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Stopping Cervical Cancer

Vaccine targets young audience

A flurry of scientific developments in the last 15 years has given researchers far more insight and information than ever before about HPV, the sexually transmitted human papillomavirus.
Better still, there is more than just awareness of the disease: In 2006, Merck & Co. introduced Gardasil®, the first Food and Drug Administration-approved vaccine created to prevent cervical cancer that can be caused by HPV.

Gardasil has been shown to have no more side effects than a flu shot; and like the childhood vaccines for polio, measles, and mumps, it offers prevention. Yet its introduction was met with controversy, not so much over whether to have the vaccine, but when, says Dr. Donelle Laughlin, chair of Community Hospital's Obstetrics and Gynecology Division.

Because the benefits of Gardasil work best when given prior to contact with HPV, it is recommended for girls before they become sexually active - as young as 9, but with a target age of 11 to 12, according to the Centers for Disease Control (CDC).

That has presented a moral dilemma among those concerned that introducing such a vaccine to teens and preteens is synonymous with giving them permission to have sex.

"That has
 presented a
 moral dilemma
 among those
 concerned that
 introducing
 such a vaccine
 to teens and
 preteens is
 synonymous
 with giving
 them
 permission to
 have sex."

"I say yes and no to that," Laughlin says. "Sex or no sex, that is a discussion and a boundary to be set within the family. This is not about the sexually promiscuous. Most females are going to engage in sexual activity at some point in their lives; most will get married and have a family. It's a matter of when, and a matter of protecting their bodies for when that day comes."

According to the CDC, human papillomavirus is actually a group of viruses that includes more than 100 different strains. More than 30 of these strains are sexually transmitted and can infect the genital area of men and women. Each year, the CDC says, there are approximately 6 million new cases of genital HPV in the United States; and it is estimated that 74 percent of them occur among 15- to 24-year-olds.

The good news is that the vast majority of those cases do not progress to cancer. In some people, HPV causes visible genital warts or precancerous changes in the genital area. In a subset of those cases, those precancerous cells progress to cancer. Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical cancer, the CDC says.

"Most people mount their own immune system response to the virus," Laughlin says, "so it never causes any harm. Those who are unable to fight off the virus are subject to the genital warts and precancerous changes that can lead to cancer.

"The American Cancer Society states that the United States sees 10,000 new cases of cervical cancer each year, and 4,000 cervical cancer deaths. Worldwide, cervical cancer is actually the most common gynecologic cancer.

"We don't see huge numbers here in the United States because we have the Pap smear, through which we can identify abnormal cells in the cervix and treat them before they are allowed to reach a cancerous stage. To much of the rest of the world, a Pap smear is a luxury. But because of it, cervical cancer is 100-percent preventable here."

Those who get the Gardasil vaccine should still have regular Pap tests. Studies have found that the vaccine is almost 100-percent effective in preventing diseases caused by four HPV types, but it does not protect against all types of HPV. About 30 percent of cervical cancers are not prevented by the vaccine, according to the CDC.

For more information about HPV and Gardasil, visit http://www.gardasil.com/ and talk with your family physician.

~ The HPV vaccine is given in a series of three shots. The cost, usually $150 a shot, is covered by most large insurance companies for the prescribed age group.