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Vaccine for Cervical Cancer!

  
 
Fist of Fun
11:22 / 20.11.02
OK, this is pretty astonishing. It appears that scientists have come up with a "vaccine for cervical cancer". Sounded weird to me, then I read the article below:
http://news.bbc.co.uk/1/hi/health/2495029.stm

It turns out it's a vaccine for the virus which causes almost 100% of cervical cancers. It has had a 100% success rate on initial trials (technically a 100% reducction in cases of the relevant virus, which I guess means nobody in the trial group had the virus). Going to do wider trials around the world this year.

Odd thing though - only applicable to pre-sexually active females, so most of our age group are out.

Anybody any idea why this is the case? Does the vaccine make you blow up if you've had nookie? Is it the scientists' way of pointing out that "We're not getting any, and I don't see why anybody else should...". More seriously, would 'sexually active' be limited to heterosexual activity?
 
 
Linus Dunce
17:39 / 20.11.02
The phrasing used is:

The vaccine would be given to teenage girls. It would only work in females who have not yet become sexually active.

This is because HPV is transmitted through sexual intercourse.

and is a spectacularly poor piece of writing/copy editing. The truth is probably that it will work with females who are sexually active but only if they've not got got the virus already. I'm pretty sure nothing likely happens, good or bad, if you give a vaccine to someone already infected with something. But maybe the chance of side effects (and/or possibly the expense) statistically outweighs the likely benefits to older women. And I'm guessing HPV is HPV, whomever you're shagging.

Having said that, I'm not a doctor. Nurse?!
 
 
ibis the being
16:22 / 04.02.07
Odd thing though - only applicable to pre-sexually active females, so most of our age group are out.

Anybody any idea why this is the case? Does the vaccine make you blow up if you've had nookie?

Odd thing though - only applicable to pre-sexually active females, so most of our age group are out.

Anybody any idea why this is the case? Does the vaccine make you blow up if you've had nookie?

I'm pretty sure the reason is that HPV infection rates are so high that if you have had sex even once, you've more than likely already contracted HPV and therefore the vaccine would be useless to you. The stats say that (at least in the US) over 70%, or 3 out of 4, sexually active adults have had HPV at one time. You could get tested for HPV and if you have not had any of the four strains that Gardasil protects against, you could get the vaccine at any age. But the idea behind the age recommendation is to catch girls before they become sexually active... and since you can contract HPV without having actual intercourse, it's wise to set that age limit pretty low.

Planned Parenthood HPV info
 
 
harmonic series
00:53 / 17.02.07
Odd thing though - only applicable to pre-sexually active females, so most of our age group are out.

This is incorrect information. The age limit (of effectiveness) for the vaccine is 26 years old.

There are many strains of HPV (Human papillomavirus), about 25% of those strains have a high rate of causing cell mutation that can lead to cervical cancer. If a woman has been exposed to one of these strains and cells are changing they are likely to undergo a procedure which removes the affected tissue, generally a LEEP procedure. Often times the procedure itself will cause the body to "kick-start" the fighting off of the initial HPV infection. Thus a woman who has had the infection can still receive the vaccine so that it may be effective in the future. Also, any woman who has or has not had sex can benefit from this vaccine if they are ever to be sexually active (if they are 26 or younger).

The vaccine is administered in 3 sessions over a period of 6 months. The first vaccine, 2 months, the second vaccine, 4 months, the third vaccine. The area of injection was reported to be quite painful in studies, so expect lots of pain in that arm for maybe most of the day. Other than that, few (or rarely occuring) side effects have been reported.

The most important reason for women to get this vaccine is because men can carry HPV with absolutely no symptoms, and it is not currently possible to test for the virus in men.

Men cannot be vaccinated for HPV at this time.

So, ladies, get paps regularly (at least once a year), look into this vaccine, and if your partner has slept with anybody besides you, be as safe as you can be.
 
 
ibis the being
02:00 / 17.02.07
Lolo... I think your statistics are a bit off. It's my understanding that there are about 100 strains of HPV, most of being non-genital strains; around 40 are mucous-membrane strains (including genital HPV). Two strains in particular are linked with cervical cancer - HPV 16 and 18. However, I think it's important to note that medical literature does not precisely say that HPV causes cancer... rather, most cervical cancer cases will show HPV 16 or 18 to be present as well.

