Immunization Against Cervical Cancer: from Dr. A.Z

[sdanyaro]

Barka da warhaka,

This may be useful for the health section of the Kanoonline/dandali website.
A nan gaba in Allah ya yarda zan dinga aiko maka da irin wadan nana labaru.

Sai munyi magana.

Abba



Immunization Against Cervical Cancer: Who? When? Where?

from Medscape Women's Health eJournal[TM]
http://www.medscape.com/viewpublication/128
Posted 11/21/2002
Paul D. Blumenthal, MD, MPH

The recent report[1] of a successful "proof-of-principle" trial of a vaccine
that would prevent infection with the "16" subtype of the human
papillomavirus (HPV) is great news. Perhaps the "war on cancer" begun by
President Nixon in the early '70s will finally be fought and won through the
kind of preemptive, preventive approach that a vaccine portends, at least as
far as cervical cancer is concerned. Importantly, however, as with any
initial research findings, more questions are engendered than there are
answers for.
The study by Dr. Laura A. Koutsky (University of Washington, Seattle) and
colleagues reported this week in The New England Journal of Medicine[1]
involves a vaccine against 1 subtype of the virus that is responsible for a
significant proportion of cervical cancer cases, HPV subtype 16. The
vaccine, planned for eventual commercial distribution, will potentially
cover other subtypes, especially 18, which together with 16 account for 70%
of cervical cancer cases for which a viral etiology has been established. It
will also cover types 6 and 11, which are responsible for a majority of
cases of genital warts -- a condition well known to clinicians as a commonly
seen, inconvenient, and often problematic clinical entity. This more
broad-spectrum vaccine is still at least several years away from actual
commercial implementation, but trials are already under way, according to a
report in The New York Times.[2]
Perhaps the issue that is often most difficult for researchers to address is
how to move from a research protocol to a service project, from a vaccine to
a vaccination program. Although commercial entities are expert at marketing
and distribution, there are innumerable details to be worked out not only
from a technical perspective but from sociological and logistical
perspectives, too, and that, of course, is where the devil lives. How long
will immunity from a single set of injections last? What if a woman doesn't
finish the series? How often will women need "booster" shots? Given that
this is a sexually transmitted disease (STD) and that immunity is probably
best initially provided before sexual activity begins, at what age will
immunizations be started? Will it be accepted as a routine service not much
different from getting vaccinated against polio or tetanus, or, bearing in
mind the STD connection, will it be fraught with sociopolitical overlay as
we have seen with some hepatitis vaccination programs? Will we face
resistance to vaccination because of the behavioral implications raised by
the nature of the disease?
Clearly, an ounce of immunologic prevention is going to be worth a pound of
gynecologic cure, and nowhere will this be more important than in developing
countries, where more than 80% of the world's 200,000 annual deaths from
cervical cancer occur. In such countries, a safe, effective, affordable,
long-lasting vaccine that does not require refrigeration could have
tremendous impact. Indeed, throughout most of the developing world, cervical
cancer screening programs remain virtually nonexistent. Only recently,
through the work of the Cervical Cancer Prevention Program at the nonprofit
JHPIEGO Corporation http://www.jhpiego.org/cecap ? and other members of the
Alliance for Cervical Cancer Prevention http://www.alliance-cxca.org ?(a
network of organizations funded by the Bill and Melinda Gates Foundation),
have resource-appropriate, low-technology approaches to cervical cancer
prevention been identified and tested in large-scale demonstration projects.
Even if a vaccine were to be commercially available tomorrow, there are
millions of women around the world who likely have already been exposed to
HPV but who have never been tested for a cervical cancer precursor and, when
necessary, been offered treatment. However, since a vaccine is not going to
be ready for routine service delivery for at least 5 years, and perhaps
longer in developing countries, the need for appropriate secondary
prevention programs remains acute. Even when the vaccine is commercially
distributed, the need to provide information, education, and communication
about what it does and does not do will be vitally important, and the
generations of women who have never been vaccinated will need continued
surveillance and management.
The study by Koutsky and colleagues[1] is a great start at what, in his
accompanying editorial,[3] Dr. Christopher P. Crum, Brigham and Women's
Hospital, Boston, Massachusetts, states could be "the beginning of the end
for cervical cancer." However, perhaps like most commencement speakers, we
should rather state that having gone so far as to identify the etiology of
cervical cancer and demonstrate the potential of a vaccine, this is really
"the end of the beginning" in our war against this tragic but preventable
disease. A vaccine will give us an incredibly powerful tool, but for the
women never likely to be vaccinated and who need care now we have promises
to keep and miles to go before we sleep.

[HUSNAA]

Good News
This drug for the prevention of HPV has been approved by the FDA in the US and is commercially available already as from this year or several months ago. I accidentally heard it on some program, I cant remember exactly which, (not sure if I didnt hear it on David Letterman's boring placid - but still addictive - late  night show!!!!!).
PS its still very expensive and not readily accessible to third world countries at an affordable price.