By Dr. Kabyemela
Special to NurseZone
The recent launch of a Human Papilloma Virus (HPV) vaccine aimed at protecting girls and women against cervical cancer has provoked a lot of debate. Debate is good because it is the catalyst of mass information and information is the truest form of empowerment.
In the United States in 2002, over 12,000 women were diagnosed with cervical cancer and nearly 4000 women died of the disease that year. About 3,700 women were expected to die of the disease in 2006.
World-wide, over 270,000 women die of cervical cancer each year and it accounts for 9 percent of all female cancer deaths annually with women in the developing world bearing the brunt of this disease. Cervical cancer is the most commonly diagnosed cancer among women in Central America and Southern Africa.
With the introduction of regular cervical cancer screening, the rate of the disease and death in western countries has fallen steadily over the years. In the United States, the annual rate of fall has been around 4.5 percent but it is still a significant cause of morbidity and mortality among women of all age groups.
The HPV Vaccine
The HPV infection is known to be the leading predisposing factor to cervical changes which lead to cervical cancer. The infection accounts for almost all cervical cancers. It is also responsible for genital warts. HPV is the most common sexually transmitted infection in the United States and quite possibly the world. Crucially, it is almost always symptom-less at the time of transmission.
There are over 100 strains or subtypes of the Human Papilloma Virus, a third of which are sexually transmitted. The other non-sexually transmitted strains are dubbed low-risk and possibly clinically insignificant. The strains that are known to be predisposed to cervical cancer are subtypes 16, 18, 31, 33 and a few others. Subtypes 16 and 18 are by far the most important, accounting for 70 percent of cervical cancers. Subtypes 6 and 11 are the strains up to 90 percent responsible for genital warts.
The newly introduced HPV vaccine, Gardisil®, protects against subtypes 6, 11, 16 and 18. These, as shown above, are responsible for the vast majority of genital warts and cervical cancer cases. What’s more, studies have shown the vaccine to be almost 100 percent effective in preventing cervical cancer and other diseases, including dysplasia (pre-cancer) of the cervix, vulva, vagina and genital warts caused by the four HPV strains. That is so if given to girls and women who have not been exposed to the virus. With that logic, it has been recommended that it be made available to girls and young women from the age of 9 to 26 years. With universal coverage, such a program has the potential of dramatically cutting down the rate of cervical cancer and save millions of lives. With universal vaccination, it is estimated that such a program could cut cervical cancer deaths by as much as 75 percent.
Gardisil® and Cervarix®
At the time this article was written in the summer of 2007, over 75 countries have approved Gardisil. Another vaccine, Cervarix® protecting against HPV subtypes 16 and 18—the strains responsible for cervical cancer—should be approved in Europe by the end of 2007. It is already licensed for use in Australia.
In the United States, Indiana became the first state in January 2007 to legislate for this vaccine. The bill requires girls to be vaccinated against HPV before the start of sixth grade. Texas followed soon after, with an executive order in February 2007, launching the vaccination program starting with girls entering the 6th grade in 2008. The order also makes the vaccine available free to uninsured girls aged 9 to 18.
When to Start Vaccinating
The adopted age is a reasonable and understandable compromise; it is clear why the recommended start age is 9 years. It is to ensure girls are protected well before they become sexually active. HPV is largely sexually transmitted and the whole process starts there. For some, that process inexorably leads to pre-cancer (dysplasia) changes and then cancer. This is a very distressing disease which might eliminate the woman’s fertility, lead to premature menopause and for some, tragically, death.
The HPV vaccine is a very important milestone in our fight against cancer. I put its advent, not quite, but almost in the same league with the discovery of aspirin and penicillin. Unsung and shrugged shoulders were at it’s launch, but it is now responsible for thousands of saved lives and the well-being of billions of women across the world. These women are our mothers, sisters and daughters. It is incumbent upon us with the knowledge and the facts to spread the word.
Joe Kabyemela, M.D., MRCOG, is an obstetrician & gynecologist and author of “The Daily Telegraph Complete Pregnancy and Childbirth Answers.” For any and all questions regarding conception, pregnancy, childbirth and antenatal issues access his Web site at www.pregnancy-bliss.co.uk.