In addition, it's my personal feeling that LEEP procedures are pushed too aggressively in the US. I personally know at least five women who've had them, but studies show that most HPV infections clear in 6-12 months, and most cases with low grade cervical displaysia clear within 2 years. The vast majority of HPV cases will never be cancerous. And when it does lead to cancer, it is a very slowly progressing and treatable cancer. This is not to downplay the importance of the vaccine, but I think there is a tendency to overblow the risks of HPV, while many gynecologists believe that generally the virus is about as common, and about as dangerous, as the common cold.

How is HPV related to cervical cancer?

Almost all (>99 percent) cervical cancers are related to HPV. Of these, about 70 percent are caused by HPV types 16 or 18. About 500,000 pre-cancerous cell changes of the cervix, vagina, and vulva are diagnosed each year in the US, and over half are related to HPV 16 and 18. Low-grade cervix cell changes are caused by a variety of HPV types, including 16, 18, 6, or 11.

Although nearly all cervical cancers are related to HPV, most genital HPV infections do not cause cervical cancer. Most people who test positive for genital HPV DNA in research studies eventually test negative, often within 6 to 12 months. Scientists are still not sure whether this means that a person’s immune system has completely destroyed all of the HPV or has only suppressed the infection to an extremely low level (too low to be detected by available tests). If even a few cells of the cervix still contain HPV, it’s possible that the virus may start to become active again if your immune system becomes very weakened.

It is possible that some low-grade cervix cell changes and some high-grade cervix cell changes may suddenly occur many years after first HPV exposure. This could help explain how a woman could get such changes after many years of normal Pap tests and no history of a partner change.

If the HPV infection isn’t eliminated or suppressed, the virus may cause cervix cells to change and become pre-cancer cells. True pre-cancer cell changes are called high-grade SIL (squamous intraepithelial lesions), sometimes abbreviated as HSIL. Another term for HSIL is CIN 2 and CIN3. CIN is an abbreviation for cervical intraepithelial neoplasia.

Pre-cancer cells are not cancer. Although some pre-cancer changes may return to normal on their own, most cases of CIN 3 are likely to progress to cervical cancer over a period of time that probably takes about 10 years if not detected and treated. But very few HPV infections lead to cervical cancer. Pre-cancer cells are found by having regular Pap tests.

(Source for above info.)
 
 
harmonic series
19:36 / 17.02.07
Lolo... I think your statistics are a bit off.

I apologize for the simplified statistics. Following is some more detailed information about the strains of HPV, their effects and the risks involved.

However, I think it's important to note that medical literature does not precisely say that HPV causes cancer... rather, most cervical cancer cases will show HPV 16 or 18 to be present as well.

Please note the first few lines of the following information.

Human Papilloma Virus Testing in Cervical Cancer Prevention (I had to link to the Google search for the website b/c using the link to the direct page requires user name and password. Choose the second link on Google with the name of the above link.)

Almost all strains of HPV that infect the anogenital tract are capable of causing abnormal cervical cytology. A clear causal relationship has been established between HPV infection and cervical cancer, and HPV is found in nearly 100% of cervical malignancies worldwide. This link is the highest attributable fraction ever identified for a specific cause of a major human cancer worldwide. The latency period between initial HPV exposure and development of cervical cancer may be months to years. Although rapid progression is possible, average time from initial infection to manifestation of invasive cervical cancer is estimated at up to 15 years.

Genital HPV strains are divided into two groups, based on their oncogenic potential and ability to induce viral-associated tumors. Certain strains termed "high-risk strains" (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) are associated with intraepithelial neoplasia and are more likely to progress to severe lesions and cancer. Of these, HPV 16 and 18 are the most carcinogenic and most prevalent. HPV 16 is the predominant strain in almost all regions of the world, with the exception of Southeast Asia, where HPV 18 has the highest prevalence. HPV 16 alone accounts for more than 50% of HPV infections, and it is estimated that almost 20% of American women are infected. High-grade cervical intraepithelial lesions are most commonly associated with HPV 16 and 18, yet these strains are also frequently found to be the etiologic factor in minor lesions and mild dysplasia.

Low-risk strains (HPV 6, 11, 42, 43, and 44) are associated with condylomata and low-grade cervical changes, such as mild dysplasia. Lesions due to low-risk HPV infection have a high likelihood of regression, little potential for progression, and are considered of no or low oncogenic risk. It is hypothesized that the different high- and low-risk HPV strains exert varying degrees of transmissibility, yet no clear data exist to define this parameter of infection.

