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Cancer vaccine on sale - but at what cost?20 October 2006 This month, the first vaccination against cervical cancer was launched in Europe. The vaccine, called Gardasil, protects against the human papillomavirus (HPV) - a sexually transmitted disease which can trigger cervical cancer. What is cervical cancer?Cervical cancer develops when the cells that line the cervix - the neck that connects the uterus (womb) to the vagina - become abnormal and start to grow out of control. This forms a tumour. The cancer can spread to other parts of the body. How common is it?Each year there are 2,800 new cases of cervical cancer in the UK. Although the national cervical screening ("smear test") has dramatically reduced the number of deaths since it was started in 1960s, about 1,000 women in the UK still die from cervical cancer every year. What causes it?The exact reasons for developing cervical cancer are not always known, but nearly all cases - over 99 percent - are associated with an HPV infection. However, it is important to remember that only a small proportion of women with certain types of HPV will go on to develop cervical cancer. HPV is not the only risk factor for cervical cancer, and many women with HPV do not develop it. Other factors that increase the risk include smoking, having a poor diet or a weakened immune system from autoimmune diseases, such as rheumatoid arthritis or human immunodeficiency virus (HIV) infection, or taking immunosuppressant drugs after an organ transplant increases the risk. What is HPV?HPV is a common virus which can be spread though unprotected sex. It usually causes no symptoms at all. In most women, the immune system will get rid of the infection so they might never be aware of it. There are over a hundred different types of HPV. Some types cause genital warts, although these strains don't increase the risk of getting cancer. Others can cause anal or cervical cancer. What does the vaccine do?Gardasil, developed by Merck and Sanofi Pasteur, protects against HPV types 6, 11, 16 and 18. HPV types 16 and 18 are thought to be responsible for 70 percent of all cervical cancers, while types 6 and 11 cause about 90 percent of genital warts. A second vaccine is under development by GlaxoSmithKline, but this is not due to be approved for another year in Europe. When is it used?The vaccination is designed to be used before an HPV infection happens. In September, the European Commission (EC) approved it for children aged 9 to 15. At this age they are not yet sexually active and are unlikely to have caught HPV. It is also approved for use in young women between the ages of 16 and 26 - many of whom may not yet have been infected with all four types of HPV that the vaccine protects against. Who's paying?In the UK, questions remain. The Department of Health is waiting for a report from the Joint Committee on Vaccination and Immunisation - an independent expert advisory body - before deciding if the vaccine will be available on the NHS, who it will be given to, and when. And according to a recent editorial in respected medical journal The Lancet, there is increasing evidence that to wipe out HPV, the vaccine should be given to boys as well as girls. This would have additional benefits, they argue; the vaccination protects against HPV types that cause genital warts and anal cancer, which can affect either sex. ConcernsSome parents worry that giving the vaccination to children so young could encourage underage sex. There is also some concern that a vaccination against a sexually transmitted disease might discourage safe sex. However, others argue that this is exactly the right time to use the vaccination. A spokesperson for the Family Planning Association commented: "You need to vaccinate young women before they become sexually active, in the same way that you vaccinate young women for German measles." Related links
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