Wednesday, March 15, 2006

Status of HPV Vaccine and Cervical Cancer Prevention

The current issue of the New England Journal of Medicine contains a Perspective piece authored by Dr. Robert Steinbrook entitled, "The Potential of Human Papillomavirus Vaccines" (free full-text available). Steinbrook explains the advance an HPV vaccine could represent with regards to preventing cervical cancer, as well as some anal, penile, vaginal, and vulvar cancers. The investigational vaccines in development by Merck and GlaxoSmithKline are described; questions about the vaccine's long-term effectiveness, appropriate age of administration, and public response are also outlined.

A second, related piece in this issue of the NEJM is entitled, "Preventing Cervical Cancer in the Developing World" (also free full-text). The authors state, "Most women in low-income countries do not have access to routine screening: only 5 percent have undergone a Pap smear in the past five years.1 In parts of Latin America and the Caribbean, more women die from cervical cancer than from complications of childbirth" and explain that, "In the United States, rates of cervical cancer have fallen by 75 percent since the Pap smear's introduction more than 40 years ago." The authors, who are likely correct, point out that at at an estimated $300 to $500 per course, women most in need of the vaccine may not have access to it. Perhaps less correctly, the authors state, "In addition to cost, there is the worry that the vaccine could have a negative effect on screening — offering false security to vaccinated women, who may incorrectly believe that they no longer need to undergo Pap smears." This is an issue that is not at all limited to "the developing world" - all women will need to understand what the vaccine can and cannot do, regardless of nationality. With their statement, the authors come very close to implying that this concept cannot be communicated to women who are underprivileged due to some deficiency of the women themselves.

In related news, although a representative of the conservative Family Research Council was previously quoted as stating, "Giving the HPV vaccine to young women could be potentially harmful, because they may see it as a licence to engage in premarital sex," the organization released a statement on February 21st in support of the vaccine. One interesting point of the release: "We are grateful to representatives of both Merck and GlaxoSmithKline for taking time to meet with us at the Family Research Council to explain their goals in developing these vaccines and their plans for the marketing and distribution of them." It's intriguing to me that pharmaceutical corporations felt it necessary to "explain their goals" to a non-healthcare-focused organization due to the concern of some that such a vaccine would encourage sexual activity, while the primary purpose of the vaccine is clearly not to prevent all STDs or give the "go ahead" for unprotected sex, but to prevent a common and deadly cancer caused by the virus.

Resources:
Cervical Cancer Prevention - National Cancer Institute
The Pap Test - Questions and Answers - National Cancer Institute
Cervical Cancer Treatment - National Cancer Institute
Human Papillomavirus (HPV) and Genital Warts - National Women's Health Information Center
Frequently Asked Questions About Human Papilloma Virus (HPV) Vaccines - American Cancer Society
What Every Woman Should Know About Cervical Cancer and Human Papilloma Virus - American Cancer Society
HPV vaccine clinical trials - ClinicalTrials.gov

Technorati Tags: ; ;
MeSH Tags: Papillomavirus, Human/immunology; Uterine Cervical Neoplasms/prevention and control; Vaccination

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