The Greater Good New Vaccines Expected to Combat Cervical Cancer, Highlight Public Health Issue of HPV

An epidemic. That’s what the virus that causes cervical cancer is being called across the country.

But health care professionals say new developments in the prevention and treatment of the virus and the disease are calling greater attention to this pervasive health issue.

A new class of vaccines slated to hit the market in 2006 is aimed at curbing instances of cervical cancer, the secondlargest cancer killer in women, by protecting against certain strains of the human papillomavirus (HPV) that cause the disease.

The vaccines are expected to have a significant impact on the prevention of cervical cancer, which kills approximately 4,000 women a year in the U.S. But they are also prompting discussion of a myriad of issues surrounding cervical cancer and HPV, including the social impact of both the virus and the vaccine.

Dr. James Wang, a gynecologist based in Westfield, compared the new developments to the advent of the Pap smear in the 1950s, in terms of their impact on women’s health.

“Since then, there has been a 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} improvement over the original Pap smear, and there is also a test specifically for HPV,” he said. “But screening can’t do it all, and there are a number of issues surrounding HPV that could potentially be helped with a vaccine. This is great news.”

The Shot Heard ’Round the World

But just as the introduction of the Pap smear spurred awareness of cervical cancer among the general population, the vaccine is bringing HPV toward the forefront of the country’s consciousness, and that of the global community.

HPV is a common virus that includes more than 100 different types, most of which are harmless, according to the National Institute of Allergies and Infectious Diseases (NIAID).

About 30 types can be spread through sexual contact, however, some low-risk and others considered high-risk. Both can lead to abnormal Pap smear results in women, and the NIAID estimates that there are more cases of genital HPV infection than any other sexually transmitted infection in the U.S.; approximately 5.5 million new cases of sexually transmitted HPV infections are reported every year. Condoms are also often ineffective in guarding against the virus.

High-risk HPV can lead to cancers of the cervix, vulva, vagina, or anus, and it’s these strains of the virus that the vaccines in development hope to target.

The first vaccine available to the public will likely be one developed by Merck & Co., called Gardasil. In trials, the vaccine has proven effective in preventing earlystage cancers and pre-cancerous lesions caused by two common, high-risk strains of HPV: types 16 and 18, which are believed to be responsible for 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all cervical cancer cases.

A second vaccine being developed by GlaxoSmithKline, Cervarix, has also proven effective in combating HPV types 16 and 18 as well as types 6 and 11, and is expected to be released in the U.S. after Merck’s product.

Dr. Ronald Burkman, chairman of the gynecology and obstetrics department at Baystate Medical Center, said the vaccines have been in development for about a decade, and will likely be available by next summer. He agreed with Wang that the introduction of the vaccine to the list of gynecological options available for women is an important one.

“The whole deal with these viruses is they’re not like the flu,” he said. “They’re pretty stable, and they don’t mutate, so the vaccine won’t have to be constantly reinvented. Once we can prevent an HPV type like 16 or 18, we’re essentially preventing the cause of 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all cervical cancers, and as the vaccines improve that percentage will go up.”

Ginny Miller, certified nurse midwife with Midwifery Care of Holyoke, said that once the vaccine is available, she expects that educating patients about the vaccine will begin simultaneously.

“We’ll start talking with patients about the option right away,” she said. “Our numbers (of HPV-infected patients) are high … so naturally we’re very interested in seeing the vaccine come out.”

Not only is the virus a major public health concern, however, but it is also a costly one.

Wang noted that with the reduction of health care costs a pressing concern for the nation, the impact that preventing some types of a virus that currently affects more than 20 million Americans cannot be overlooked.

In addition, HPV infection rates are skyrocketing worldwide, especially in areas where screening is not prevalent.

“When you look at the actual cost of one abnormal Pap smear, I wouldn’t be surprised if overall they are costing our country billions every year,” he said. “This is a significant development that relates directly to reducing the cost of medical care.”

That’s because screening alone, while important, cannot eliminate the need for follow-up care when a woman receives word of an abnormal Pap smear, he said, or of greater problems.

According to the National Cervical Cancer Coalition (NCCC), most invasive cancers of the cervix can be prevented with the proper screening and care, but that doesn’t negate the possibility for costly medical exams and procedures.

At the least, an abnormal Pap smear will likely necessitate a second test; it could also lead to procedures such as a colposcopy (an exam that uses a powerful magnifier to spot developing problems, such as cervical dysplasia, which can develop into cancer), a biopsy, cryotherapy (freezing), laser treatments, or a ‘loop excision,’ which removes an affected area.

Plus, Wang said the understanding of HPV is forever in flux as the virus is studied further, and the ability to prevent the some types of the virus all together would eliminate some guesswork.

“Our current knowledge is constantly changing,” he said. “As recently as five years ago, women diagnosed were being told things by their doctors that they aren’t being told now.

“It also has to be taken into account that there are 13 different types of HPV out there that can cause cervical cancer that we know of,” Wang stressed. “But HPV itself has a huge spectrum, and theoretically, a woman can have more than one HPV infection in her lifetime, which makes it hard to pinpoint how each type behaves and advances. Some can advance rapidly.”

Bumps in the Road?

The vaccine’s impending availability doesn’t come without some concerns, however; health care professionals are still somewhat cautious about its future.

While many are hopeful that the vaccine will prove to require only a one-time vaccination (a three-shot program) that remains effective for a lifetime, the product has not been studied for a long enough period of time to know how long the vaccine will work in humans.

“We don’t know how long it will last, we’re unsure of its effect after 10 years,” said Burkman.

Miller added that given the newness of the vaccine, and the time left before it actually becomes available to women, there are also questions as to whether or not insurance carriers will cover the vaccination.

“For us it all depends on whether or not it’s going to be covered by insurance,” she said. “Only time will tell.”

Lastly, given its relation to sexual activity, some conservative groups have come out against the vaccine and the proposal that it be administered to adolescents prior to sexual contact between the ages of 10 and 12.

Many such organizations, however, have also issued statements recently in support of the vaccines.

Jonathan Imbody, senior policy analyst for the Christian Medical and Dental Association, for example, wrote recently for The Daily Texan that “the Christian Medical Association enthusiastically welcomes the HPV vaccine. Not only does the vaccine promise to save millions from contracting (HPV), it also reinforces the abstinence message. The vaccine actually highlights the gap between objective medical evidence and ‘safe sex’ hype.”

Similarly, the Family Research Council released a formal statement bunking reports that the group had been vocal in its opposition to the vaccine.

“The Family Research Council welcomes the news that vaccines are in development for preventing infection with certain strains of the (HPV). … Media reports suggesting that the Family Research Council opposes all development or distribution of such vaccines are false.”

Forward Thinking

Burkman said he feels that opposition to the vaccine will prove to be a minor issue over time.

“The whole social aspect will likely be a minor player in this,” he said. “The bottom line is condoms don’t protect against HPV, and HPV is responsible for nearly all cases of cervical cancer. It’s a major health issue.”

Wang agreed, adding that in some cases, a medical breakthrough can overshadow divergent opinions.

“We all have things we don’t agree with,” he said, “but some things are meant to achieve the greater good. This is one of them.”