On March 11, the House of Representatives Committee on Government Reform Subcommittee on Criminal Justice, Drug Policy and Human Resources held a hearing on cervical cancer and human papillomavirus (HPV). The subcommittee heard testimony on the connection between HPV and cervical cancer and whether warning labels on condom packages should be required to state that condoms do not protect against all sexually transmitted diseases (STDs).
As reported in SIECUS' January 2004 policy update, the correlation between some strains of HPV and cervical cancer has been politicized as part of the debate over whether young people should receive abstinence-only-until-marriage programs or comprehensive sexuality education that includes information about both abstinence and contraception.
The hearing was called by subcommittee chairman Rep. Mark Souder (R-IN), a strong proponent of abstinence-only-until-marriage programs, who charged that the federal Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) failed "to abide by the law" after those agencies were late in responding to requirements set out in the Fiscal Year 2001 Labor, Health and Human Services appropriations act.
Those requirements, drafted by then-Rep. Tom Coburn (R-OK), an outspoken opponent of reproductive and sexual rights, and signed into law by President Clinton in 2000, required the CDC to issue a report in December 2003 on the best strategies to prevent HPV, a virus that affects nearly 80% of sexually active adults. The CDC released this report in January 2004.
The report recognized that "Cervical cancer is an uncommon consequence of HPV infection in women, especially if they are screened for cancer regularly with Pap tests and have appropriate follow-up of abnormalities."
After a postponement in January, the cervical cancer/HPV hearing was re-scheduled for March. The re-scheduled hearing included new testimony from Rep. Dave Weldon (R-FL), an outspoken proponent of abstinence-only-until-marriage programs, as well as representatives from the CDC and FDA, among others.
Rep. Weldon's testimony focused on abstinence-only-until-marriage and "avoiding sexual promiscuity" as a prevention tool.
The Coburn-drafted provision also required the FDA to examine condom labels to ensure that they provide medically accurate information about protection from sexually transmitted diseases, including HPV.
In what advocates of reproductive and sexual health call a political play, the Bush administration is considering requiring that condom packages warn that condoms do not protect against all STDs, including HPV.
At the hearing, Dr. Daniel Schultz, director of the Office of Device Evaluation at the FDA, said that the FDA "has developed a regulatory plan to provide condom users with a consistent labeling message and the protection they should expect from condom use." Condom labels are currently silent on the issue of HPV but say that if used properly, condoms reduce the risk of AIDS and other STDs.
Dr. Schultz's testimony acknowledged that "there does appear to be a benefit from condom use for prevention of HPV-related disease." He explained, "FDA is working to present a balanced view of the risks and benefits in condom labeling, being careful to neither encourage device use in circumstances where it may not be medically appropriate, nor to discourage device use in circumstances where it is," Dr. Schultz testified.
In fact, the CDC report stated that "There is evidence that indicates that the use of condoms may reduce the risk of cervical cancer." Later in the report slightly stronger language is used: "Available studies suggest that condoms reduce the risk of the clinically important outcomes of genital warts and cervical cancer."
Two such studies, conducted in the Netherlands, bolstered the claim that condom use can positively affect HPV outcomes by finding that consistent condom use can hasten the time it takes for the lesions to disappear.1
Advocates for sexual health fear that warning labels are a dangerous idea based on ideological viewpoints rather than scientifically sound public health concepts. "Anything that undermines the effectiveness of condoms for these uses will have serious public health consequences," said Rep. Henry Waxman (D-CA) at the hearing.
In response, Rep. Jo Ann Davis (R-VA) said, "This is not about social ideology or religious ideology…It's about informing women. And, truly, the only way to be protected is abstinence. That's not ideology-it's fact."
"It seems ironic that the Congresswoman, a strong supporter of abstinence-only-until-marriage programs that restricts young people's access to critical health information, would suggest that informing women is the goal," said Bill Smith, director of Public Policy for SIECUS. "Such inconsistency merely underscores the clear ideological motivation."
For more information about the CDC report on HPV, please see SIECUS' January 2004 policy update.
- Hogewonig CJA et al. Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial. International Journal of Cancer 107: 811-816, 2003. Bleeker MCG et al. Condom use promotes regression of human papillomavirus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia. International Journal of Cancer 107: 804-810, 2003.