Vaccine Against Cervical Cancer: Worth It?
Joe Kabyemela
The recently launched HPV vaccine aimed at preventing 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.
The Facts:
Cervical cancer accounts for 1% of all cancers in the UK
causing over 1100 deaths every year. 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 3700
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% of all female cancer deaths annually with
women in the developing world bearing the brunt of this disease.
Cervical cancer is the commonest diagnosed cancer among women in
Central America and Southern Africa.
With the introduction of regular cervical cancer screening
using smears, the rate of the disease and death from it in
western countries has fallen steadily over the years. In the
United States, the annual rate of fall has been around 4.5% but
it is still a significant cause of morbidity and mortality among
women of all age groups.
The HPV Vaccine
The Human Papilloma Virus (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 commonest 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 (HPV), 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 predispose 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% of cervical cancers.
Subtypes 6 and 11 are the strains most responsible for genital
warts (90%).
The newly introduced HPV vaccine (Gardasil®) 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% effective in preventing cervical cancer and other
diseases, including dysplasia (pre-cancer) of the cervix, vulva
and 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.
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, via 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. This is
an example of bold political foresight and decision making.
Other states are almost certain to follow suit.
In Britain, where such a program would fall under the auspices
of the National Health Service (and therefore significant long
term budgetary implications), it is under active consideration.
It is, however, already available privately at a total cost of
about £450 for the full course (three doses). This is
significant for the individual who might feel impatient with
the grinding of the state machinery towards decision making.
The Age
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 issue of age has exercised many a mind
and has been one of the main areas of contention in this
debate.
There is a school of thought that argues that giving this
vaccine to such young girls is giving them a green light to be
sexually active without worrying about consequences.
Personally, this is a track of reasoning that I find absurd.
This is similar to the mainly religious lobby which frowns upon
the availability of condoms. Only it is worse. Unfortunately,
this anti-vaccine lobby is quite powerful and voluble and sadly
the most vulnerable members of our societies are the most
susceptible to this self-righteous pious posturing.
Encouragingly, in a recent study by Cancer Research UK, most
(75%) mothers were in favour of having their daughters
vaccinated and 80% of them felt 10-14 years will be the
appropriate age.
Young girls grow into young women and most young women, sooner
or later, become sexually active. The sexual activity involves
another individual (usually) which means it removes the
absolute control the individual might want to have about its
consequences. This is regardless of whether the sexual activity
is in a religiously acceptable context or not. It follows,
therefore, that any reasonable individual will applaud the
availability of this protection for our children and young
women against one of these perennial scourges.
The HPV vaccine is a very important milestone in our fight
against cancer. I put its advent, not quite, but almost at par
with the discovery of Aspirin and Penicillin. Unsung and
shrugged shoulders at launch but now responsible for saved
lives and wellbeing of billions of people across the world over
the intervening decades. It is incumbent upon those in the know
to spread the word.
About The Author: Dr Joe Kabyemela, MD, MRCOG. Obstetrician &
Gynaecologist: ACWH, University Hospital Aintree and Liverpool
Women’s Hospital. http://www.hpv-centre.co.uk: Information on
vaccine availability in UK.
http://www.pregnancy-bliss.co.uk :
Portal for comprehensive information on Pregnancy and
Childbirth
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