Vaccine protects against HPV

By Paula McGarvey for The Montana Standard - 09/26/2006

In a major breakthrough in women’s health care, a new vaccine is offering young women the opportunity to protect themselves from several cancer-causing strains of the human papillomavirus (HPV).

Recently licensed by the Food and Drug Administration, the Gardasil® vaccine protects against four virulent types of HPV. According the Centers for Disease Control and Prevention (CDC), these strains are responsible for

70 percent of all cervical cancers and 90 percent of genital warts.

The American College of Obstetricians and Gynecologists (ACOG) are currently recommending the vaccine be given to females between the ages of 9 and 26. The federal Advisory Commission on Immunization Practices is recommending that the vaccine be routinely given to all girls between the ages of 11 and 12.

Worldwide, cervical cancer is the second leading cause of cancer deaths in women with nearly half a million new cases and

275,000 deaths annually. ACOG reports that the HPV vaccine shows great promise in controlling the spread of cervical cancer and

genital warts.

“I really feel it will change the face of cervical cancer as we know it,” said local pediatrician Dr. Jill Robison of Pediatrics Plus. Robison said that the HPV vaccine has been found to be extremely effective when given to girls prior to

becoming sexually active.

“In the studies they did,

100 percent of the women

developed immunity,” said Robison.

The CDC reports that the

vaccine is slightly less effective in women who have already been exposed to one of the four HPV types covered by the vaccine.

The Gardasil vaccine is given in a series of three shots over a

six-month period and costs about

$120 per dose.

Most large insurance plans

usually cover the costs of recommended vaccines, although there is often a lag time between the time

of recommendation and when

coverage goes into effect.

Despite the effectiveness of the vaccine, recommendations on Pap screening tests for cervical cancer remain unchanged. ACOG currently recommends Pap test screening begins within three years of having sexual intercourse, or by age 21. Annual testing should continue up to the age of 30, when women who have had three consecutive

negative Pap tests may choose to decrease screening to every two to three years.

Butte Obstetrician and Gynecologist Dr. Rindo Sironi of Continental Divide OB/GYN said the Pap test is an effective

screening test for cervical cancer.

“It’s not 100 percent,” he cautioned, but added that the test does have a very low rate of false

negative results.

To perform a Pap test, the doctor inserts a device called a speculum into a woman’s vagina. This widens the vagina and allows the lower, narrower end of the uterus called the cervix to be seen. Cells are collected from the cervix and placed in a transport solution. The sample is sent to a laboratory and the cells are placed on glass slide and

examined under a microscope.

“HPV causes abnormal cells,” explained Sironi.

Abnormal cells are routinely classified according to their appearance. Although some cells are obviously cancerous, Sironi said that when a cell’s appearance is questionable, the sample is

tested for HPV. If a strain of HPV that is considered high risk for causing cervical cancer is found, the patient undergoes a follow up procedure called a colposcopy.

During the procedure, a doctor will apply a dilute acetic acid solution inside the vagina. A thin, lighted tube called a colposcope, is used to look for abnormal changes in the cervix and vaginal lining. During the procedure, the physician also performs a biopsy, which takes small tissues samples for

microscopic exam.

Treatment is based on the degree of cell abnormality found on biopsy. Sironi said certain cell changes will automatically go away on their own within six months, and women can chose to “watch and wait” to see if their condition improves. In more severe cases, the affected areas can be frozen, removed with a scalpel or burned with a laser. Treatment is more aggressive if cancerous cells are found.

“If it’s cervical cancer, the treatment is usually a radical hysterectomy or radiation,” Sironi said.

The only sure way to avoid contracting HPV is to abstain from intercourse, Sironi said, but people could decrease their exposure by limiting their number of

sexual partners.

Sironi added that condoms are only partially effective in limiting the spread of HPV because the virus can be present in skin located outside protected areas. As an added warning, Sironi said smokers and those who are immunosuppressed are more susceptible to infection.

Despite the benefits of the new vaccine, Sironi encouraged women to continue to have regular Pap tests according to ACOG guidelines.

“Our whole goal is to prevent cervical cancer,” he said.