Human Papilloma Virus Vaccination: Promoting the Fight Against Cervical Cancer in the US
We previously covered how cervical cancer is being tackled in developing countries. Here, Julia Mills discusses what is happening in the US
Cervical cancer kills over 4,600 women annually, in the U.S. (1) The fight against cervical cancer began 50 years ago with the advent of the Papanicolaou test, commonly known as the Pap smear. The Pap smear is a screening exam that allows for the detection of benign, pre-cancerous, and cancerous lesions of the cervix. (2) Cervical cancer was the deadliest cancer for women prior to the availability of this test. The availability of this simple procedure has made a major impact on the incidence of cervical cancer, which now ranks as the thirteenth most common cause of cancer related deaths for women. (2)
If a screening test exists which allows for the detection of cervical cancer in its earliest stages, why does cervical cancer continue to claim the lives of so many women? Just as there is no silver bullet for the majority of cancers, cervical cancer remains uncurable. There is, however, a vaccine that may prevent the cause of cervical cancer. (2) The Human Papilloma Virus (HPV) is a sexually transmitted infection (STI) responsible for causing various cancers, including cervical cancer, as well as genital warts. (3) Currently there are 13 strains of HPV identified as “high risk” which are more likely to be responsible for the development of cervical cancer in women. (4) In 2006 the U.S. Food and Drug Administration (FDA) approved the vaccine Gardasil® which, according to the FDA, is the “first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to HPV types 6, 11, 16, and 18.” (5) The HPV vaccine Gardasil® may be a highly effective preventative measure against cervical cancer, but since the announcement of approval for the vaccine by the FDA; Gardasil® has become a highly controversial topic.
One primary source of debate was instigated by the national Advisory Committee on Immunization Practices which recommends that females between the ages of 11 and 12 be vaccinated against the HPV virus. (6) Based on this recommendation some states have passed legislation which requires anti-HPV vaccination of school children, addresses funding for the vaccine, and educates the public regarding the vaccine. As it stands, twenty-four US states have introduced legislation that, if passed, would require anti-HPV vaccination for school children. (6)
As a female and a future Advanced Practice Nurse, I am in support of legislation which would require that children be vaccinated against HPV. I view the prevalence of HPV as a major public health crisis, as an estimated 20 million people are infected with HPV in the U.S. alone. (7) Additionally, the anti-HPV vaccine may be beneficial to not just women, but men as well. The American Cancer Society reports that in addition to preventing cervical cancer, Gardasil® may also defend against vaginal, vulval, and anal cancers and even possibly some head and neck cancers.(8) This vaccine is also cost effective. Although the cost of the entire Gardasil® series is about $360 U.S, the overall saving is estimated to be between $15,000 and $25,000 U.S. per quality-adjusted life year based on the prevention of HPV strains 16 and 18. Many states currently offer the vaccine at little or no cost at public health department clinics or have legislation that require health insurance to cover the cost of the vaccine. (9)
Although the anti-HPV vaccine seems to be a beneficial means of reducing the prevalence of cervical cancer in the U.S., HPV vaccination legislation has met opposition on many fronts. Parents have expressed several concerns regarding the efficacy, safety, and cost of the use of the vaccine in children. (6) Results of a study which analyzed parental attitudes towards anti-HPV vaccination indicated “that HPV is a sexually transmitted disease…and sexually transmitted diseases are associated with significant social stigmata, and some parents may believe that having their child vaccinated against an STI would equate to condoning precocious sexual behavior.” (7) The study also found that because ideas about STI’s are so embedded in, and influenced by, society that there is no amount of education that can change parental perception of the HPV vaccine.(7)
The U.S. is making strides at combating cervical cancer via the introduction of anti-HPV vaccine legislation. Although there are still many obstacles to overcome, the development of legislation which addresses the education, funding, and administration of the anti-HPV vaccine is an imperative starting point to curbing the public health crisis caused by the HPV virus. In time, with the appropriate support from governmental agencies, health care providers, and educators the benefits of vaccinating children against HPV will be better understood by the public. Conclusively, the administration of Gardasil® vaccine is a cost effective means of reducing the incidence of the high risk strains of the HPV virus subsequently decreasing the devastating morbidity and mortality from several types of cancer, including cervical cancer.
Julia Mills
Family Health Nurse Practitioner candidate
University of Pennsylvania, School of Nursing
Pennsylvania
US
jumills@nursing.upenn.edu
(1) U.S. Department of Health and Human Services. (n.d.). Healthy People 2010. http://www.healthypeople.gov/document/html/volume1/03cancer.htm
(2) Saslow, D., Runowicz, C., Solomon, D., Moscicki, A., Smith, R., Eyre, H., et al. (2002). American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA: A Cancer Journal for Clinician 2002: 52: 342-362.
(3) Centers for Disease Control and Prevention. (2007). HPV Vaccine- Questions and answers for the public about the safety and effectiveness of the Human Papillomavirus (HPV) vaccine. http://www.cdc.gov/print.do?url=http://www.cdc.gov/vaccines/vpd-vac/hpv/hpv-vacsafe-effic.htm
(4) Ronco, G., Giorgi-Rossi, P., Carozzi, F., Dalla Palma, P., Del Mistro, A., Marco, L., et al. Human papillomavirus testing and liquid-based cytology in primary screening of women younger than 35 years: results at recruitment for a randomized controlled trial. Lancet Oncology 2006; 7: 547-555.
(5) U.S. Department of Health and Human Services. FDA licenses new vaccine for prevention of cervical cancer and other diseases in females caused by Human Papilloma Virus. http://www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html
(6) National Conference of State Legislatures. (2007). HPV vaccine. http://www.ncsl.org/programs/health/HPVvaccine.htm
(7) Dempsey, A., Zimet, G., Davis, R., Koutsky, L. Factors that are associated with parental acceptance of human papillomavirus vaccines: A randomized intervention study of written information about HPV. Pediatrics 2006; 117: 1486-1493.
(8) American Cancer Society. (2007). HPV vaccine may offer more than cervical protection may also prevent vaginal, vulvar, anal abnormalities. http://www.cancer.org/docroot/NWS/ content/NWS _1_1x_HPV_Vaccine_May_Offer_More_Than_Cervical_Cancer_Protection.asp
(9) U.S. Department of Health and Human Services (2006). HPV and HPV vaccine information for healthcare providers. http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine-hcp.htm
Bookmark on delicious | Digg