WASHINGTON, DC—Physicians, public health advocates, and women legislators gathered here at the Second Annual HPV & Cervical Cancer Summit to emphasize the urgency of making the recently approved human papillomavirus (HPV) vaccine widely available so that it can deliver on its promise of helping to eliminate cervical cancer.
The summit was sponsored by the nonprofit, bipartisan Women in Government, which represents female state legislators.
The federal Advisory Committee on Immunization Practices (ACIP) has recommended that the HPV vaccine—which protects against HPV types 16 and 18—be given routinely in a series of three doses over six months to girls age 11 and 12, an action that Women in Government supports.
The Centers for Disease Control and Prevention will likely adopt ACIP's recommendations. More than 20 million US men and women are infected with HPV, and there are 6.2 million new cases each year, according to the CDC. In the United States, there are about 9,710 new cases of cervical cancer each year and about 3,700 deaths. Globally, cervical cancer is the second leading cancer-killer of women, with nearly 250,000 deaths a year—and not just in the developing world.
“In Ireland today we are still seeing advanced cases of cervical cancer,” said Henrietta Campbell, MD, Chief Executive of the All Ireland Cancer Foundation in Belfast.
State Policies Key
Regardless of the CDC's recommendations, state policies will be the key to widespread availability of the HPV vaccine in the United States, according to speakers at the summit.
The broadest coverage would occur if states required public schools to mandate the HPV vaccine as a condition of school entrance, they said. (The majority of states still allow vaccination exemptions for medical or religious reasons, and it is not known how many parents might object to the vaccine.)
State bills related to HPV immunization have been filed in New Jersey and Texas, while Vermont and Illinois are considering such legislation.
“This vaccine really, really works; we can prevent HPV from now on,” said Juan C. Felix, MD, Professor of Pathology and Obstetrics and Gynecology at the Keck School of Medicine, University of Southern California. ''But if we don't have widespread use of this vaccine, we won't eradicate the virus.
“We can do it, and what we have to do is make sure our kids get it. If you don't mandate it, I assure you that women in the United States who are dying of cervical cancer will continue to die of cervical cancer.”
“Cervical cancer is one of the few types of cancer that can be prevented,” commented Marie Savard, MD, Associate Clinical Professor of Medicine at Jefferson Medical College. “The journey to protect women from cervical cancer has been remarkable, and with HPV testing and the HPV vaccine we are much further down the road.”
“Cervical cancer is a preventable disease,” agreed Ralph Richart, MD, Emeritus Professor of Pathology in Obstetrics and Gynecology in the Department of Pathology at Columbia University College of Physicians and Surgeons. “This vaccine offers 100% protection against HPV types that cause about 70% of cervical cancers and their precursors, as well as 90% of venereal warts and HPV-related lesions of the vulva, vagina, and probably, anus. Vaccination of girls prior to their sexual debut offers the highest level of protection.”
He said protection from the HPV vaccine “appears to be type specific and long-lasting,” with data out to four years suggesting no need for a booster shot.
The cervical cancer vaccine is a major step forward in part because the Pap test, good as it is, is far from 100% accurate, speakers noted.
“The Pap test is only about 70 to 80 percent accurate; it can miss an abnormality as much as 30 percent of the time,” said Mark S. DeFrancesco, MD, Chief Medical Officer for Women's Health Connecticut and Assistant Clinical Professor at the University of Connecticut School of Medicine.
In addition, he said, “most women become infected with HPV soon after beginning intercourse…most people will have clear high-risk HPV, but some do not.” Dr. DeFrancesco added, “We're not talking about the sailors in Marseilles; we're talking about our kids….We could argue all day about who funds it [the HPV vaccine], but the fact is we are going to get there. If you can get it into the schools, I think it makes a lot of sense.”
So why doesn't everyone else seem to be as concerned about vaccinating young girls with the HPV vaccine as physicians and health advocates speaking at the summit? “When I talk to physicians about this, I say, ‘Why aren't you excited?’” Dr. DeFrancesco said. “And they say, ‘Well, we don't see a lot of cervical cancer.’”
He said it is important for physicians to advocate for the vaccine whether or not their patient population reflects high-risk groups of women more likely to develop cervical cancer.
Dr. Felix emphasized that parents need to understand the realities of sexual activity in the US society. “Absence of genital contact in our society is very rare,” he said. “Condoms are effective, but they're often improperly used.”
He noted that young women attending an urban college have as high as an 8% chance of being raped. And married adult women are not free of risk. On a questionnaire study, some 80% of married US men and 40% of married US women freely admitted having extramarital affairs, he said.
Dr. Richart predicted that once the infrastructures are in place to deliver the HPV vaccine, it will have a remarkable effect: “Because it can prevent HPV infection and subsequent development of cancer precursors and cancer, the impact is expected to be enormous—particularly in developing countries where cervical cancer risks are high and access to care is low.”
He also predicted that two other advances related to HPV will occur: protection against other high-risk types and an HPV vaccine for men.
“It is likely that more oncogenic risk HPV types will be added to increase the level of protection,” he said. “Approval of an HPV vaccine for men is also likely.”
In 2004 Women in Government declared a challenge campaign to eliminate cervical cancer in the United States. As part of that campaign, in 2005 the group issued a call to action assessing state efforts to eradicate cervical cancer.
In 2005 and 2006, no state scored an “excellent” grade on that effort, but in 2006 10 states received a “very good” rating, whereas in 2005 only four states received that rating. Factors that go into a state rating include: more insured women; Medicaid coverage for HPV testing in screening; and a strong legislative focus on the issue of eradicating cervical cancer.
The group's call to action made the point that while widespread use of the HPV vaccine is a critical component of eradicating cervical cancer, cervical cancer screening is still important and should be available to all women.
Further information is available at the organization's Web site: www.womeningovernment.org