vaccine against HPV and cervical cancer: Is it worth vaccinating ?

past two years, a campaign less for Gardasil, the new vaccine against HPV to protect against cervical cancer, has brought the discussion of human papillomavirus in the foreground, making light of new not only about the vaccine itself, but also on issues that surround it.

HPV is ubiquitous. Nearly 50% of sexually active people will get HPV at some point in their lives. There are about 20 million people with HPV infections in the United States, with 6.2 million new cases occurring each year. The most serious consequence of HPV infections is cancer of the cervix, yet public knowledge about HPV is low – less than 50% of women had heard of HPV and its link to cancer col.

It is crucial that the public gains more knowledge about HPV and cancer of the cervix, especially in the current climate where the merits of this vaccine have been clouded by a political rhetoric. Information about the link between HPV and cervical cancer, how the disease is common and who gets it, detection methods, other effects of the disease and the role and effectiveness of the vaccine should be addressed. The examination of these topics will help guide decisions as medical professionals recommend this vaccination to a whole generation of 11-12 year old girls and boys may be in the future

The relationship between HPV and cervical cancer. There are over 100 types of HPV. About 15 of them are “high risk” types that cause cervical cancer. HPV infections are more common in the young population, with nearly 75% occur in 15-25 years. Most HPV infections are “silent” – people who are infected are unaware they have it and transmit it freely to their sexual partners. The good news, however, is that most of these infections are self-limiting, which means that almost 90% resolve by themselves within 24 months without causing problems. In a minority of people, however, persistent infection, either due to high-risk sexual behavior (such as partners multiple and unprotected sex), or weakened immunity because of smoking, stress and long-term use of certain drugs like steroids. These factors can propel HPV infections to cause precancerous and cancerous lesions of cervix. More than 99% of cancers of the cervix caused by HPV. HPV infections are necessary but not sufficient alone to cause cervical cancer

Pap tests and cancer of the cervix:. A Pap test detects early changes in the cells of the cervix due to HPV or other effects, which if left untreated, can develop into cervical cancer. Fortunately, thanks to a program Pap test well organized in the United States, the incidence of cancer of the cervix has decreased by 75% over the past 50 years. Therefore, Women who get regular smear, the incidence of cervical cancer is low. Currently the United States, approximately 11,000 new cases of cervical cancer develop each year and about 4,000 deaths occur from it. Even if we would that there were no cases of cervical cancers to reckon with, in relation to the number of HPV infections that occur each year, the ratio of HPV infections in cervical cancer is low. According the American Cancer Society, four out of five women who died of cervical cancer have not had a Pap test within the previous five years. These figures show that the Pap test has been very successful in limiting the impact of cervical cancer in this country.

The role of vaccines against HPV to prevent cervical cancer: There are now two vaccines against HPV available in the world to protect against two major types of HPV that cause cancer. Gardasil, manufactured by Merck, was available in the U.S. since June 2006. Cervarix, manufactured by Glaxo Smith Kline, is planned to be introduced into the United States in late 2008 or early 2009. Both vaccines target HPV types 16 and 18, which cause most cervical cancers. HPV 16 accounts for nearly 50% of cervical cancers and HPV 18 cause about 20% of cervical cancers. Clinical trials have shown that both vaccines prevent 70% of cervical cancer with almost 100% efficiency. However, this is true only when the person has been vaccinated before exposure to virus types 16 and 18. The effectiveness of the vaccine decreases once these types of viruses to enter the body. That is why the CDC recommends the vaccine for girls 11-12 years before their first sexual intercourse in order to get maximum benefit

Pap test compared vaccine against HPV. The two Pap tests and HPV vaccine against cervical cancer avoided, but they do so in different ways. The vaccines produce antibodies against the HPV virus well before it can invade the cervix. Therefore, the vaccine prevents the development of any HPV related pathology on the cervix. On the other hand, the Pap test, detects abnormal changes cervix as a result of HPV, many of which require follow-up visits and procedures to prevent these abnormalities progress to cancer. Most people would agree that prevention is better than detection or treatment. Management of abnormal smears -3000000000 only costs a year in this country. But as the vaccine only protects against 70% of cervical cancers, Pap tests should be continued in order to detect the remaining 30% of cervical cancers that are not covered by the vaccine. It is important to note that apart from the prevention of cervical cancer, the vaccine was also found to be beneficial against many other diseases related to HPV, and could possibly help reduce the medical and emotional as these diseases are the people.

Those most prone to cervical cancer in the United States are those groups of people who lack access to Pap smears or does not obtain because lack of access or because of poor socio-economic status, poor knowledge or cultural differences. These groups are mostly composed of women from ethnic minorities and whites in areas of the Appalachians. Therefore, education aimed at the general public should not only include complete prevention programs in simple terms, but should also be culturally sensitive to meet the needs of people from diverse backgrounds. The vaccine against HPV has the potential to save millions of young lives and families, but unless it reaches the same group of women who are not receiving their smear today, he will be missed on maintaining its “one less” promise both here at home and around the world,

Shobha S. Krishnan © 2008, MD

Author Bio

Shobha S. Krishnan, MD, a gynecologist and a physician is board certified in family medicine at Barnard College, Columbia University. His new book, The Controversy vaccine against HPV: Sex, Cancer, God and politics: A guide for parents, women, men and adolescents was published August 30, 2008 by Greenwood Publications. The book presents the latest information about the vaccine without the influence of pharmaceutical companies and other interest groups.

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