Subtle Cervical Cancer Ads Raise Questions

Have you seen this ad? A young woman follows a mysterious stream of glitter up an elaborate staircase. She is mesmerized by a dazzling perfume bottle that should be filled with something wonderfully alluring. Instead, as a cloud of mist clears, we realize that the bottle is emblazoned with the chilling words CERVICAL CANCER. The announcer apologizes, then explains that disguising the message as a perfume ad was the best way to draw viewers' attention to a disease they need to know more about.

Not that there's anything wrong with that. Or is there?

The ad, which made its debut on Oscar night before 41 million viewers, is sponsored by the pharmaceutical giant GlaxoSmithKline, which makes Cervarix, a cervical-cancer vaccine approved by the FDA in October. The company says it is part of a new and very innovative campaign to make young women more aware of the threat of cervical cancer. Two other videos directed at this audience are available to watch on YouTube and also at the site, which is where viewers of all three are directed to turn for more information. Although the company's name is at the bottom of every page of the eb site, it's still possible to click on link after link without realizing that this is actually a very subtle way of getting young women to ask their doctors about cervical cancer and the vaccines that help prevent it, one of which is made by the sponsoring company.

The main message is front and center, as the Web site states at the top of its chart of facts about cervical cancer: "Every 47 minutes, another woman is diagnosed with this cancer." Vaccination is one of three recommended preventative strategies; the others are lifestyle changes (such as stopping unprotected sex and smoking) and having an annual Pap test, which checks for changes in cells in the cervix.

The Glaxo campaign couldn't be more different from the publicity onslaught that surrounded the introduction of Gardasil, the competing cervical-cancer vaccine manufactured by Merck. When it was introduced in 2006, very explicit and frequent ads bombarded parents with urgent messages to get their young daughters vaccinated. That drew wide-ranging criticism, both from social conservatives who thought it would encourage underage sex and from health-care advocates who worried about the heavy-handed marketing. In a study published last year in the Journal of the American Medical Association, two Columbia University researchers concluded that Merck helped promote an overly simplified picture of the benefits of Gardasil by giving substantial grants to major medical associations for educational materials promoting use of the vaccine.

Both the Glaxo and Merck vaccines prevent infection by certain types of human papillomaviruses (HPV), a group of more than 100 viruses. More than 30 varieties of HPV can be passed through sexual contact, and infection by some of them is the major cause of cervical cancer. According to the National Cancer Institute, both vaccines are highly effective against two high-risk HPVs (called 16 and 18) that cause 70 percent of cervical cancers. Gardasil also protects against HPV 6 and 11, which cause 90 percent of genital warts. There is some evidence that Cervarix may also protect against other types that cause cervical cancer, but more research is needed to confirm this. Because the vaccines have been proven effective only if they are given before HPV infection, the FDA recommends that they be administered before a girl or young woman is sexually active, roughly between the ages of 9 and 26. The vaccines are delivered in a series of three shots over a six-month period.

While the controversy over Gardasil has quieted down a bit, the lesson apparently remains. Marketing anything to do with sex can be tricky, especially if young girls are involved.

A Glaxo spokesperson, Jennifer Armstrong, says the company decided to take a much more subtle route after considerable market research and focus groups showed that "this approach worked" with young women. They could be on to something because the campaign almost immediately drew the attention of blogs read by young women. Some liked it, but not all were complimentary. wrote: "The ad definitely got the attention of the friends I was watching with, but is it demeaning to women to suggest that we'll only pay attention to our health if we're tricked into thinking it's all about something that smells nice?" In a poll of the site's readers, a majority thought it was effective.

But the basic premise behind the campaign raises questions from some women's health advocates. Cynthia Pearson, executive director of the National Women's Health Network, questions whether the ads really do provide a public service—as Glaxo claims—since they don't target women who are most at risk for cervical cancer. "Their message is fear, fear of being unable to have children, and portraying cervical cancer as a threat to that," Pearson says. "That's what really made my blood boil. They are taking a grain of truth, and exploding it into a cloud of marketing misinformation, that they hope will motivate women to take action. They are trying to use that grain of truth to blow up this issue into a much bigger problem than it is, and pushing women to get what they may or may not need."

Although the National Women's Health Network advocated for the vaccines to be approved, and believes them to be safe and effective, the group believes that they are primarily needed among populations of women who do not routinely get Pap smears. And these women, Pearson says, "are not the ones who will be getting the message through these ads." In this country, Pearson says, these tend to be women who are disconnected from the mainstream: new immigrants or women who live in rural, isolated communities. "Cervical cancer doesn't happen evenly across the population," Pearson says. "It's much more likely in women who are uninformed, unreached, underserved, and this kind of awareness message won't get to them."

Glaxo's estimate of the prevalence of cervical cancer in this country roughly matches the National Cancer Institute's statistics. But according to the World Health Organization, the disease is far more common in developing countries, which account for 80 percent of the annual cases worldwide and about 190,000 deaths a year (compared to about 4,000 deaths in this country). Pearson wishes the vaccine makers would do more to reach women in Africa, Latin America, and Asia where cervical cancer is a major health risk. "These are the places where there are no Pap smears, or only for the tiny slice of the population that is upper-middle class," she says. "These vaccines have a lot of potential worldwide. But I think they are looking to make a profit here."

Before the Pap test became widespread in this country more than 40 years ago, cervical cancer was the leading cause of cancer deaths among American women. Now lung cancer tops that list. It could be a while before we know how much vaccination will change the current death rate, even in the U.S. That's because it can take more than 10 years for HPV to become cervical cancer, which is most often found in women between 25 and 35. Even if you get the vaccine, you should still have an annual Pap test, because neither vaccine protects against all the types of HPV that cause cancer.

As far as Glaxo is concerned, the campaign in this country is ongoing, and Armstrong says the company is pleased so far. "After just one airing of the cervical cancer spot during the Oscars," she wrote in an e-mail, "we have seen hundreds of thousands of young people engaging online. This has far exceeded our expectations. Our goal is to get young women thinking and talking about cervical cancer and what they can do to help prevent it. We are thrilled that young women are engaging in these important discussions."

Whether that translates into more customers for Cervarix and, ultimately, fewer deaths from cervical cancer is another story. But knowing the facts is a good first step.