Vaccines, early detection targeting cervical cancer for elimination

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Cervical Health Awareness Month

Vaccines, early detection targeting cervical cancer for elimination

By Dennis Thompson
HealthDay Reporter

(HealthDay News) -- Cervical cancer has been in retreat for decades, as effective testing rendered it one of the most preventable forms of the disease.

Now, it has been targeted for elimination.

Public health officials are pressing for widespread use of a 2-year-old vaccine that can fully protect women from cervical cancer, and they'll use Cervical Health Awareness Month in January to make their case.

An estimated 25 percent of American girls between the ages 11 to 17 have received a dose of Gardasil, the vaccine that targets human papillomavirus, or HPV, according to the U.S. Centers for Disease Control and Prevention. HPV causes virtually all cases of cervical cancer and is present in one in four American women.

As the rollout of the vaccine continues, and as older women continue to receive regular Pap test screenings, doctors believe that cervical cancer's days as a health menace are dwindling.

"We certainly have worked hard to try to educate the public regarding the effectiveness of the vaccine, the safety of the vaccine, and 16 million women have received it already," said Dr. Edward Partridge, a professor of obstetrics and gynecology at the University of Alabama at Birmingham and first vice president of the American Cancer Society. "Cervical cancer is a disease that can truly be prevented."

Cervical cancer already has gone through a stunning decline as more women use regular Pap tests to protect their health. The death rate for cervical cancer fell by 74 percent between 1955 and 1992 -- owing largely to increased use of the Pap test, which can find abnormalities in the cervix either before cancer develops or is in its earliest, most curable phase, according to the American Cancer Society.

The death rate from cervical cancer continues to decline by nearly 4 percent a year. But nearly 3,900 American women will still die from the disease this year. That's because many women, mostly those with low incomes and poor health insurance coverage, don't get regular Pap tests, according to the cancer society.

That's where the vaccine can come in. It protects young women by helping to eliminate the major cause of cervical cancer. Some estimates say giving the vaccine universally to women would eliminate 70 percent of cervical cancer cases.

The CDC has said that 11- and 12-year-old girls should be targeted for the vaccine, as most girls this age aren't yet sexually active and will achieve the best protection.

"The vaccine is most effective when it's given prior to an HPV infection or exposure," Partridge said. "That basically means it's most effective prior to the onset of intercourse."

Many experts have recommended the vaccine be made a required vaccination for entry to middle school.

But, doctors are facing some resistance from parents. One recent study found that only 49 percent of almost 10,000 American mothers surveyed planned to vaccinate a daughter if she were 9 to 12 years old. The numbers rose the older the girl -- 68 percent of mothers would vaccinate if the daughter was 13 to 15 years old, and 86 percent would vaccinate if the daughter was 16 to 18 years of age.

" Texas passed a law that made it mandatory, but they had so much backlash they had to back off," Partridge said. "Because the (HPV) virus itself is sexually transmitted, there's a belief on the part of parents that their daughter is not going to be sexually active until she gets into a monogamous relationship, and therefore wouldn't need it. They can't see the immediacy of it, there's no question about it."

In a report that may have eased some parental concerns, the CDC's Immunization Safety Office said in October that a study of 370,000 doses given to girls and young women over the past two years found no evidence that the vaccine causes any serious complications.

Family physicians will prove key to resolving parents' worries in the future, said Debbie Saslow, director of breast and gynecologic cancers for the American Cancer Society.

"A doctor's recommendation is the most influential factor in whether a child gets vaccinated or not," Saslow said. "It's probably an easy sell for them, but what we've been hearing is that the doctors are making incorrect assumptions about the parents and what they'll accept. If they would put those assumptions aside and just stick to the recommended guideline, the parents will be more accepting."

In the future, women also might benefit from better screening. Researchers have weighing whether testing for the presence of HPV might be a better screen for cervical cancer than a Pap test, Saslow said.

"It's a more predictive test," she said of HPV testing. "If a woman does not have HPV, her chance of getting cervical cancer in the next three to five years would be extremely low."

Currently, the cancer society thinks it's a good idea for women over 30 to take both tests, Saslow said. "If the Pap test is positive and the HPV test is negative, she's still pretty safe because whatever the abnormality is, it's likely not going to lead to cervical cancer," she said.

On the Web

To learn more about the Gardasil vaccine, visit the U.S. Centers for Disease Control and Prevention at http://www.cdc.gov/std/Hpv/STDFact-HPV-vaccine.htm.