The Story Behind the HPV Vaccine: It Can Protect Young Women From a Cancer-Causing Virus

Mar 06, 02:29 PM

Current Headlines: By Janice Gaston, Winston-Salem Journal, N.C.

Mar. 6--The letters HPV have flashed up frequently on TV screens and appeared in newspaper headlines, with good reason. HPV is short for human papillomavirus, a sexually transmitted virus that can cause cervical cancer. The virus will affect, at some point in their lives, at least half of all people who have sex. At least 250,000 people are infected with HPV each year in the United States.

Results of a recent study in the Journal of the American Medical Association showed that the virus is even more prevalent than experts previously thought. The study showed that a quarter of teenage girls have been infected with HPV and nearly half of women ages 20 to 24 have been infected. The study did not include men.

Two forms of the virus are responsible for about 70 percent of the cases of cervical cancer diagnosed around the world. Cervical cancer will kill more than 3,500 women in the United States this year.

The virus isn't new; experts have known about it for years. Researchers have discovered more than 100 types of the virus.

What is new is a vaccine that can protect women against HPV types 16 and 18, which cause 70 percent of cervical cancer, and types 6 and 11, which cause most genital warts. The Food and Drug Administration approved the vaccine, Gardasil, for sale last June.

The vaccine is available through the offices of obstetricians/gynecologists and some pediatricians. It will be available at the Forsyth County Health Department starting March 15.

The vaccine's developer, Merck & Co., has lobbied heavily for state legislatures to make the vaccine mandatory for girls. Although legislation to do so has been talked about in at least 30 states, only one state, Texas, has made the vaccine mandatory. A bill mandating HPV vaccinations for girls is awaiting the governor's signature in Virginia.

In North Carolina, the Commission for Health Services, the rule-making body for vaccines, has not yet discussed the vaccine, said Dr. Kevin Ryan. Ryan is the chief of the women's and children's health section in the N.C. Division of Public Health.

Vaccines work by destroying or making the disease they are fighting harmless. Gardasil, the HPV vaccine, tricks the body, said Dr. Andrea Fernandez, into thinking it is infected by a strain of HPV and causing it to fight back. Fernandez is an obstetrician and gynecologist at Wake Forest University Baptist Medical Center.

The ability of some vaccines to keep diseases at bay can lessen over time, requiring booster shots. Researchers don't have enough data yet to know how long Gardasil remains effective or whether women will eventually need boosters.

The vaccine's use is limited to females between the ages of 9 and 26. Experts recommend that girls be vaccinated at 11 or 12, before they are likely to be sexually active. The vaccine is administered in three doses, at a cost of $120 for each dose, which most insurance companies cover.

Fernandez has seen many mothers bring their daughters in for vaccinations and ask for it themselves. But data on the vaccine's effectiveness for women over the age of 26 is not available.

HPV can live in the body without causing any adverse effects, and it can go away on its own. But the nature of a woman's cervix makes the tissue especially susceptible to the virus, said Dr. Rolland Barrett. Barrett is a gynecologic oncologist at Forsyth Medical Center.

The cervix contains a "transformation zone" where tissue changes from one type to another during a woman's childbearing years.

"Any cell that is rapidly changing, reproducing and replicating is more susceptible to the effect of a virus," he said.

HPV causes about 90 percent of genital warts, which can be treated but not cured, Fernandez said. They can disappear on their own, or they can grow large enough to obstruct the birth canal. Treatments include creams and removal by freezing or burning. Warts can grow back after being removed.

The best prevention for genital warts is to avoid getting the HPV virus or being vaccinated against it, she said.

Local doctors who treat the effects of the HPV virus have greeted the development of the vaccine with enthusiasm, Barrett said.

"Many of us think it's certainly one of the major breakthroughs in the world of cancer research in the past decade," he said. "The best way to treat cancer is to prevent cancer. This is the first time we've had anything we could use widely to prevent cancer."

According to the National Cervical Cancer Coalition, 493,000 women worldwide will develop cervical cancer this year, and 273,500 will die. It is the second-leading cause of cancer deaths worldwide.

The HPV vaccine has proven to be virtually 100 percent effective, Ryan said. And clinical trials have shown side effects to be minimal.

According to Fernandez, the effects are the same that people experience with any injection -- pain at the injection site, redness and a low-grade temperature. The introduction of the vaccine and state governments' interest in it has prompted much public discussion.

"On the pro side, it's a tremendously effective vaccine," Ryan said. "On the other side, there are a lot of concerns."

People have complained about Merck's self-serving advocacy on behalf of the vaccine. Merck stopped its lobbying efforts last month.

People have fretted over their states' abilities to pay for the vaccine. And people have voiced resentment that a state would mandate the use of a vaccine that they feel could encourage early sexual activity.

An argument that satisfies both sides, Ryan said, is a mandate that allows parents an out if they don't want their children vaccinated. In Texas, parents can ask for an exemption for their children. From a public-health standpoint, Ryan said, he would like to see this vaccine provided to as many girls as possible.

Dr. Tim Monroe, the director of the Forsyth County Health Department, said that every child should receive all the protection that is available, including the Gardasil vaccine.

"Its ability to prevent disease is enormous," he said. "I feel that it ultimately needs to be a requirement and will be. How long it will take to occur in North Carolina, I'm not sure." In North Carolina, all vaccines required by the state are paid for by state money.

"There's going to be a price tag on this," he said. But as a child grows into an adolescent, sexual activity becomes a possibility. With a mandatory vaccine, girls would have protection against the most damaging forms of HPV, whether they choose to be sexually active or not, he said.

"It's difficult to control those decisions. Those decisions they will make on their own."

When it comes to money, he said, "you have to look at the burden of disease that it can prevent and all the loss that would be associated with that."

Fernandez said that making the vaccine mandatory takes the focus off where it needs to be -- on the underprivileged, including young women who can't afford to get routine Pap smears, the most valuable weapon against cervical cancer for the past 50 years.

"Those are the girls we really want to get vaccinated," she said. Rather than allocating state money to vaccinate every middle-school girl against HPV, she would rather Medicaid in North Carolina make money available to pay for vaccinating young women who would not be covered under a mandatory vaccination law.

Medicaid covers the vaccination for eligible girls ages 9 to 18.

Right now, Fernandez said, she can and does vaccinate girls with health insurance against HPV.

"If you're between 18 and 26, you are in that one group that no one has coughed up the money for," she said. "We cannot get them vaccinated; we cannot prevent the risk of cervical cancer.

"And it breaks my heart."

--Janice Gaston can be reached at 727-7364 or at jgaston@wsjournal.com.

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Copyright (c) 2007, Winston-Salem Journal, N.C.

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