HPV vaccine beyond the hype.(Gardasil)(Product/service evaluation)

"I want to be one less, one less," sing the giggling girls jumping rope in TV ads for Gardasil. The promise is that the vaccine will make a woman "one less" victim by protecting her against the four dangerous strains of human papillomavirus (HPV) that cause most cases of cervical cancer and genital warts.

Gardasil's manufacturer, Merck, has lobbied aggressively to make the new vaccine mandatory, and at least 20 states are considering requiring it for girls entering sixth grade.

But at $360 for a three-shot series (covered by most insurers), is a vaccine against HPV necessary? CONSUMER REPORTS has found that there are indeed compelling reasons for it--though they may not be ones you've heard.

POTENTIAL BENEFITS

The number of Gardasil ads might give the impression that cervical cancer is a public-health emergency. But in the U.S., that's not the case. Today, regular widespread screening with Pap tests allows doctors to detect and treat abnormal cell changes in the cervix years before cancer develops.

So what's gained by getting the vaccine? For one thing, the presence of HPV triggers abnormal Pap smears in many women, and "that sets off a whole sequence of diagnostic procedures that take time, cost money, and cause pain," notes Vanessa Cullins, M.D., vice president for medical affairs at Planned Parenthood. The vaccine, she says, might spare them the angst and decrease the financial cost of follow-up.

For about 500,000 women a year, an abnormal Pap smear causes more than angst: They turn out to have precancerous abnormal cells, called high-grade cervical dysplasia, that are caused by HPV. Surgery is often required to ...