A very sobering editorial in today’s New England Journal of Medicine asks a number of pointed questions about the safety and effectiveness of the new HPV vaccines. These are the same questions that have caused a number of us to wonder why we are using twelve-year-old girls as guinea pigs for a vaccine that won’t be proven until those girls are approaching menopause.

This editorial from one of the world’s most respected medical journals asks for caution and further study before introducing large-scale vaccination against HPV: “...We will not know for many years whether the intervention will work or — in the worst case — do harm.”

Most HPV infections are easily handled by the immune system without a single vaccination being given. Will the HPV vaccines interfere with this natural process, and if so, in what ways? If two of the cancer causing strains of HPV are effectively suppressed by these vaccines, will nature put pressure on the remaining strains of HPV to become oncogenic?

While it has been shown that the HPV vaccines prevent precancerous lesions, we don’t know if they will prevent cancer itself, or if they will continue to prevent precancerous lesions by the time today’s teens have teens of their own.

This editorial asks how the vaccine will affect preadolescent girls, given the limitations of the current trials. It points out how models for the cost-effectiveness of the vaccines are based on assumptions that are “quite optimistic.” It wonders if women who have had the vaccine will continue to get cancer screenings, even though they should.

This editorial closes with the following warning: