Guest Author - Denise Howard, M.D., M.P.H.

The identification of Human Papilloma Virus (HPV) as the causative agent of cervical cancer made development of a vaccination possible. This is indeed a landmark event in the battle against cancer. The vaccination has the potential to significantly decrease the incident of cervical cancer. It is estimated that the incident of high grade cervical dysplasia would be reduced by 33-50% in industrialized countries.

HPV is associated with cervical and vaginal dysplasia , cervical cancer and genital warts. There are approximately 35 types that infect the genital tract. Types 16 and 18 are associated with 70% of the cervical cancers while types 45 and 31 are associated with another 5%. HPV types 6 and 11 cause 80% of the cases of genital warts. Roughly 40% of people are infected with more than 1 type of the virus. The good news is that 75-90% of these infections are cleared by the body within 1 year of initial infection.

There are 2 vaccinations that are being studied. The bivalent vaccination is designed to prevent infection with HPV types 16 and 18. It is not yet available for general use. The quadrivalent vaccination is currently available as Gardasil. It is manufactured by Merck. It is designed to prevent infection with HPV types 6, 11, 16 and 18.

One trial of the bivalent vaccination in over 1000 women showed efficacy in 99% of the recipients at 4.5 years. In addition protection against HPV 45 and 31 was found in 94 and 55% of enrollees. The vaccination was safe and well tolerated.

Another trial of the quadrivalent vaccine in over 500 women revealed a >85% efficacy against the HPV types targeted and 100% effectiveness in preventing cervical dysplasia, cervical cancer and genital warts due to the targeted HPV types. Again the vaccine was well tolerated and safe. The clinical trials are still ongoing.

The quadrivalent vaccine is now recommended for females age 9-26 years. It ideally should be given before the onset of sexual activity. It is administered in 3 doses. The second dose is 2 months after the first and the final dose is 6 months after the initial one. If a woman is 21 years or older a pap test should be performed prior to vaccine administration. If cervical dysplasia is found then it should be treated appropriately. The vaccine can be administered once resolution of the cervical disease is confirmed.

Vaccinations are a routine part of healthcare prevention. This addition to the preventative armamentarium could prevent needless death and suffering in our daughters.

http://www.bellaonline.com/articles/art34256.asp Human Papilloma Virus and Cervical Cancer

http://www.bellaonline.com/articles/art37873.asp Detection and Treatment of Cervical Dysplasia