I recently read there is a new vaccine available to prevent cervical cancer, and it is recommended for patients between the ages of 9 and 26 years. Why should my daughter get such a vaccine if she is not sexually active?
Cervical cancer carries a heavy burden, yet it is relatively preventable. This form of cancer is associated with a virus known as the Human Papillomavirus (HPV), which is transmitted during sexual intercourse. There are more than 150 types of HPV, in which 15 types are associated with a high risk of cervical cancer.
This past summer, a vaccine for HPV known as Gardasil was approved in Canada. This new vaccine can prevent 70% of all cases of cervical cancer. It may also prevent some forms of vulvar and vaginal cancers associated with HPV.
At a recent International Papilloma Conference in Prague, one of the conference organizers, Dr. V. Vonka, was quoted as saying, "This is one of the best vaccines ever developed." A senior medical specialist with the Public Health Agency of Canada, Dr. Shelley Deeks, echoed this opinion.
Currently, there are only two pharmaceutical companies which provide a vaccine for HPV: Merck and GlaxoSmithKline. The Gardasil vaccine, manufactured by Merck, is known as a quadrivalent vaccine because it covers against four HPV types: 6, 11, 16, and 18.
The vaccine is given intramuscularly in the arm or thigh. Three dosages are required to give maximum protection. After the first dose, a second dose is given 2 months later, and the third dose is given 6 months after the first dose. Studies have not shown any interaction between the vaccine and products such as anti-inflammatory medication, antibiotics, analgesics, herbs, some foods, or vitamin supplements.
Experts recommend vaccination should start in the teen years (as early as 9 years of age), even if a teenage girl is not sexually active, in order to protect her from probable future risks of cervical cancer. There is also some suggestion that the younger a girl is when she receives the vaccine, the higher her protection level will be later in life.
According to a recent publication (April 2006) by Dr. Jane D. Brown and colleagues from the University of North Carolina at Chapel Hill, children are heavily influenced by media when they decide to become sexually active during the teen years. For a free abstract of this study, see www.Pediatrics.org (“Sexy media matter: Exposure to sexual content in music, movies, television, and magazines predicts black and white adolescents' sexual behavior”. Pediatrics, 117, 1018-1027).
Other disturbing data from a recent survey (www.monitoringthefuture.org) showed that approximately 23% of sexually active teens used alcohol or other drugs before their sexual encounters. The point is that even though some teens plan not to be sexually active, they often engage in such behavior under the influence of intoxicating substances.
But what if a girl is not sexually active and remains that way until she gets married? This is where things get complicated. A woman may be a virgin when she gets married, but unless her future husband is also a virgin, she may still be at risk for contracting HPV from him.
How likely is it that her future husband will have HPV if he is not a virgin when they get married? Nobody knows for sure, but experts estimate that at least 50% of sexually active people will contract genital HPV. Furthermore, at least 75% of sexually active men and women will be exposed to HPV at some point.
The question of if and how condoms protect against HPV remains difficult to answer. According to a recent North American survey of teens, a greater percentage of sexually active teenagers are using condoms (63% in 2006 versus 46% in 1991). However, the protection of condoms against this virus remains uncertain. At the very least, there is agreement that whatever protection may exist, it may not be as high as previously thought. This finding has lead to the excitement over the Gardasil vaccine.
As is the case with most new vaccines, there are still some questions which need to be addressed such as:
- Should boys also be vaccinated?
- How long will the protection last? (Present evidence shows no sign of waning immunity after 5 years).
- When will a booster dose be required?
- What protection exists with incomplete dose administration?
The vaccine is quite expensive, and is not covered by any province in Canada at the present time. In order to have a Canadian perspective, towards the end of this year, the Canadian National Advisory Committee on Immunizations (NACI) will provide Canadian physicians with more recommendations on how to utilize and promote this vaccine.
Corporate research of physicians and consumers, conducted in 22 countries between the years 2001 and 2005, came up with data showing there is also much room to improve on awareness of HPV:
- Only 4% of Canadian pediatricians said they were very or extremely knowledgeable about HPV.
- Of Canadian family physicians, 25% said they were very knowledgeable.
- Consumer surveys showed there is a general lack of knowledge about HPV. When told that HPV is a sexually transmitted disease which can cause cervical cancer, many expressed shock, fear or anxiety.
Currently, there is a public awareness effort under way in Canada to address this deficiency (www.tellsomeone.ca).
Information geared toward physicians (www.hpvtoday.com) provides ongoing clinical education. More information, independent of industry sponsored sites, can be found on the site of The Society of Obstetricians and Gynecologists of Canada (www.hpvinfo.ca).
An additional site which provides very detailed and extremely useful information on the cervical cancer vaccine can be found at the Mayo Clinic web site (www.mayoclinic.com/health/cervical-cancer-vaccine/WO00120).
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