Detroit Free Press

Young women and parents of girls as young as 9 likely will face a new question at the doctor’s office: Should they accept a vaccination to protect against the sexually transmitted virus that causes most cases of cervical cancer?

“I’m going to do the same thing I did when they recommended the chicken pox vaccine. I’m probably going to follow the recommendation of my pediatrician,” said Gwen Scales of Detroit, who has two teenage daughters.

The vaccine, Gardasil, was approved this month by the federal Food and Drug Administration. On Thursday, the Centers for Disease Control and Prevention’s advisory committee unanimously voted to recommend Gardasil for 11- and 12-year-old girls as a routine vaccination and for girls and women 13- to 26-years-old as a catch-up.

The committee also said girls as young as 9 can be vaccinated, which has sparked debate about whether vaccination would encourage girls to be sexually active.

The vaccine is effective only before a female is exposed to the human papillomavirus, or HPV. In most cases, that means before she first has sex.

Cervical cancer is one of the most preventable cancers if cell changes are caught early. The traditional way to do this is through a Pap smear.

Some parents are opposed. Others say they will take a wait- and- see approach. Medical professionals and parents like Scales say they are optimistic.

“It’s like any other vaccine. If it’s something that is going to prevent them from acquiring any type of disease, I would want that,” said Scales.

“It’s a virus, and we have to bring it down to the scientific basis and take the emotion out of it.”

Scales added that some parents might be resistant to the idea because the vaccine is to prevent a sexually transmitted disease. “But I don’t see how administering a vaccination for chicken pox would make my daughter want to expose herself to chicken pox,” Scales said.

Angie Smith, 43, of Farmington Hills, Mich., is the mother of three girls ages 8, 14 and 18. She said she was shocked to learn that the vaccine might be recommended for girls so young.

“We’re not talking about measles, mumps, chicken pox or rubella,” Smith said.

“At 9 years old, to have your child vaccinated against a sexually transmitted disease? Me personally, I would not take my child. For some parents, if you take your child to get that vaccine,” it’s like saying sex is OK. She said she might warm up to the idea of the vaccine for girls a few years older.

Lynette Anthony of Detroit, 51, said she would want to know more about any new vaccine, like who did the studies and any side effects. She has two daughters, 14 and 24.

“I’m not really crazy about that. I have mixed views,” she said. “I think I’d wait another five years to see more long-term studies.”

Dr. Ronald Strickler, chairman of women’s health services at Detroit’s Henry Ford Hospital, said he expects a challenge from some parents who say pre teen is premature for this vaccination. He stressed that it’s not just about the sexually transmitted disease, but about a pro active approach to cancer prevention.

“You want to vaccinate people before they are exposed to the virus. Yes, it is true that the most common way people are going to be exposed to the virus is through sexual contact,” Strickler said.

He added that the idea is to get this vaccination incorporated into a regular immunization regimen, which typically is administered in a child’s early years.

HPV is transmitted by genital skin-to-skin contact; the body’s immune system usually clears it within several weeks. Up to 80 percent of sexually active people have HPV at some point in their lives. Survival rates for women who have HPV are very high, but only if the virus is detected. Less often, the virus causes pre cancerous cell changes. Those abnormalities take between 10 years and 15 years to become cancer.

The vaccine studies report Gardasil was 100 percent effective in preventing the two strains of HPV that cause 70 percent of cervical cancer cases, and 99 percent effective against two other strains that cause 90 percent of genital warts cases.

Nancy Berman, a nurse practitioner, said she also is excited about Gardasil.

“The young daughters who get preventative vaccines may be saved in addition to prevention of cancer, also prevention of invasive treatments” such as colposcopy, biopsy or surgical techniques to remove the lesions so they don’t spread, Berman said.

Gardasil is the latest development in a decade of medical progress in the fight against cervical cancer. Three years ago, health care providers began giving women HPV tests, something that Kathy Toffolo said she wishes she had gotten.

Toffolo says she did everything right. She went for a Pap test every year. But in April 2003, just two months after her last test came back normal, an ultrasound for another condition showed spots on her ovaries. She also discovered she had invasive cervical cancer.

Today, Toffolo, 42, is taking care of her three boys and has been in remission for almost three years.

“I’m alive and the boys get to enjoy Mom, so what more can one ask for?” she said.

While Berman is optimistic, she said she wants to make sure women know that even if they get the vaccine, they still need to get health exams, regardless of their age .

“Women have been so well-taught to expect the Pap every year that it’s become, in their mind, the reason for the visit. And we now have reason to teach women that the Pap is just part of the exam,” she said.

When she was 31, Christine Baze of Marblehead, Mass., left her day job to focus on her blossoming music career. Like Toffolo, she had always had normal Paps, and it took just one doctor visit to discover that she, too, was developing cervical cancer.

“My whole world was in one moment turned into saving my life,” she said. Six years, later, after radiation and a hysterectomy, Baze is a survivor and has traveled the country on her Yellow Umbrella music tour. She also started a Web site, www.popsmear.org, to raise awareness about cervical cancer.

For Baze, there’s no debate about whether parents should allow daughters to be vaccinated.

“Ask my mom if she would have wanted me to have the HPV vaccine. For her to have the experience of having her daughter go through what she went through … there’s nothing harder on a mom,” Baze said.

“You want to give your daughter every chance to protect herself and to be protected against a cancer. If there was a vaccine against lung cancer, would they not give it because it would encourage smoking?”

Although Strickler said he doesn’t foresee major change for a generation or two, health professionals agree that the vaccine will reduce the incidence of cervical cancer in the United States.

“We should be pleased that science has helped us understand the cause of a cancer and provided us with a tool that we can actually prevent it with. There aren’t many cancers that we can say we can actually prevent,” Strickler said.

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HPV QUICK FACTS

What it is: Human papillomavirus, or HPV, is a highly contagious sexually transmitted virus.

How it is transmitted: Through genital skin-to-skin contact. Most sexually active people will have HPV in their lives. In most cases, the body’s immune system clears it before a person knows he or she has it.

Symptoms: In men, the virus is largely without symptoms. Some strains cause genital warts, and other strains lead to cell abnormalities in women that cause cervical cancer.

How it is detected: A woman’s annual Pap smear is meant to detect cell abnormalities on the cervix. Women with abnormal Pap test results and women over 30 are given the HPV test, which studies say is more than 96 percent accurate.

Prevention: A new vaccine was approved June 8 and is available. The vaccine prevents cervical cancer if given before a woman is exposed to the virus, especially in girls and young women before they’re sexually active.

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GARDASIL

What it does: Protects against four strains of HPV that cause genital cancers and warts.

Who can take it: Girls and women ages 9 to 26 who have not been exposed to HPV – preferably before they’re sexually active. It’s not approved for boys and men, but clinical trials are under way to get approval.

How it’s administered: Three shots in the arm. The second should be two months after the first, and the next one four months after that.

Side effects: The study reported no serious side effects. The most common are soreness at the injection site and fever.

Availability: The vaccine is available now that the Food and Drug Administration has approved it. It won’t be officially recommended until the Centers for Disease Control and Prevention’s advisory committee votes on whether to do so. It must also go through an official process. After that, the vaccine could become part of immunization schedules.

Cost: $120 a dose, or $360 total. If it is recommended to become part of the Vaccines For Children program, it would be free to those 18 and younger who are uninsured, underinsured or on Medicaid.

Maker: Merck & Co. Inc.

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HPV BY THE NUMBERS

20 million: Number of Americans exposed to HPV in their lifetimes.

500,000: New cases of HPV worldwide each year.

9,710: Number of women in the U.S. affected by HPV each year.

3,700: Number of women who die every year in the U.S. of cervical cancer. HPV causes it 70% of the time.

10: Average number of U.S. women who die daily of cervical cancer.

Source: American Cancer Society

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