Despite the significant correlation between high-risk HPV and cervical cancer, 80% of infections are transient, asymptomatic, and resolve without treatment (Figure 1). When this occurs, HPV-related cervical intraepithelial lesions spontaneously regress, and HPV is no longer detectable in the cervix…. Median duration of locally detectable HPV infection ranges from 6 to 14 months. Within 2 to 4 years, only 15% to 25% of low-grade cervical intraepithelial lesions progress to high-grade severity. Persistent high-risk HPV infection is the key attribute of high-grade cervical disease.

Prevalence of HPV is greatest in young, sexually active individuals. For women, prevalence peaks in the 20- to 24-year-old age group, with estimates as high as 50%. The 15- to 19-year-old age group has the next highest rates of HPV infection.

HPV in adolescents is frequently short-lived and spontaneously regressive, whereas infection in older women tends to persist.


And when it does lead to cancer, it is a very slowly progressing and treatable cancer.
This is not to downplay the importance of the vaccine, but I think there is a tendency to overblow the risks of HPV, while many gynecologists believe that generally the virus is about as common, and about as dangerous, as the common cold.

This does downplay the importance of the vaccine. How many common colds can lead to hysterectomies? Not to be doom and gloom here, but have a look at this website which discusses treatment options for cervical cancer.

Which surgery for cervical cancer?

Note that early cervical cancer treatment includes hysterectomy. Who wants a “very slowly progressing and treatable cancer”? The “treatments” are not pleasant options. Why risk not getting the vaccine? If a woman is living her life based on odds, on dice, there really isn’t any fore-thought or calculated safety involved. And if one is a male, he shouldn’t advise a woman to play her life as if it is a roulette game.

Do you have a medical problem with the vaccine itself?

In addition, it's my personal feeling that LEEP procedures are pushed too aggressively in the US.

As far as LEEP being aggressively pushed, that’s a totally different issue. Receiving a LEEP depends largely on the woman’s desires, concerns and level of personal research and understanding of her own condition. If her reports are showing CIN 2 or CIN 3, it would probably be wise to consider the procedure. Also remember that a doctor has a requirement to minimize risk of death, and that should be taken into consideration as a reason for why LEEP is strongly suggested. It is the woman’s ultimate responsibility to ask where her risk lies, and it is her decision how she wants to proceed with her own physical health.
 
 
ibis the being
21:50 / 20.02.07
Do you have a medical problem with the vaccine itself?

No, I have no problem with the vaccine; I'm strongly in favor of it. I just have a personal distaste for what I perceive to be scare tactics (not from you per se, but from some of the medical profession) about sexual infections, particularly when they relate to women's health issues... but that is probably not a Lab discussion so I'll leave this be.

In other news, Merck is suspending lobbying efforts to have state mandates for the vaccine, in response to pressure from conservative and parents' groups.

The drug maker, which announced the change Tuesday, had been criticized for quietly funding the campaign, via a third party, to require 11- and 12-year-old girls get the three-dose vaccine in order to attend school.

Some had objected because the vaccine protects against a sexually transmitted disease, human papilloma virus, which causes cervical cancer. Vaccines mandated for school attendance usually are for diseases easily spread through casual contact, such as measles and mumps.

"Our goal is about cervical cancer prevention and we want to reach as many females as possible with Gardasil," Dr. Richard M. Haupt, Merck's medical director for vaccines, told The Associated Press.

"We're concerned that our role in supporting school requirements is a distraction from that goal, and as such have suspended our lobbying efforts," Haupt said, adding the company will continue providing information about the vaccine if requested by government officials.
 
 
Evil Scientist
11:08 / 21.02.07
No, I have no problem with the vaccine; I'm strongly in favor of it. I just have a personal distaste for what I perceive to be scare tactics (not from you per se, but from some of the medical profession) about sexual infections, particularly when they relate to women's health issues... but that is probably not a Lab discussion so I'll leave this be.

I disagree that this is not a Lab issue. A discussion of this nature is precisely suited to this forum.

Can I ask why you percieve them to be scare tactics?
 
 
ibis the being
22:26 / 21.02.07
Well, it's hard for me to discuss this subject without veering into heavily anecdotal territory, which makes me frown... but if you're interested anyway....

Depending on the source, HPV is either a dangerous life-threatening pre-cancerous disease or a mild skin infection that usually just goes away. I've read as much as I could bear to on it and always the information varies in that way. I personally know (well) at least six women who've gotten an HPV diagnosis, as have I.

