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On Guard
Local health professionals weigh in on the new HPV vaccine.

It’s a conversation doctors have been having with patients every day for almost a year. Last June, the Food and Drug Administration approved Gardasil, the first vaccine for cervical cancer and genital warts associated with human papillomavirus (HPV).

Pharmaceutical giant Merck & Co., the manufacturer of Gardasil, has been heavily promoting the vaccine, recommending that it be given to girls 11 to 12 years old—and many consumers have questions. There’s been concern among medical specialists that parents might even avoid the vaccine for fear they’d be encouraging promiscuity. But according to Dr. Stephanie Bui, a pediatrician with Penn Medicine at Radnor, “we haven’t seen that backlash at all.”

Then there’s the push by politicians to ensure the vaccine is mandatory in schools. Texas Gov. Rick Perry directed state health officials to make the vaccine a requirement for girls in sixth grade and up (the Texas House of Representatives voted to overturn the order in March). More than 30 other states have introduced their own bills. Pennsylvania’s would require insurance companies to cover the cost of the vaccine.

Perhaps all the hype is justified. HPV is the most common sexually transmitted virus in the United States. The Centers for Disease Control and Prevention estimate that about 6.2 million men and women are infected each year. People can be exposed to HPV’s numerous strains many times in their lifetime depending on how many sexual partners they have; it can be contracted from just one partner or even a single sexual encounter. Some of the strains are low-risk, causing genital warts and low-grade cervical infections. It’s the high-risk strains that can result in cervical cancer.

“When parents walk in and ask, ‘Why should my daughter get this vaccine?’ I say, ‘Because it protects against cervical cancer.’ It’s as simple as that,” says Bui.

HPV, unfortunately, is not a simple virus. Except in the case of genital warts, most types have no symptoms. A woman may only know she has HPV if an abnormality shows on a pap smear, and even testing won’t reveal the strain. “What will happen for most women is that they’ll produce an immune response to the virus and clear it themselves from their system,” says Bui.

Some types of HPV can infect a woman’s cervix and cause cells to change. If the virus goes away on its own, the cells return to their normal state. If it doesn’t, the changes can eventually lead to a malignancy if they’re not treated. It can take years for the virus to manifest itself as cancer.

“If all women went in and got their pap smears and had treatments for these precancerous changes, we probably would see almost no cases of cervical cancer,” says Dr. Margaret Burns, an ob/gyn with Bryn Mawr Women’s Health Associates.

Approved for use by girls and women between the ages of 9 and 26, Gardasil protects against four strains of the HPV virus—two of which cause 70 percent of cervical cancer cases and two that cause 90 percent of genital wart outbreaks. “Gardasil has been shown to be 100 percent protective against cervical cancer that’s caused by those two strains covered by the vaccine,” says Bui.

The vaccine is given in a three-shot series over a six-month period. It’s recommended that Gardasil be administered to 11- and 12-year-old girls when other vaccinations are due. “The younger you are, the less likely you are to be exposed to that virus and the better your immune system responds to vaccines,” says Burns. “We want girls to get vaccinated before they’ve had any sexual contact at all.”

Still, women in their late teens up to age 26—even if they’ve had sex—are viable candidates for the vaccine. If you’ve already been exposed to some strains of HPV, the vaccine won’t treat the previous infection, but it will protect against new infections that could lead to cervical cancer.

“The response to the vaccine has been overwhelmingly positive,” says Bui, who estimates that as of February, she’s given at least 1,000 vaccinations since receiving her first supply of Gardasil in November.

Regardless, parents are concerned about Gardasil. “Some parents say, ‘The vaccine has only been out a year; I want to wait a few years,’” says Bui. “I think that’s fine. Getting vaccinated is a choice—I think it’s a good choice to make—but it’s still up to the parents. I’ve had very few people who haven’t wanted to do it.”

Bui strongly encourages any patients headed to college to get vaccinated. She also reminds her vaccinated patients that they still need to get pap smears—and they should still use condoms. “The number of women exposed to HPV in college is huge,” says Bui. “I wouldn’t want to see them holding off on receiving the vaccine.”

A majority of health plans cover the cost of the vaccine for girls and women 11-26. Side effects are minimal. You might experience slight arm pain, and one in 10 women develop a low-grade fever. Merck is also continuing its research on the use of vaccine in boys and men.

And Gardasil won’t be the only HPV vaccine for long. GlaxoSmithKline hopes to have FDA approval for its own version, Cervarix, by the end of the year.
 


8 Facts About Cervical Cancer

1. There will be about 11,150 new cases of invasive cervical cancer in the United States in 2007.

2. About 3,670 women will die from the disease that same year.

3. Researchers believe non-invasive cervical cancer is about four times as common as the invasive type.

4. When found and treated early, cervical cancer often can be cured.

5. Since 1955, the number of deaths from cervical cancer has declined significantly thanks to the Pap smear.

6. Only some women with pre-cancerous changes of the cervix will develop cancer. This process usually takes several years but sometimes can happen in less than a year.

7. For most women, pre-cancerous cells will remain unchanged and go away without treatment.

8. If pre-cancerous cells are treated in a prompt fashion, almost all cervical cancers can be prevented.

Source: American Cancer Society


Cancer-Screening Guidelines

Breast: Annual mammograms starting at age 40 for as long as a woman is in good health. Clinical breast exams (CBE) as part of a periodic health exam, preferably every three years for women in their 20s and 30s and every year for women 40 and over. Breast self-exams (BSE) for women in their 20s and up. Women at increased risk might benefit from earlier initiation of screening, shorter screening intervals and/or the addition of ultrasound or MRI.

Cervix: All women who are sexually active or 18 or older should have an annual Pap test and pelvic examination. After three or more consecutive satisfactory examinations with normal findings, the Pap test may be performed less frequently. Discuss the matter with your healthcare professional.

Endometrium: Women at high risk for endometrial cancer of the uterus should have a sample of endometrial tissue examined when menopause begins.

Source: American Cancer Society

 

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