most efficacious.

Why don’t you cite your sources? Your information is totally and completely inaccurate.
Again CITE YOUR SOURCES!!

 

[Margaret33]

…

You cannot equate HPV infection with dysplasia. HPV is widespread, dysplasia caused by HPV is less common, and cervical cancer is relatively very uncommon.

 

[timotheos]

Why don’t you cite your sources? Your information is totally and completely inaccurate.
Again CITE YOUR SOURCES!!

OK magician, relax, you don’t have to get all bent out of shape. My information may be found in any pathology textbook, you know, books, those things that do not fit in well with the “phrase-bite” culture of the internet. It’s not your fault, I find the internet fairly ignorant of written material published before the mid 1990s. Take Robbins Pathologic Basis of Disease, 5th ed., pp. 1052 - 1053:

“It is apparent … that cancer of the cervix and its precursors evolve slowly over the course of many years. During this interval, the only sign of disease may be the shedding of abnormal cells from the cervix.”

But this is not some obscure reference to try to out-duel you on a website forum, it is real information upon what real and current clinical practice is based. Cytopathologists and technologists deal with this every day, to prevent real cervical cancers. I myself do work in this area, so I know what I’m talking about.

But again, my aim is not to duel with you or anyone else, I just want to make sure all of the relevent information is available for discussion. I have read many of the threads re:HPV vaccine on CA, and I find that many of the posters assume that nothing, prior to the introduction of the vaccine, has been done by the medical community to prevent cervical cancer. Some have even insinuated that there has been withholding of information about the association HPV and cancer, and has amounted to some type of conspiracy. This couldn’t be farther from the truth.

Peace, Timotheos

 

[timotheos]

timotheos;1964752:

… HPV is a precancer. More importantly than equating HPV with dysplasia, is the direct causal relationship between HPV and Cancer of the Cervix. (National Cancer Institute: “Over 99 percent of cervical cancer cases are linked to long-term infections with high-risk human papillomaviruses.” cancer.gov/cancertopics/understandingcancer/HPV-vaccine/Slide4

)

It is far cheaper to pay for a vaccine now, than to pay for thousands of dollars of post-diagnosis treatment in the long run. For me, it is just better parenting to save up a few hundred dollars now to pay for my daughter to receive a vaccine that has the potential to prevent her a future which may contain many months and the larger financial and emotional cost of tests, treatment, as well as possible loss of her uterus and the risk of death from a cancer which could have been prevented. This is not even taking into account the risk of passing it on to others should she or the man she marries err in judgement - who will then face a risk of urogenital/penile cancers themselves which could have been prevented, in addition to their partners and their partner’s partners. As for funding, some insurance companies are already covering the vaccine and as with most vaccines, more and more insurance companies will come on board in a short period of time. For those without insurance, there is current funding already available. Safety & efficacy of the vaccine, as well as funding discussion is addressed at
cdc.gov/std/HPV/STDFact-HPV-vaccine.htm#hpvvac2
fda.gov/bbs/topics/NEWS/2006/NEW01385.html

Hi Margaret33-

I completely understand, and what it comes down to is a personal choice, for you, your daughter, or anyone else. But if you jump in, jump in with your eyes open. Do you know how long the immunity is good for? Do you know what oncogenic HPV virotypes the current vaccine does not cover? Do you know that, even if vaccinated, you may still acquire an HPV infection, get dysplasia, and require a Pap to detect and treat this infection before it may lead to cancer?

A well developed and tested vaccine is a great approach to preventing disease, HPV included. But from what I have seen, the immunity may not last more than a few years, so you better be compulsive about finding if boosters will be required. Also, I know that other HPV virotypes are present in our community that are not covered by this current vaccine, so you would be wise not to think the shot will be the cure-all.

Last, I too have seen the rhetoric about “HPV is a precancer”. This statement incites panic. It is a potential precancer. I don’t have a compilation of sources, but probably less than 1% of HPV infections would lead to cancer even if undetected and untreated. True, HPV is considered a necessary factor in cervical carcinogenesis, and I am not downplaying its importance. But it’s not like once you’re infected, now you’re going to get cancer.

Peace (and sigh), Timotheos

 

[astegallrnc]

HPV is a precancer.

HPV is not a precancer.

More importantly than equating HPV with dysplasia, is the direct causal relationship between HPV and Cancer of the Cervix. (National Cancer Institute: “Over 99 percent of cervical cancer cases are linked to long-term infections with high-risk human papillomaviruses.” cancer.gov/cancertopics/understandingcancer/HPV-vaccine/Slide4)

HPV is linked to cervical cancer (99.7%) and most experts consider it the cause/necessary for cervical cancer development although no direct link has been shown. “The finding of HPV viral DNA integrated in the majority of cellular genomes of invasive cervical carcinomas supports epidemiologic data linking this agent to cervical cancer; however, direct causation has not been demonstrated.” cancer.gov

It is far cheaper to pay for a vaccine now, than to pay for thousands of dollars of post-diagnosis treatment in the long run.

