Cervical Cancer Vaccination

Cervical Cancer

An estimated 4,000 women die annually in the United States from cervical cancer, where it is the eighth leading cause of cancer deaths among women. Hispanic and African American women are affected in higher numbers than whites. Worldwide, cervical cancer ranks [Page 121]fifth in the cause of cancer deaths, a difference attributed to better preventative testing and treatment in the United States. While smoking, use of oral contraceptives, and family history of cancer are among additional risks factors, HPV has been linked to cervical cancer as the factor of highest risk. In some studies, statistics of HPV presence in DNA testing of cervical cancers is as high as 99%. HPV can also affect men's health, and it has been linked to penile, throat, and anal cancer.

Human Papillomavirus (HPV)

HPV is the most common STI (sexually transmitted infection) in the United States. It is not a single virus, but a family of over 100 viruses that result in a host of symptoms, from common warts to genital warts (low risk) to the types that cause cancer (high risk). The viruses are spread by skin-to-skin contact that cannot always be prevented by the use of barrier contraceptives. Some of these types are harmless, and many patients have reported that symptoms clear up on their own with no medical intervention. Removal treatments for noncancerous types include medicated creams, liquid nitrogen, and laser removal. Statistics on the prevalence of genital HPV infection vary widely, with studies indicating that as few as 30% to as many as 80% of the adult population of the United States are infected with at least one type of genital HPV. Routine Pap testing is recommended for women to detect abnormal cells in the cervix that may develop into cancer if left untreated. There are currently no federally approved tests for HPV in men.

Vaccines

In 2006, the FDA approved Gardasil, a vaccine for four types of HPV, including types 16 and 18, which are known to cause cervical cancer. As of 2007, another vaccine, Cervarix, is under consideration. While Gardasil protects against two additional types of HPV known to cause genital warts, Cervarix is designed to vaccinate against types 16 and 18 only. Merck & Co., the developer of Gardasil, recommends its three-dose vaccination for females age 9 to 26. Gardasil's recommendations have received CDC (Centers for Disease Control) endorsement. Gardasil studies have suggested that the vaccine protects against the four HPV strains for up to 5 years. Studies to determine the vaccine's effectiveness beyond 5 years and for male subjects are ongoing. The current cost of the vaccination series is $360.

Controversy

After FDA approval in 2006, Merck & Co. launched a vigorous marketing campaign, urging state lawmakers to require the vaccinations for girls as part of routine vaccine series administered to school-age children. Several states considered or approved such a measure. Some states considering the measure sought to include parental objection options, or “opt out.” This was due in part to an immediate outcry from parent and conservative groups who felt that such a measure would encourage premarital sexual activity. Controversy also arose about the use of public funding for mandated vaccinations and the aggressiveness of Merck's lobbying tactics. Others objected to the short length of medical studies and questioned the safety of the vaccines. At the time of this publication, the debate has yet to be resolved.

...