New Vaccine to Prevent Cervical Cancer Available at DCPH
According to the American Cancer Society (ACS), about 11,150 cases of invasive cervical cancer will be diagnosed in the United States this year. Once one of the most common causes of cancer death for American women, the number of deaths caused from cervical cancer between 1955 and 1992 decreased 74 percent. The main reason for this change is the increased use of the Pap test as well as having a human papillomavirus (HPV) DNA test as part of the Pap test. These measures have come a long way in diagnosing abnormal cells before they become cancerous.
Dickinson County Public Health (DCPH) Supervisor Mary Dunleavy announces now there is a vaccine available that takes it a step further and can actually prevent cases of cervical cancer.
Cervical cancer is caused when normal cervical cells gradually develop pre-cancerous changes that eventually turn into cancer. According to the ACS, smoking, an immune system deficiency, and the presence of certain types of HPV infection are risk factors for cervical cancer. Scientists have recently found that certain types of HPV adversely affect genes that usually suppress tumors from growing in the cervical lining cells.
HPV is a group of over 100 related viruses. Each HPV virus in the group is given a number, which is called an HPV type. About 60 HPV types cause warts, which are non-cancerous tumors, and occur on non-genital skin such as on the hands and feet. The other 40 types occur in the genital areas of the body and are considered sexually transmitted infections. According to the Centers for Disease Control and Prevention (CDC), these types of HPV viruses affect up to 75 percent of sexually active people at some point in their lifetime, and are the most common sexually transmitted infections in the United States. Some types of genital HPVs cause warts to appear in the genital area. These warts rarely develop into cancer, and are therefore called “low risk” viruses, and include types 6, 11, and some others.
Other genital HPV viruses have been linked with genital or anal cancers in both men and women. They also cause low and high-grade cervix cell changes and pre-cancers. These are called “high risk” viruses and include types 16, 18, 31, 35, 39, 45, 51, 52, 58, and some others. According to the ACS, over 99 percent of cervical cancers are related to HPV. Of the types that cause cervical cancer, about 70 percent are caused by HPV types 16 or 18.
Most genital HPV infections do not cause cervical cancer. The majority of people who test positive for genital HPV DNA eventually test negative, often within six to 12 months. However, even if a few cells of the cervix still contain HPV, it is possible the virus may start to become active again if the immune system becomes very weakened. The CDC says it is possible that some cervix cell changes may suddenly occur many years after initial HPV exposure. This could help explain how a woman could experience such changes after many years of normal Pap tests and no history of a partner change.
HPV usually has no symptoms, unless it is a type that causes genital warts. The CDC says most people will never know they have HPV because no significant disease develops and the immune system suppresses the virus. Unlike the HPV DNA test that is available for women, according to the CDC there is currently no test approved to detect HPV in men. However, there are ways to detect the most common problem caused by HPV in men, genital warts.
Abstaining from sexual activity can prevent HPV infection. Limiting the number of sexual partners and avoiding sex with people who have had many other sexual partners decreases risk of exposure to HPV. However, because HPV infection is so common, these measures do not guarantee that a person will not get HPV according to the CDC. The ACS states the use of condoms reduces the infection rate by about 70 percent.
The new advancement that works to prevent cervical cancer is an HPV vaccine. In June 2006 the United States Food and Drug Administration (FDA) approved the vaccine, which protects against HPV types 16 and 18, which cause 70 percent of all cervical cancers. The vaccine also protects against HPV types 6 and 11, which cause 90 percent of all genital warts. The other types of HPV are not prevented by use of the vaccine. The vaccine will not protect against or treat infections in women who have already been infected with HPV types 16, 18, 6, and/or 11. Also, it is never known how long a newly developed vaccine protects people. Research is being done to find out how long protection against HPV will last, and if a booster vaccine will be needed.
The FDA has determined the vaccine is safe and effective for females aged nine to 26. According to Dunleavy, “To be most effective, the vaccine should be given before a person becomes sexually active. It is recommended that it be routinely given to females aged 11 to 12.”
The vaccine is given via an injection, administered in three doses over one year. DCPH offers the vaccine to females ages nine to 26 at $10 per dose, for a total cost of $30. Dunleavy said, “The price is usually about $120 per dose, so this is a very cost-effective way to get the vaccine.”
OB/GYN physician Brian Wilson, M.D. said, “I perform several colposcopies each year on women to diagnose abnormal cervical cells. A lot of the time it is because the women are infected with high risk HPV. This vaccine is a tremendous breakthrough and I strongly encourage young girls to receive the vaccine before becoming sexually active.”
Wilson said some parents are apprehensive to offer the vaccine to their daughters, concerned it may send the message that it is okay to engage in sexual activity. He responds to that by saying, “You do not need to have intercourse to become infected with HPV. It just takes activity involving skin on skin contact. Plus, even if your daughter waits until marriage to engage in any sexual activity, there is no way to guarantee her husband has not waited and has not become infected with a high risk HPV. It is not a question of morals, but a question of health and protecting your daughter against cervical cancer.”
Studies are currently underway to determine if the vaccine will protect males from warts or from transmitting HPV to their partners, which would also reduce cervical cancer rates.
Women that have received the HPV vaccine must continue to have Pap tests. The ACS recommends the following guidelines for early detection of cervical cancer:
• All women should begin cervical cancer testing about three years after they begin having intercourse, but no later than 21 years of age. Testing should be done every year with the regular Pap test or every two years if using the newer liquid-based Pap test.
• Beginning at age 30, women who have had three normal Pap test results in a row may get tested every two to three years using either Pap test. Women who have certain risk factors such as DES exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be tested yearly.
• A reasonable option for women over 30 is to get tested every three years with either Pap test, plus the HPV DNA test.
• Women 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer testing. Women with a history of cervical cancer, DES exposure before birth, HIV infection, or a weakened immune system should continue to have testing as long as they are in good health.
• Women who have had a total hysterectomy may also choose to stop having cervical cancer testing, unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.
Those interested in more information or in receiving the vaccine are encouraged to talk to their healthcare practitioner or call Dickinson County Public Health at 712-336-2682.