Dealing Cervical Cancer a Knockout Blow

FRIDAY April 18, 2008 -- For the first time, a doctor's arsenal now includes a vaccine that can actually prevent cancer.

Gardasil targets human papillomavirus, or HPV, which causes virtually all cases of cervical cancer and is present in one in four American women.

And health-care providers are beginning to integrate that vaccine into the schedule of other immunizations that children receive during childhood and adolescence.

About 13 million doses of the vaccine have been distributed globally since its approval in June 2006, said Kelley Dougherty, director of public affairs for Merck & Co., the company that created Gardasil. Of those, 10.5 million doses have been distributed in the United States.

"We estimate between 3 to 5 million girls have been vaccinated with Gardasil, but that is a very rough estimate," Dougherty said.

The American Cancer Society estimates that 11,150 new cases of invasive cervical cancer were diagnosed in the United States in 2007, and 3,670 women died from the disease.

Cervical cancer used to be one of the most common causes of cancer death for U.S. women, but the death rate declined by 74 percent between 1955 and 1992. That was largely due to increased use of the Pap test, which can detect cellular changes in the cervix before cancer develops, the cancer society says.

"Women for so many years have heard the message that they need Pap tests, it's almost equivalent to seeing a gynecologist," said Debbie Saslow, director of breast and gynecologic cancers for the American Cancer Society. "I think for breast exams, many women wait for their doctor to recommend it, whereas for the Pap test, they're more likely to go get one."

The death rate from cervical cancer continues to decline by almost 4 percent a year, thanks to the Pap test.

But doctors now believe they are poised to deal cervical cancer a knockout blow, thanks to the HPV vaccine.

In the nearly two years that have followed its approval, Gardasil has been added to the U.S. Centers for Disease Control and Prevention's vaccination recommendations for girls ages 11 to 12. The vaccine, designed for females from ages 9 to 26, requires three shots taken within a six-month period.

Researchers have also discovered that the vaccine guards against vaginal and vulval cancers. HPV is present in 80 percent of the 6,000 cases of vulval and vaginal cancers diagnosed each year.

It's hard to know how many girls have actually received the vaccine. Merck bases its estimate on anecdotal reports from the field, but the American Cancer Society has no estimates of its own.

"We don't know how many [vaccines] are sitting in a refrigerator somewhere, versus in a girl's arm," Saslow said.

New research is looking at other ways the vaccine could be used to guard against cancer.

For example, Merck is studying whether the vaccine would work in women as old as 45, Dougherty said. The company also is exploring whether the vaccine works against other strains of HPV beyond the four it was originally meant to target.

Research also is under way to see if boys should receive the vaccine, as a way to protect girls from HPV. While males obviously can't get HPV-linked cervical cancer, they can help spread the sexually transmitted virus.

"Because males can transmit HPV to their partner, putting their partner at risk for developing cervical diseases, we have had a male research program going for some time now," Dougherty said.

The vaccine may also prove to be a way to protect men as well. HPV has been shown to be a cause of throat cancer, which affects both sexes.

"We just know the vaccine is safe in males, but we need to prove that it works," Saslow said. Test results for males are still two to three years away, she said.

For older women, the best way to prevent cervical cancer is through the Pap test.

Cervical cancer tends to occur in midlife, with half of women diagnosed between the ages of 35 and 55, according to the American Cancer Society.

Under current cancer society guidelines, all women should begin cervical cancer screening about three years after they begin having vaginal intercourse but no later than age 21. Testing should be done every year with the regular Pap test or every two years using a newer liquid-based Pap test.

Beginning at age 30, most women who have had three normal Pap test results in a row can space out their screenings to every two to three years.

Most women 70 or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years can choose to stop having the test.

More information

To learn more, visit the American Cancer Society.

Posted: April 2008


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