Talking to these women, most of whom were close friends of mine (meaning we could discuss it intimately & thoroughly), I have heard different accounts of what their/my doctors told them about it. Generally they fall into one of two camps - one says this is a horrible, incurable sexually transmitted disease that never goes away, is highly contagious, threatens women's fertility and often leads to cancer (and my friends who received that type of diagnosis adamantly adhered to that attitude)... it should be closely monitored and probably involve LEEP; one should tell all of one's past & present & future partners one has an STD. The other camp says this is an extremely common, usually not serious infection, rather like a skin infection, that is as prevalent and in most cases about as severe as the common cold, and should be closely monitored but will more than likely just go away on its own; one should practice safe sex as a matter of course (my GYN fell into that category, as did others I've heard about from friends).

The statistics I've read say that somewhere around 75%-95% of HPV infections clear on their own (depending on the source), and yet of the 6 or so women I know who've had/have HPV, at least 4 have have LEEP. Do I associate with a disproportionate number of high-risk displaysia HPV cases, or is LEEP perhaps overprescribed?

I think sexual politics almost always come into play when sexual disease is addressed. I have always wondered why, at least in my experience & perception, HPV is primarily focused on as a woman's problem (and maybe a gay men's problem depending on source). (Straight) Men don't know they have it, they don't usually have symptoms, so... whatever? If it is so highly cancerous and life threatening oughtn't they worry as much as we do about this? Or is the risk overplayed because women are more commonly diagnosed - due to the simple fact that we go for regular pap smears - and it is still not completely acceptable for women to have recreational sex in our (US) culture?
 
 
Evil Scientist
07:36 / 22.02.07
I think sexual politics almost always come into play when sexual disease is addressed. I have always wondered why, at least in my experience & perception, HPV is primarily focused on as a woman's problem (and maybe a gay men's problem depending on source). (Straight) Men don't know they have it, they don't usually have symptoms, so... whatever? If it is so highly cancerous and life threatening oughtn't they worry as much as we do about this? Or is the risk overplayed because women are more commonly diagnosed - due to the simple fact that we go for regular pap smears - and it is still not completely acceptable for women to have recreational sex in our (US) culture?

Sexually-transmitted HPV is believed to be a major cause of anal and throat cancers, and you're right that it shouldn't just be of concern to women. However the fact remains that, as far as I am aware, woman who do not have a history of infection by HPV are at a greatly reduced risk of developing cervical cancer.

I'm surprised that a form of PAP smear hasn't been developed to look for non-cervical HPV-caused cancer, and isn't regularly used to check other groups at risk of HPV-caused cancers. But, that said, the biggest population at risk is the female population (again, as far as I am aware).

I agree that sexual politics is a factor, but I don't think that the risk should be underplayed.

Do I associate with a disproportionate number of high-risk displaysia HPV cases, or is LEEP perhaps overprescribed?

Armchair commentating here but I would probably be inclined to think that it may be being overprescribed simply to play it safe rather than leave something that may turn out later to be malignant (and considering the slow development of the cancer cells in this particular instance I can see how that would be a concern). Also consider that failure to diagnose cancer as a result of PAP smear has (in at least one case) resulted in the doctor involved being prosecuted for negligent homicide.

Surely if anything this vaccine, combined with usual safe sex methods, ensures that women can enjoy risk-free recreational sex?
 
 
ibis the being
22:00 / 22.02.07
woman who do not have a history of infection by HPV are at a greatly reduced risk of developing cervical cancer.

True enough, but not so for the inverse statement. One could also say that men are at a greatly reduced risk of developing breast cancer... however, to say that women have a drastically higher rate of breast cancer, while strictly true, doesn't present a complete or accurate picture of what causes breast cancer or how likely any given woman is to get it.

Armchair commentating here but I would probably be inclined to think that it may be being overprescribed simply to play it safe rather than leave something that may turn out later to be malignant (and considering the slow development of the cancer cells in this particular instance I can see how that would be a concern). Also consider that failure to diagnose cancer as a result of PAP smear has (in at least one case) resulted in the doctor involved being prosecuted for negligent homicide.

Okay. But that bothers me. Though LEEP is a minor outpatient procedure, I don't like the idea of preemptive surgery where the risk factor of the disease is skewed by fear of lawsuits. LEEP is not without its complications, it costs money (we don't have natl health insurance remember), and there is still the unaddressed issue of what the effect on the woman - the person - is by being told/suggested they have skirted cancer by just barely a hair when that may not be true at all.

Surely if anything this vaccine, combined with usual safe sex methods, ensures that women can enjoy risk-free recreational sex?

Once again, big fan of the vaccine. But I think there are ways of promoting it without a scare campaign.
 
  
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