We don’t know about the cost-effectiveness of this vaccine yet. “Public health cost-effectiveness analyses demonstrate that more than one booster to extend duration of treatment protection past the initial 10 years is not cost-effective in countries with screening programs”. CEU offering from UpToDate.

.

 

[Margaret33]

Margaret33;1965002:

… Do you know what oncogenic HPV virotypes the current vaccine does not cover? Do you know that, even if vaccinated, you may still acquire an HPV infection, get dysplasia, and require a Pap to detect and treat this infection before it may lead to cancer?

I mean you no disrespect timotheos, just engaging in discussion here… And yes, of course I know these things, they are stated in almost every peer reviewed journal on the subject. But just because it is not a cure-all or cover every strain, does not mean it isn’t worth the effort (to me). And anyone who would consider the vaccine an alternative to detection would be ignorant in my opinion, or improperly educated by their physician, who I would assume, would distribute literature with this vaccine, just as with the Meningococcal vaccination or any other. These things would be the responsibility of the recipient/parent to read and be aware of, in addition to listening to their primary care provider.

Last, I too have seen the rhetoric about “HPV is a precancer”. This statement incites panic. It is a potential

precancer. If the CDC, FDA and NIH call it a precancer, I tend to believe it.

I don’t have a compilation of sources, but probably less than 1% of HPV infections would lead to cancer even if undetected and untreated.

Have not seen this percentage or anything close to it in what I’ve read, and I’m sorry, not trying to antagonize, but sources would help tremendously.

True, HPV is considered a necessary factor in cervical carcinogenesis, and I am not downplaying its importance. But it’s not like once you’re infected, now you’re going to get cancer.

Never stated this. But to me anyway, the risk is great enough. Thank you for the discussion.

 

[astegallrnc]

If the CDC, FDA and NIH call it a precancer, I tend to believe it.

Precancer is a condition that tends to become malignant. Cervical dysplasia is a precancer.
Once cervical cells begin to change, it typically takes 10-15 years before invasive cervical cancer develops. As the cells change, they first become “pre-cancerous” - a condition also known as “dysplasia” or CIN - the abbreviation for cervical intraepithelial neoplasia. Dysplasia is the medical term for abnormal cells on the cervix caused by the HPV virus. If the abnormalities are mild and few in number, they usually go away without treatment. However, some cases of moderate dysplasia, and most cases of severe dysplasia, will not go away on their own. At this stage, the cells are considered “pre-cancer”: In other words, if they are not found and treated, they could develop into cervical cancer. thehpvtest.com

 

[Margaret33]

HPV is not a precancer.

HPV is linked to cervical cancer (99.7%) and most experts consider it the cause/necessary for cervical cancer development although no direct link has been shown. “The finding of HPV viral DNA integrated in the majority of cellular genomes of invasive cervical carcinomas supports epidemiologic data linking this agent to cervical cancer; however, direct causation has not been demonstrated.” cancer.gov

Perhaps the difference in our data is year of publication? Or credibility of source… I don’t know: Here is what the NIH says:
"Does HPV cause cervical cancer? Yes. Scientists have concluded that there is a causal relationship between HPV and cervical cancer. " tjclarkinc.com/d_hpv_and_cervical_cancer.htm

The World Health Organization: "Based on many epidemiological and experimental studies, a causal link between HPV and the development of cervical cancer in women has been shown. In fact, over 99% of cervical cancers contain HPV DNA, and four specific HPV types (16,18,31, and 45) cause at least 80% of diagnosed cervical cancers. " who.int/vaccines/en/hpvrd.shtml

Now, I am not a scientist, nor am I engaged in research in any shape or form. However, I do know the value of backing up what I say with credible, (citable) sources. And when I cannot do so, I state that it is an opinion. I do not wish to argue, and my participation in this discussion is complete.

Best of luck,

Margaret

 

[astegallrnc]

“The finding of HPV viral DNA integrated in the majority of cellular genomes of invasive cervical carcinomas supports epidemiologic data linking this agent to cervical cancer; however, direct causation has not been demonstrated.” cancer.gov

Does HPV cause cervical cancer? Yes. Scientists have concluded that there is a causal relationship between HPV and cervical cancer.

"Based on many epidemiological and experimental studies, a causal link between HPV and the development of cervical cancer in women has been shown. In fact, over 99% of cervical cancers contain HPV DNA, and four specific HPV types (16,18,31, and 45) cause at least 80% of diagnosed cervical cancers. "

This supports what I have posted. How does it differ?

I do know the value of backing up what I say with credible, (citable) sources. And when I cannot do so, I state that it is an opinion

As have I (national Cancer Institute). You have not posted a source stating that HPV is a precancer nor have you provided a source stating direct causastion has been established.

Please know that my intent is not to nit pick but, like you, to share the most accurate and current information.
God bless!
Autumn