February 15, 2007
Cervical cancer vaccine stirs hope and debate
The first human papillomavirus (HPV) vaccine approved last year is inspiring passionate debate as state legislatures take up the issue of compulsory inoculation for preteen girls as a way to prevent cervical cancer. HPV infection is the major cause of cervical cancer in women. A bill, written by California Assemblywoman Sally Lieber (D-Mountain View), would make the FDA-approved vaccine mandatory for girls entering the sixth grade.
The Merck-produced HPV vaccine, Gardasil, is approved for girls and women between the ages of 9 and 26, and is recommended to be given to girls between 11 and 12. It was found to be more than 95 percent effective against the four types of HPV that account for approximately 70 percent of all cervical cancers and 90 percent of genital warts. There are currently 100 strains of HPV, 30 of which are sexually transmitted.
According to the Centers for Disease Control, at least 50 percent of sexually active people contract a genital HPV infection. About 6.2 million new cases are diagnosed each year, the agency reports, and by age 50 at least 80 percent of women will be infected.
Dr. Ilana Cass, a gynecologic oncologist at Cedars-Sinai Medical Center and assistant professor of obstetrics and gynecology at UCLA, will discuss the vaccine and its implications for women's health at Cedars-Sinai's sixth annual Women's Health Conference on March 16.
Jewish Journal: How does the vaccine work?
Dr. Ilana Cass: Pretty much every single person who has cervical cancer has been infected with the human papillomavirus.... The idea of this vaccine is to prevent cervical cancer by preventing infection with the human papillomavirus.
With this vaccine, it is estimated that we can completely prevent 70 percent of cervical cancers. That's huge. That's why this is so incredibly important.
JJ: Why does the HPV vaccine target such a young population?
IC: The vaccine has specifically been designed to target young girls before they start to have sexual intercourse. These women have the highest antibody levels and enjoy the most protection from HPV if they are vaccinated before their sexual debut, before any exposure to HPV.
Based on what we clearly know about sexual practices in the U.S., we have to target preteens and teens. Data suggests that fully one-third of 15-year-old girls in the United States have had vaginal sexual intercourse. So the target age chosen ... is essentially ages 9 to 26, with a big effort by the Advisory Committee on Immunization Practices recommending vaccination for all girls between the ages of 11 and 12.
JJ: Is it a single-dose vaccine?
IC: The vaccine is given as three shots: baseline, two months later and then six months later. At this point in time, we don't know if patients will need to have a booster.
JJ: Are there any risks?
IC: There are risks with everything. But it is incredibly safe. The most common side effect is, like with many other vaccines, some soreness on the arm. It should not be given to women who are pregnant. We don't have a lot of data yet about women who are breast-feeding.
JJ: But it's not a substitute for regular screening?
IC: The vaccine does not eliminate the need for routine screening. [Regular Pap screening should begin at age 21 or within three years of beginning sexual activity.] It will reduce cervical cancer incidence over time by 70 percent, but there are still HPV types not included in the vaccine that can cause cancer.
JJ: If a woman already has been infected with one strain of HPV, can the vaccine still help?
IC: Women exposed to one type absolutely still derive benefit from the vaccination from the other three, but less overall protection from cervical precancer.... Girls and women ages 9 to 26 should still be vaccinated, even if they have had sex and have been infected with HPV, because the studies show that even these women derive benefit from the vaccine.
JJ: Does cervical cancer impact Jewish women differently than the general population? And are Jewish women less susceptible to cervical cancer because men who are circumcised are less likely to transmit the disease?
IC: Jewish women are not differentially affected by this disease, as there is no familial syndrome or inherited predisposition that we are aware of at this point in time. HPV transmission is higher from non-circumcised men to women than from circumcised men, yes, but so many boys are circumcised these days, and with the frequency of interfaith marriage, this is less of a component in cervical cancer incidence.
JJ: What are your thoughts on the proposed legislation introduced by California Assemblywoman Lieber?
IC: I know that in Texas, there have been protests [against similar efforts]. I don't understand the protests. As a mother, I'm vaccinating my kids on a regular basis to prevent much less significant diseases.... I'm vaccinating them to prevent whooping cough and chicken pox.... If I can vaccinate them against cervical cancer and it's a shot, where do I sign up?
We have to be very clear: this is a vaccine to prevent cancer. Wouldn't everyone want to protect their child and loved one from getting cancer?
The 2007 Cedars-Sinai Women's Health Conference will be held March 16 at the Hyatt Regency Century Plaza Hotel. For more information or to register, visit www.womenshealthconference.org or call (800) 233-2771.
Dr. Ilana Cass: http://www.cedars-sinai.edu/5574.html
Assemblywoman Sally Lieber: http://democrats.assembly.ca.gov/members/a22/
California Assembly Bill 16: http://www.leginfo.ca.gov/cgi-bin/postquery?bill_number=ab_16&sess=CUR&house =B&author=lieber
Centers for Disease Control HPV facts: http://www.cdc.gov/std/HPV/STDFact-HPV.htm
Make the Commitment: http://makethecommitment.org/
Gardasil commercial: http://www.youtube.com/watch?v=hJ8x3KR75fA
Dr. Donnica Moore, women's health expert, and Stacy London, host of TLC's "What Not To Wear" talk about the Make The Commitment campaign and ways to prevent cervical cancer: http://www.youtube.com/watch?v=UDooMSb6Hn4